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factors that influence wound healing
- nutrition
- blood flow and oxygenation
- impaired immune response
- impaired inflammatory response
- wound separation
- infection
- foreign bodies
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Differentiate b/w labile, stable, and permanent cell types.
- labile - divide constantly
- stable - retain ability to regenerate
- perm - have left cell cycle, cannot divide
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examples of labile cells
- skin
- lymphoid organs
- mucus membranes of GI, urinary, and reproductive tracts
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examples of permanent cells
- neurons
- skeletal and cardiac mm
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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
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5 cardinal signs of acute inflam
- rubor
- calor
- tumor
- dolor
- loss of fx
- (fever = systemic)
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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
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what causes rubor?
hyperemia d/t vasodilation
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what causes calor?
^ metabolism at site of inflammation
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what causes pain (dolor)?
- nerve stimulation by chemicals (eg histamine, prostaglandins) pressure from fluid in area
- change in pH
- change in local ionic concentration
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what causes swelling?
- fluid shift to interstitial spaces
- accumulation of exudate
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what is primary intention?
healing where we approximate the edges ourselves. no tissue is lost.
ex: staples, stitches
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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
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resolution
tissue regenerates back to normal. back case scenario.
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if there is no resolution of tissue damage, what happens?
repair: granulation tissue, angiogenesis, fibrinogenesis, scar tissue
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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.
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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.
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what is dehiscence? when does it occur?
when suture lines pull apart. usually 5-12 days post op.
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What's a contracture? What kind of pt at most risk?
contracture = excessive mm contraction. Burn pts at risk.
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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
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what do cytokines do?
examples of cytokines?
- regulate and direct actions of cells. they are intracellular communicators.
- IL, TNF, interferons, colony stimulating factors
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"The role of the phagocyte begins when the inflammatory response causes it to stick to capillary walls in a process called?"
margination
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debridement
cleanup of a lesion involving breakup of fibrin clots by fibrinolytic enzymes
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name the 2 sources of inflam mediators
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which inflam mediators come from plasma?
- kinins - ^ cap perm, ^ pain
- complement fragments - vasodilate, ^ cap perm, promote phagocytosis
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which inflam mediators come from cells?
- histamine - form mast cells, plts, basophils
- serotonin - from plts
- cytokines
- NO
- plt aggregating factor
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what does NO do?
- powerful vasodilator
- antagonist of plt aggregation --> decreases clotting
- decreases leukocyte recruitment
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5 types of exudate
- serous
- sanguinous / hemorrhagic
- firbinous
- membranous / pseudomembranous
- purulent / suppurative
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3 phases of wound healing process
- inflam
- proliferative - healing by primary or secondary intention
- remodeling / reconstruction
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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
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what secretes collagen?
What is it?
where is it found?
- secreted by fibroblasts
- protein
- found all over body
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