Comprehensive Wound Care – Questions/Answers (A+), Exams of Health sciences

Download Comprehensive Wound Care – Questions/Answers (A+) and more Exams Health sciences in PDF only on Docsity!

Comprehensive Wound Care – Questions/Answers (A+)

This structure is important to keep the top skin layers together, and as we age the decreased effect from these structures can contribute to skin tears Right Ans - Rete pegs Adult human skin is thickest in what area of the body? Right Ans - ·Palms and soles of the feet Which statement regarding skin across the lifespan is INCORRECT? - · Adult dermal turnover is about every 21-42 days · Impaired tensile strength · Fetal healing can be scarless · Increased sweating in the elderly is common Right Ans - Increased sweating in the elderly is common What is routinely performed to screen for osteomyelitis? Right Ans - · Probe to bone What term describes wound edges that have curled over on themselves and stopped epithelial migration due to contact inhibition? Right Ans - · Epibole

Which drainage type will appear clear or light yellow? Right Ans - · Serous When assessing the periwound over a leg ulcer with moderate drainage a moist white tissue is seen. What term likely describes this tissue? Right Ans

• Maceration Visual assessment reveals dry material beneath the nail plate. This should be documented as Right Ans - Subungual Debris

A leg ulcer presents with large lobes of burgundy moist tissue across 100% of the wound base. The patient reports that the tissue bleeds easily. This tissue type is most likely: Right Ans – Hypergranulation What stage is a pressure injury that presents as a blood-filled blister surrounded by persistent non-blanchable maroon and purple discoloration over the bony prominence of the left heel Right Ans - Deep Tissue Injury

What are the three Layers of Skin? Right Ans - epidermis, dermis, subcutaneous What structures are located in the Dermis? Right Ans - contains connective tissue, hair follicles, blood vessels, lymphatic vessels, and sweat glands. What structures are located in the Epidermis Right Ans - -nerve endings, keratinocytes (avascular so no blood vessels) -Layers: 1)stratum correum: top layer; all cells dead 2)stratum basal: deepest; cells divide to make new cells What structures are located in the Subcutaneous Layer of skin? Right Ans - Collagen and elastin fibers (these attach the dermis to muscles and bones) Fat cells. Blood vessels. Sebaceous glands. Nerve endings. Hair follicle roots. What are the age specific changes that occur in skin and skin function? Right Ans - Decreased vitamin D, decreased sun protection, ruduced barrier function, decreased sweating, immune dysfunction which can lead to cancer and infection What are the stages of Healing Right Ans - hemostasis, inflammation, proliferation, remodeling

What occurs in the Hemostasis Stage? Right Ans - Disruption of blood vessels exposes blood to collagen, cell disruption leads to release of histamine, coagulation pathways lead to fibrin clot formation, platelets degranulate and release growth factors. What occurs in the Inflammation Stage? Right Ans - Histamine causes vasodilation, plasma, neutrophils and macrophages to leak. Vasodialtion/plasma Leakage leads to edema, erythema, warmth, and exudate. MMPs debride necrotic tissue. Phagocytosis of Bacteria. ****When wounds have delayed healing they are stuck in this Stage!**** What Occurs in the prolifeative Stage? Right Ans - Continued recruitment of growth factors, contraction of wound edges and epithelialization, grandulation tissue formation (angiogenesis and connective tissue synthesis What Occurs in the Remodeling stage? Right Ans - Ballance of collagen lysis and collagen synthesis to reform scar tissue. In young and healthy individuals this takes 3-6 months. What are the most common conditions that contribue to delayed wound healing? Right Ans - Medications like Steroids, Anticoagulants, and Chemo therapy Comorbid diseases: Diabetes/thyroid, Peripheral Artery disease, and autoimmune diseases. What are the main causes of wounds? Right Ans - Mechanical - pressure , friction, shere, epidermal stripping Chemical- Extravastation, Burns Vascular- Arterial,venous, Diabetic Infectious- Ecythema, cellulitis, candidiasis , impetigo , Herpes Allergic- Radation Trauma Autoimmune and genetic disorders What are the components of a Wound assessment Right Ans - Location, Size(tunneling/undermining), Drainage, Odor, Wound tissue, Periwound, Edges , full/partial thickness.

