Understanding Jamie's Skin Barrier and Wound Healing Assessment Answer

Question:- As a keen gardener, Jamie is constantly suffering scratches, cuts, and grazes when working. One day when he comes inside and gets changed, he finds a significant cut on his right arm. With appropriate consideration of Jamie’s case:

1. Discuss how Jamie’s normally intact skin acts as a barrier towards infection, detailing specific anatomy and physiology of the integumentary system.

1 answer:  The skin is the body's primary organ, responsible for about 15% of the whole adult body weight. The skin is incessant, having mucous membranes coating the body's surface. The purpose of the skin barrier is to guard the body's inner structures from pollution, ultraviolet rays, inflammation and infection, dehydration, and toxins (Akat et al., 2022). Jamie's skin performs as a barrier between the body system and the atmosphere; it prevents the invasion of pathogens like bacteria from the external environment also, protects the internal tissues of the body. Jamie has a significant cut on his right arm, the abrasion of skin may lead to the entry of pathogens and germs into the body, there are chances that Jamie can suffer from chronic wound if the cut in not treated on time (Dąbrowska et al.,2018).

The epidermis, mainly the upper layer known as the stratum corneum, acts as the skin barrier and first line of defense. The skin of the body consists of three layers the epidermis, or the outer layer, which is the thin layer, second is the thick dermis, and the third layer is a subcutaneous fatty layer (Dekoninck et al., 2022). 

The integumentary system comprises the skin, nails, hair, and glands. The skin consists of three layers: the epidermis, the dermis, and subcutaneous tissue. The epidermis, mainly the upper layer known as the stratum corneum, acts as the skin barrier and first line of protection. The epidermis or the outer layer is the thin layer, the second is the thick dermis, and the third layer is a subcutaneous fatty layer. The thickness of these layers differs significantly based on terrestrial location in the anatomy of the body; the thinnest layer of the epidermis is of eyelids, measuring less than 0.1 mm (Walker et al., 2022). The palms and soles of the feet have the thickest epidermal layer, measuring approximately 1.5 mm; on the back, the dermis is the widest, 30-40 times as thick as the covering epidermis. Nails protect the ends of fingers and toes and consist of a nail plate, nail bed, cuticle, matrix, and lunula. Hairs consist of three parts the shaft, follicle, and bulb; hair protects to maintain heat in the body, and eyelashes and eyebrows prevent the entry of dirt and water into the eyes. Glands are present all over the skin; the integumentary system comprises four types of glands sudoriferous glands, sebaceous glands, ceruminous glands, and mammary glands. Glands release the water, oil, and salt from the inner surface of the skin to the outer surface (Koeppen et al., 2021).

 2. Outline the key steps involved in the healing of his wound.

(II) answer:  Four stages of wound management will help Jamie in wound management, including the homeostasis phase, inflammation phase, proliferation phase, and maturation phase.

1. Hemostasis phase: in the process of hemostasis, the wound gets closed by a clot; hemostasis begins when blood begins to flow; in the primary step, the blood vessels begin to contract to reduce the flow of blood, then platelets start to join together to close the break in the wall occurred in a blood vessel. Lastly, a platelet plug with the fibrin threads forms the coagulation like a molecular binding agent (Ellis et al., 2018). 
2. Inflammatory phase: It is another stage of wound healing and begins when leak transudate in the form of water, salt, and protein begins to cause localized swelling; the process of inflammation is to prevent infection and controls bleeding. Through the process of inflammation, pathogens, damaged cells of the body, and other bacteria are removed from the wound area. This process is carried out by white blood cells and causes heat, pain, and swelling at the infected site during the stage of wound healing (Ellis et al., 2018).
3. Proliferative phase: the wound is rebuilt in this phase with new tissues composed of extracellular material and collagen. As the tissues develop, the wound contracts at this stage, and the granulation tissue appears red, pink, or uneven in texture when there is healthy healing (Ellis et al., 2018).
4. Maturation phase: this stage is also known as the remodeling phase; the cells that are no longer in use after repairing the wound are destroyed by apoptosis (programmed cell death). Typically remodeling phase begins after 21 days of injury; this is a multifaceted and delicate process as, in this stage, the failure of healing can lead to chronic illness (Johns Hopkins Medicine, 2022).

