NR224 Exam 2 Study Guide

CH 48: Skin Integrity and Wound Care

1. Describe the dermis and the epidermis.

 Dermis: The dermis, the inner layer of the skin, provides tensile strength; mechanical 

support; and protection for the underlying muscles, bones, and organs. It differs from the 

epidermis in that it contains mostly connective tissue and few skin cells.

 Collagen (a tough, fibrous protein), blood vessels, and nerves are found in the dermal layer. 

Fibroblasts, which are responsible for collagen formation, are the only distinctive cell type 

within the dermis.

 Epidermis: The epidermis, or the top layer, has several layers. The stratum corneum is the 

thin, outermost layer of the epidermis. It consists of flattened, dead, keratinized cells. The 

cells originate from the innermost epidermal layer, commonly called the basal layer.

 Cells in the basal layer divide, proliferate, and migrate toward the epidermal surface. After 

they reach the stratum corneum, they flatten and die. 1185This constant movement ensures 

replacement of surface cells sloughed during normal desquamation or shedding.

2. What are three pressure related factors that contribute to pressure ulcers? Why?

 Three pressure-related factors which contribute to pressure ulcer development:

 1. Intensity

 2. Duration

 3. Tissue Tolerance

 These can be caused by:

 Major cause is PRESSURE!

 Impaired mobility

 Decreased/impaired sensory perception

 Fecal and/or urinary incontinence

 Poor nutrition

 Aging skin

 Presence of a cast

 Alteration in the level of consciousness

 Moisture



3. Describe the following terms:

a. Granulation tissue: Granulation tissue is red, moist tissue composed of new 

blood vessels, the presence of which indicates progression toward healing. 

b. Slough: Soft yellow or white tissue (stringy substance attached to wound bed), 

and it must be removed by a skilled clinician or with the use of an appropriate 

wound dressing before the wound is able to heal.

c. Eschar: Black, brown, tan, or necrotic tissue,which needs to be removed before 

healing can proceed.

d. Exudate: Fluid, cells, or other substances that have been discharged from cells or 

blood vessels slowly through small pores or breaks in cell membranes.

e. Necrotic tissue: pertaining to the death of tissue in response to disease or injury.

4. Describe friction & shear.

 Friction: Effects of rubbing or the resistance that a moving body meets from the surface on 

which it moves; a force that occurs in a direction to oppose movement.

 Shear: Force exerted against the skin while the skin remains stationary and the bony 

structures move. Occurs when there is a change in position due to gravity. Muscle and bone 

slide in the direction of body movement. Tissue damage occurs deep in the tissues causing 

undermining of the dermis. It affects the epidermis/top layer of skin (unlike shear injuries).