when do you assess odor in a wound? Right Ans - after cleansing what are some things to consider when assessing drainage? Right Ans - odor, type of drainage , type of dressing, date of placement, and contamination. How do you measure a wound? Right Ans - NEVER estimate by comparing to an object

1. Length- Longest length from patient head to toe position
2. widest- width from patient side to side
3. Depth ( if >0.1 cm) - gently place cotton tipped applicator into the deepest part of the wound. What are the Measurements of Wound Exudate Right Ans - None, scant , small, moderate, large , copious What exudate is red (with frest blood) and thin Right Ans - Sanguineous What exudate is pink to light red. thin and watery Right Ans - Serosanguineous What is Hyperpigmentation/hemosiderin staining Right Ans - Heme= Blood Sid= Iron permanent staining What are Wound Red Flags? Right Ans - Lack of progression/stalled healing Pathergy , gets worse following debridment Peri-wound Purpura Pain out of portion to wound Multiple wounds without clear etiology Rapidly progressing Opens and Closes repeatedly without clear reason What is a stage 1 pressure injury Right Ans - non-blanchable erythema of intact skin What is a Stage II pressure Injury Right Ans - Partial Thickeness Skin loss

Blisters or pink moist wound beds without depth What is a Stage III pressure injury Right Ans - Red moist wound bed with depth; can have slough or eschar (tan/brown). Can see bottom enough to know no structures seen Full Thickness Granulation Tissue Stage IV Pressure Injury Right Ans - Red Moist, Slough , Eschar Exposed Structures: Tendon, LIgaments, Bone, Muscle Unstageable Pressure Injury Right Ans - Unable to See the base to know if there are Exposed Structures; Maybe stage 3 or 4 but base is covered in slough or eschar or otherwise not visable. Deep Tissue Injury Right Ans - usually over bony prominence, may have occured under medical device, can be blood filled bilster and persistent non discoloration, as the wound evolves will usually open. Eccymosis Right Ans - In an atypical location (thighs , arms) History of revent fall patient is on blood thinner as bruise evolves will stay intact and turn bluish/yellow in color. Burns Right Ans - Classified by Depthm depth determines the healing potential and need for surgical grafting. can progress over 2-3 days peaking at day 3. Burn Assessment includes Right Ans - Appearance, blancing to pressure, pain, sensation Superficial Burn Right Ans - dry, red, blances with pressure, painful, takes 2-6 days to heal Superficial Partial Thickness Burn Right Ans - Blisters, moist, red, weeping, blanches with pressure, painful to temperature, air and touch. takes 7-21 days to heal

Deep Partial Thickness Burn Right Ans - Blisters (easily unroofed), wet or waxy dry, variable color, blancing with pressure may be sluggies. painful to pressure only, > 21days to heel and usually requires debridment Full Thickness Right Ans - White to Leathery gray to charred black, pain to deep pressure only, healing time is rare unless surgically treated. Deeper injury Right Ans - extens to fascia and or muscle, painful to deep pressure, never heals unless surgically treated. Diabetic Foot Ulcer Wagner grade 0 Right Ans - Skin intact but bony deformities lead to "foot at risk" Diabetic Foot Ulcer Wagner grade 1 Right Ans - Superficial ulcer Diabetic Foot Ulcer Wagner grade 2 Right Ans - Deeper Full thickness Extension Diabetic Foot Ulcer Wagner grade 3 Right Ans - Deep Abcess formation or osteomylitis Diabetic Foot Ulcer Wagner grade 4 Right Ans - Partial Gangrene of forefoot Diabetic Foot Ulcer Wagner grade 5 Right Ans - Extensive gangrene ISTAP skin tear classification Right Ans - 1. No skin loss

2. Partial skin loss
3. Total flap loss Why is the skin more fragile in the elderly Right Ans - thinning of epidermis less adherence between epidermis and dermis: loss of collagen and elastin Decreased turgor and hydration- Less activity in sebaceous glands with aging. Describe Hemostasis Right Ans - The Coagulation cascade is activated to restore tissue integrity and return to homeostaiss. bascular spasm, platelt plug formation, platelets stick to the exposed collagen at the site of injury.

