1. factors that influence wound healing
    • nutrition
    • blood flow and oxygenation
    • impaired immune response
    • impaired inflammatory response
    • wound separation
    • infection
    • foreign bodies
  2. Differentiate b/w labile, stable, and permanent cell types.
    • labile - divide constantly
    • stable - retain ability to regenerate
    • perm - have left cell cycle, cannot divide
  3. examples of labile cells
    • skin
    • lymphoid organs
    • mucus membranes of GI, urinary, and reproductive tracts
  4. examples of stable cells
    • liver
    • pancreas
    • kidneys
    • bone
  5. examples of permanent cells
    • neurons
    • skeletal and cardiac mm
  6. what is a shift to the left?
    what is a band?
    • ^ WBC count (up to 20K when normal is 4-10K)
    • d/t increased # of bands

    band = immature WBC
  7. 5 cardinal signs of acute inflam
    • rubor
    • calor
    • tumor
    • dolor
    • loss of fx
    • (fever = systemic)
  8. For what pop. is fever not useful as a sign of inflam? What is better sign?
    elderly - don't display fever

    look for confusion instead
  9. what causes rubor?
    hyperemia d/t vasodilation
  10. what causes calor?
    ^ metabolism at site of inflammation
  11. what causes pain (dolor)?
    • nerve stimulation by chemicals (eg histamine, prostaglandins) pressure from fluid in area
    • change in pH
    • change in local ionic concentration
  12. what causes swelling?
    • fluid shift to interstitial spaces
    • accumulation of exudate
  13. what causes loss of fx?
    • swelling
    • pain
  14. what is primary intention?
    healing where we approximate the edges ourselves. no tissue is lost.

    ex: staples, stitches
  15. what is secondary intention?
    edges are not approximated. tissue it lost.

    ex: scrapes, large wounds w/o stitches, anything that doesn't have edges physically put together by a person
  16. resolution
    tissue regenerates back to normal. back case scenario.
  17. if there is no resolution of tissue damage, what happens?
    repair: granulation tissue, angiogenesis, fibrinogenesis, scar tissue
  18. why is resolution preferable to repair?
    repair will not result in active tissue. collagen fills in wound area to give it strength, but it is not vascularized, active tissue.
  19. diff. b/w keloid and hypertrophic scar? what causes them?
    keloid goes beyond original wound border. hypertrophic scar is raised but stays within original border.

    both caused by excess collagen production.
  20. what is dehiscence? when does it occur?
    when suture lines pull apart. usually 5-12 days post op.
  21. What's a contracture? What kind of pt at most risk?
    contracture = excessive mm contraction. Burn pts at risk.
  22. list pss dysfunctional healing patterns
    • adhesions - internal scars r/t excess fibrin formation
    • impaired collagen synthesis: keloid, hypertrophic scars
    • dehiscence - wound disruption
    • impaired epithelialization
    • impaired mm contraction - contractures
    • infection
    • excessive inflam. response
  23. what do cytokines do?
    examples of cytokines?
    • regulate and direct actions of cells. they are intracellular communicators.
    • IL, TNF, interferons, colony stimulating factors
  24. "The role of the phagocyte begins when the inflammatory response causes it to stick to capillary walls in a process called?"
  25. debridement
    cleanup of a lesion involving breakup of fibrin clots by fibrinolytic enzymes
  26. name the 2 sources of inflam mediators
    • plasma
    • cells
  27. which inflam mediators come from plasma?
    • kinins - ^ cap perm, ^ pain
    • complement fragments - vasodilate, ^ cap perm, promote phagocytosis
  28. which inflam mediators come from cells?
    • histamine - form mast cells, plts, basophils
    • serotonin - from plts
    • cytokines
    • NO
    • plt aggregating factor
  29. what does NO do?
    • powerful vasodilator
    • antagonist of plt aggregation --> decreases clotting
    • decreases leukocyte recruitment
  30. 5 types of exudate
    • serous
    • sanguinous / hemorrhagic
    • firbinous
    • membranous / pseudomembranous
    • purulent / suppurative
  31. 3 phases of wound healing process
    • inflam
    • proliferative - healing by primary or secondary intention
    • remodeling / reconstruction
  32. manifestations of inflam
    • changes in plasma proteins
    • increased ESR - erythro sedimentation rate (RBCs settle faster)
    • WBC shift to the left
    • ^ C-reactive protein (CRP flags germs)
    • fever
    • skeletal mm catabolism --> negative N balance
    • lymphadenitis
  33. what secretes collagen?
    What is it?
    where is it found?
    • secreted by fibroblasts
    • protein
    • found all over body
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