Question:- Jamie is considering a high-protein diet as an approach for both increasing muscle mass and losing weight.

1. Detail the processes that are involved in the digestion of protein. Describe what (physiology) and where (anatomy) specific events are occurring. 

(I) answer: Protein digestion starts with the first chew; after protein reaches the stomach, protease enzyme and hydrochloric acid begin the breakdown of protein in reduced chains of amino acids. Proteases break the peptides that link the amino acids. Later from the stomach, the smaller chains of amino acids, which are already damaged by protease enzyme, move into the small intestine; the enzymes and bicarbonate buffer secreted from the pancreas act to reduce the acidity present in the digested food. Additional enzymes like trypsin, chymotrypsin, and carboxypeptidase further break down the amino acid chain in the individual amino acids (Health Line, 2021).

2. Briefly explain if a high-protein diet may cause Jamie’s desired effects.

(II) answer: James is considering a high-protein diet to increase muscle mass and lose weight; consuming a high-protein diet limits carbs so much that he might not get enough nutrients or fibre. High protein diet may not lead the effect that Jamie wants as consuming too much protein, may cause weight gain, constipation and diarrhea, rather than his desired effect. If he intended to get the increase muscle mass with weight loss he need to take the perfect amount of protein depending on his daily physical activity, health, and total diet. He needs to choose the right type and right amount of protein as recommended by the dietician (Ko et al., 2020).

Question:- 3Jamie experiences constant soreness and stiffness in his left knee, and it sometimes feels like it might ‘give way’. Jamie blames an old knee injury, which he says ended his rugby career; it transpires that Jamie suffered tears to his meniscus and anterior cruciate ligament at age 45. Using patient-friendly terminology that Jamie will be able to follow: 

1. Explain what happened at the time that Jamie injured his knee, fully detailing the structures involved and the roles they play in knee stability.

1. answer: Jamie injured her knee while playing rugby at the age of 45. Injuries to cartilage and ligaments are the most common knee injuries. When Jamie got hurt, he suffered tears to his meniscus and the anterior cruciate ligament.

The type of knee joint is a hinge type joint, accountable for weight body weight and allows movement. It comprises bone, meniscus, tendons, and ligaments. The role of these structures present in knee joints is as follows:

1. Bones- the three bones of the knee are the first femur, second tibia, and third patella; the thick layer of cartilage protects these bones, and their function is to endure the force.
2. Cartilage: two kinds of cartilage are present-
   
   a. Meniscus- There are two menisci, one medial and one lateral; they perform as a cushion or tremor absorber and let the knee bones move by rubbing directly against each other. Menisci also ensure the correct weight distribution between the femur and tibia.
   
   b. Articular cartilage- It also performs as a shock absorber and causes smooth movement of bones over one another.
3. Ligaments- Ligaments are composed of fibrous tissues, and authoritarian they connect bones to other bones and act like strong ropes; the function of ligaments is to prevent too much motion of the bones and to promote stability to the joint. There are four types of ligaments.
4. Tendons-they connect bone to muscle and provide stability to the joint.
5. Muscles- these are significant in positioning the knee.
6. Joint capsule- filled with synovial fluid; this lubricates and nourishes the joints.
7. Bursa- they decrease the resistance between the tissue of the knee and avoid inflammation (Park et al., 2022).

2. Provide an evidence-based explanation to relate this previous injury to Jamie’s current knee symptoms.

(II) answer: When Jamie injured his knee, the anterior cruciate ligament and meniscus got torn, which caused instability in the joint. The function of the anterior cruciate ligament is to control the rotation and forward movement of the tibia, which gets affected after injury. The tear of the meniscus leads to the inability to move the knee, and because of a torn meniscus, Jamie has the feeling of knee giveaway and stiffness (John Hopkins Medicine, 2022). Jamie works as a regional manager within a manufacturing organization, now because of his knee injury, it’s become problematic for him to travel to work. Jamie is in his old age and has a body weight of 100kg; it’s hard for his injured knee to bear his body weight. Thus additional stress has triggered burden on his knees, thereby favouring pain. 

Question:- 4 In attempt to manage his knee-pain, Jamie has been prescribed pain medication that contains codeine, known as Panadeine Forte. Medication that contains codeine has a potential risk of constipation. Remember that the focus of this question is on anatomy and physiology, and not specifically about details of the medication. Focus on Jamie’s potential constipation. Where appropriate, consider all elements of Jamie’s case when answering this question.