adherence of platelets and leukocytes leads to "walling off the injury site" then clot formation. Describe the inflammatory phase Right Ans - Neutrophils increase cappillary permeability: edema formation and wbc release enzymes taht facilitate autolytic debridment. As inflammation progresses , neutrophills decrease and macrophages increase phagocytes remove debris and dead tissue macrophages help transition to proliferative phase through release of growth factors and chemical mediators. Symptoms of Inflmmatory respones Right Ans - it begins immediately after injury swelling, redness, warmth, and tenderness. these signs may be supressed with steroid therapy, diabetes, older patients and immunocompromised. Histamine Reaction Right Ans - occurs DURING inflammatory phase. histamine is a chemical mediator released by injured mast cells. causes vasodilation and increased capillary permeability. allows delivery of leukocytes to the site of injury. Proliferative phase of wound healing Right Ans - Growth Factors by macrophones attracts fibroblast to injury site. Growth factors stimulate angiogenesis Fibroblasts help manufacture glycoproteins and macopolysacharrides, they are responsible for collagen production and contribute to wound contraction. Remodeling Phase Right Ans - continues 1-2 years post injury normalizaiton of scar tissue balance between collagen formation and collagen lysis .l is essential to prevention of hypertrophic scarring. What are the Types of Acute wounds? Right Ans - Lacerations Skin tears Abrasions excoration

Avulsions/DeGloving Puncture wounds Surgical wounds Animal bites/Spider bites lacerations Right Ans - Pattern of injury in which skin and underlying tissues are cut or torn. High risk for contamination/Infection. Skin Tear Right Ans - Caused by shear, friction and/or Blunt force resulting in separation of skin layers. can be partail or full thickness. Payne Martin Skin Tear classification system : Category I Right Ans - without out tissue loss either linear or with a flap that closes the tear within an approximation of 1mm of the wound edges Payne Martin Skin Tear classification system : Category II Right Ans - Partial Tissue loss considered scant when the loss is 25% or less and moderate to large when thissue loss is more than 25% Payne Martin Skin Tear classification system : Category III Right Ans - Complete tissue loss or epidermal flap covering the injury. Management of Skin tears Right Ans - Control bleeding, apply pressure/ elevate limb, Cleanse wound, use warm water or saline, gently pat dry to avoid further damage to surrounding tissues, approximate skin flap if possible , use barrier ointment to protect surrounding skin -petroleum based ointment, select dressing, avoid strong adhesives, may use gause pad and wrap. steristrips may be used to maintain tissue approximation, skin adhesives. Prevent skintears Right Ans - mitigate environmental hazards wear protective clothing, keep skin moisturized, minimize the use of adhesives on the skin. use tubular bandages to protect skin. Abrasions Right Ans - Result from shearing of the skin by a rough surface. range in severity depndent on depth/surface area, abrasions are ALWAYS partial thickness. HIGH rate of contamination.

Escoriation Right Ans - Partial THickness, linerar because of the mechanical force that caused it, Excoration Vs. Denuded Right Ans - Excorated is defined as linear erosion of skin caused by mechanical means such as scratchign and Rubbing Denuded (see picture): loss of epidermis caused by exposure to urine , feces, body fluids, wound exudate, or friction. Avulsions Right Ans - "DeGLOVING" is FULL THICKNESS occurs when tissue is separated and is forcefully torn away from body. deep into the subcutaneous tissue or further(muscle or bone). depth differentiates a skin tear vs avulsion is directly related to level of force applied. Puncture Wounds Right Ans - caused by sharp oject taht deeply penetrates the skin. little bleeding around the outside of the wound. more bleeding inside the wound causing discoloration. Risks associated with Puncture wounds Right Ans - Bacteria into deeper layers of skin. puncturing object may breakfoff and remain within the skin layers. Venous Leg Ulcers Right Ans - Rapid onset, edema, trauma, thrombophlebitis, CVI, some pain , increases with dependency , decreases with elevation. usually located : medial malleolus, ankle, lower calf. gaiter region Arterial Leg ulcer Right Ans - Slow progression, atherosclerosis, claudication, PAD, Moderate to severe Intermittent claudication, decreases pain with dependency, increases with elevation at night or leg exercises. Location: lateral malleolus, anterior tibia, toes, heels , over phalangeal heads. Diabetic /Neuropathic Right Ans - Diabetes/ Peripheral neuropathy, not painful, parestesias, anestesia. Location: pressure sites, plantar. Irregular margins, wound base with granulation tissue, heavy exudating , weaping Right Ans - Venous wound thin , undermined border. black gray or yellow wound base Right Ans - Diabetic

well demarcated, steep, punched out. pale or white base Right Ans - Arterial periwound has hemosiderine staining, hyperkeratosis, edema , stasis dermatitis Right Ans - Venous wound Periwound has dry escar, pale, cyanotic, cool, shiny, hairless. thin Right Ans

• Arterial Wound periwound is pale, callus, bullae, charcots deformity, hammer toes Right Ans - Diabetic/Neuropathy Wound Vascular exam shows Pulses may be normal ABI >0.9. abnormal findings on doppler US Right Ans - Venous wound Vascular exam shows : decreased or absent pulses, ABI<0.9, rubor dependency, Delayed venous filling, Delay Cap refil, pallor with elevation Right Ans - Arterial Wounds Vascular Exam shows: pulses present, unreliable ABI, Mixed neuropathic and Arterial Right Ans - Diabetic/Neuropathic wound. How do partial-thickness wounds differ from full-thickness wounds Right Ans - · Partial-thickness is superficial and full-thickness are deep wounds Medical Adhesive-Related Skin Injuries (MARSI): Right Ans - · Can be avoided by using adhesive remover to take the tape Tertiary Intention wound closure is used with Right Ans - · Wounds with a high risk of infection to prevent abscess formation The main difference between primary intention and secondary intention closure is: - Right Ans - · In primary intention the wound has been closed with staples or sutures and in secondary intention the wound granulates and close from the base The histamine reaction occurs in the ______ phase Right Ans - · Inflammatory

Acute wounds with a high risk of contamination are Right Ans - · Lacerations and abrasions Some causes of incision dehiscence are Right Ans - · Infection, age, anatomical position of the incision Arterial and venous ulcers differ Right Ans - · Slow progression vs. rapid onset ). Periwound skin of a diabetic/neuropathic ulcer Right Ans - · Is pale Hemosiderin staining is present in Right Ans - · In venous leg ulcers General Risk factors in who gets diabetic foot ulcers Right Ans - PolyNeuropathy Arterial disease Infection Duration fo disease History of diabetic foot ulcer charcot arthropathy/ foot deformity Factors that affect tissue tolerance Tissue tolerance Right Ans - ability of skin and its supporting structures to endure pressure without adverse sequalae Factors that affect tissue tolerance Right Ans - elevated body temp nutritional dehabilitation smoking advanced age moisture- espcially PH of incontinence fricture and shear stress low BP comorbid states: decreased perfusion, COPD, anemia, DM, PAD, Covid 19 amputation risk disparties Right Ans - people of color

• indigenous people are 2 x more likely
• black people 4x as likely

-latinx 1.5 x as likely diabetic patient mns residing in low intensity vascular care regions Prevention injury prevention bundles Right Ans - 1. skin inspection

2. risk assessmetn
3. skin health maintence
4. pressure redistribution
5. nutrition and hydration
6. patient education Community Intervention Right Ans - screening, footwear, skin care education, referral for treatment Diabetic Foot assessment Right Ans - 1st minute ask 2nd minute look 3d minute teach. diabetic foot assessment 1st minute Right Ans - history of : previous foot/leg surgery, amputation, or vascular intervention is there an open wound, smoking or nicotine use? is diabetes controlled? do you have: burining/tingling m leg or foot pain, changes in skin color or skin lesion, loss of sensation, FOLLOW UP: do you see a podiatrist. Diabetic Foot assessment 2nd minute Right Ans - Derm: dystrophic nails. signs of fungal infection, hypertrophic skin, open wounds or fissures, maceration NEURO: responsive to light touch Musculoskeletal: does paitne thave full ROM of joints, obvious deformitites, is midfoot hot, red or inflammed Vascular: hair growth, DP and PT pulses, temp differences Diabetic Foot assessment 3rd Right Ans - TEACH daily foot care regarding shoes: risks of barefoot, recommend appropriate foot wear, yearly exams Overall health: smoking cessation, glycemic control