1. Explain what is occurring in the digestive system if Jamie has been experiencing constipation since starting his pain medication.

 (I) answer: Constipation is a term that defines the difficulties patients suffer with moving their bowels. Jamie is experiencing pathophysiology: colonic motor dysfunction, which means the inability to coordinate motor activity to transfer stool over the colon, pelvic floor dysfunction, and failure to relinquish rectal contents (Viscusi, 2019).

2. Make an evidence-based recommendation for a non-pharmaceutical intervention that could help manage Jamie’s knee pain. 

 (II) answer: Jamie needs to be educated about self-management strategies and non-pharmacological activities like physical education, physical training, weight loss, and psychosocial treatment; these activities may help Jamie to manage the symptoms and can cause a delay in the progression of the disease. Jamie should follow life management programs to manage his knee pain. It includes active living, involvement in physical activity, and reducing body fats. Regular exercise may help Jamie to improve the mobility of his knee joint and help in the reduction of stiffness (Kan et al., 2019).

References:

Akat, E., Yenmiş, M., Pombal, M. A., Molist, P., Megías, M., Arman, S., ... & Ayaz, D. (2022). Comparison of vertebrate skin structure at class level: A review. The Anatomical Record. https://doi.org/10.1002/ar.24908

Dąbrowska, A. K., Spano, F., Derler, S., Adlhart, C., Spencer, N. D., & Rossi, R. M. (2018). The relationship between skin function, barrier properties, and body‐dependent factors. Skin Research and Technology, 24(2), 165-174. https://doi.org/10.1111/srt.12424

Dekoninck, S., Hannezo, E., Sifrim, A., Miroshnikova, Y. A., Aragona, M., Malfait, M., ... & Blanpain, C. (2020). Defining the design principles of skin epidermis postnatal growth. Cell, 181(3), 604-620. https://doi.org/10.1016/j.cell.2020.03.015

Ellis, S., Lin, E. J., & Tartar, D. (2018). Immunology of wound healing. Current Dermatology Reports, 7(4), 350-358. https://doi.org/10.1007/s13671-018-0234-9

Health Line. (2021). How is protein digested? https://www.healthline.com/health/protein-digestion#:~:text=Protein%20digestion%20begins%20when%20you,smaller%20chains%20of%20amino%20acids

https://doi.org/10.1016/j.cell.2020.03.015

John Hopkin’s Medicine. (2022). Knee ligament repair.  https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/knee-ligament-repair

John Hopkins Medicine. (2022). How wounds heal. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/how-wounds-heal

Kan, H. S., Chan, P. K., Chiu, K. Y., Yan, C. H., Yeung, S. S., Ng, Y. L., ... & Ho, T. (2019). Non-surgical treatment of knee osteoarthritis. Hong Kong Medical Journal, 25(2), 127. https://www.hkmj.org/system/files/hkmj_187600.pdf

Ko, G. J., Rhee, C. M., Kalantar-Zadeh, K., & Joshi, S. (2020). The effects of high-protein diets on kidney health and longevity. Journal of the American Society of Nephrology, 31(8), 1667-1679. DOI: https://doi.org/10.1681/ASN.2020010028

Koeppen, B. M., & Niekrash, C. E. (2021). Anatomy of the integumentary system. Applied Head and Neck Anatomy for the Facial Cosmetic Surgeon (pp. 65-72). Springer, Cham. https://doi.org/10.1007/978-3-030-57931-9_7

Park, J. G., Han, S. B., Lee, C. S., Jeon, O. H., & Jang, K. M. (2022). Anatomy, biomechanics, and reconstruction of the anterolateral ligament of the knee joint. Medicine, 58(6), 786. https://doi.org/10.3390/medicina58060786

Viscusi, E. R. (2019). Clinical overview and considerations for managing opioid-induced constipation in patients with chronic noncancer pain. The Clinical Journal of Pain, 35(2), 174. https://doi.org/10.1097%2FAJP.0000000000000662

Walker, P. G., & Niehaus, A. J. (2022). Integumentary system. Medicine and Surgery of Camelids, 232-302. https://doi.org/10.1002/9781119583295.ch9

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