Foot care recommendation Right Ans - Wash feet daily,dry throughly moisturize your feet but avoid between the toes keep toenails trimmed and use an emery board to file down sharp edges check your feet daily wear moisture wicking socks before putting on you shoes check for sharp ojects wear shoes that fit well and dont rub feet avoid walking barefoot , soaking feet, or smoking Medical Management of PAD Right Ans - antithrombotic lipid lowering antihypertensive glycemic control: <150 - 180 counseling on smoking cessation diet: Vit D, Protein intake 1.25-1.5kg of body wt perday, exercise preventive care. Risk Factors for Arterial Insufficiency Right Ans - - Lipoprotein Metabolism

• LDL
• HDL
• Hypertension
• Diabetes
• environmetnal risk factors
• Nutritional and obestiy
• exercise and physical activity -Sleep and stress -Smoking
• Pollution
• Intestinal microbiota
• Alcohol consumption
• Infection Where is LDL secreted and how does it affect arterial insufficiency? Right Ans - LDL is secreted by the intestine and Liver and transport triglycerides TO the tissue as a source of energy.

Where is HDL secreted Right Ans - HDL is secreted by the intestine and liver to transport cholesterol FROM the tissue to the liver How does Hypertension affect arterial insufficiency? Right Ans - It increases smooth muscle activity and intimal accumulation of LDLs How does Diabetes affect arterial insuffiency? Right Ans - Hyperglycemia promotes proinflammatory gene expression in macrophages resulting in atherosclerosis How can exercise and physical activity reduce risk of arterial insuffiency Right Ans - improved glucose tolerance, reduced plasma lipids, increased anti- inflammatory pathways and reduced obesity how does sleep affect arterial insuffiency risk? Right Ans - Stress can stimulate gluccorticoid secreation from adreanl glands. monocytosis and neutrophilla ( increases inflammation) how does smoking affect arterial insuffiency risk? Right Ans - increases LDL and Blood pressure and Inflammation how does pollution affect arterial insuffiency risk? Right Ans - air pollution on dyslipidemia, endothelial dysfunction, platelet activation, atherosclerosis and lesion stability how does Intestinal microbiota affect arterial insuffiency risk? Right Ans - Microbe metabolites promote atherosclerosis by increasing platelet reactivity and vascular inflammation. Animal proteins can increase microbe metabolites how does Alcohol affect arterial insuffiency risk? Right Ans - increases blood pressure Risks factors for arterial disease Right Ans - hyperlipidemia htn smoking dm obestiy alcohol

Signs of arterial insuffiency Right Ans - intermittent claudication rest pain- worse with elevation better in dependent rubor of dependency trophi changes to skin - thin and shiny absence of hair trophic changes to nails- thick and brittle Long term risks of Atherosclerosis Right Ans - Ulceration gangrene amputation Etiology of Venous Ulcers Right Ans - involves lower leg edema, skin trophic changes, pain and decreased quality of life associated iwth varicose veins venous hypertension caused by vein valve dysfunction causes capillary permeability allowing fluids, proteins and blood in cells to leak into tissues impaired muscle pump function venous thrombosis non thrombotic venous obstruction. Clinical presentation of venous insufficiency Right Ans - signs: pruitis, edema, skin changes, atrophie blanch, healed venous ulcer or active venous ulcer, hemosiderin staining symptoms: aching , pain, heaviness, tingling, muscle cramps, symptoms worsen with prolonged standing or sitting pathophysiology of venous ulcers: vein Vavles Right Ans - destruction in the valves in the veins result in venous hypertension, reflux, and dilation of the vein causing varicosities and fluid leakage into tissue. Characteristics of venous insufficiency ulcers Right Ans - Occcur in the gaiter area