COS-C 2 Exam: Pressure Ulcers & Surgical Wounds, Exams of Nursing

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The patient is taking his pain medication around the clock. reports he not completely pain-free and rates his neck pain as a 2 on a scale of 0-10. He reports his neck pain does not limit or affect anything he wants to do. He is able to take care of himself, fix things around the house and he can sleep well at night. His wife says that he is a different and pleasant person on this new medication schedule. - ✔✔✔ - 1- Patient has pain that does not interfere with activity or movement a patient has an unstageable pressure ulcer due to black stable eschar at 50C and during the episode it peels off and leaves an area of newly epithelialized tissue, how should this be staged at Discharge on M1311? - ✔✔✔ - Once the ful thickness pressure ulcer is completely covered with new epithelial tissue, the wound is considered healed and no Ionger reportable as pressure ulcor en the OASIS. M1306, M1311, M1322 M1324. How are mucosal membrane pressure ulcers reported in the OASIS data set? - ✔✔✔ - OASIS data set inteuumentary itcms only include wounds and lesions to the integumentary system and do not include mucosal membrane wounds or lesions. Pressure ulcers occurring to mucosal membranes would be reported in the comprehensive assessment and clinical documentation but not in any of the following OASIS items M1306, M1311, M1322, or M1324. Can pressure injuries be assessed any point during the 5-day window to collect OASIS assessment info? - ✔✔✔ - No. Pressure ulcers must be assessed on Day 1. at the SOC visit, the assessing clinician observes an open ulcer over a bony prominence, with history of pressure and visible bone, can the clinician report this as Stage 4 pressure ulcer, even if not able to get confirmation of the diagnosis from the physician prior to completing the assessment? - ✔✔✔ - A pressure ulcer/injury may be reported on OASIS based on visualization of the wourd, patient assessment and interview, review of relevant related historical documentation and clinical judgment re: etiolcgy. Allhough the assessing clinician can report the observed ulcer/injury on the OASIS integumentary status items without physician confirmation, collaboration with the physician is required in order to apply an ICD10 code M1306. We are seeking direction regarding serum filled blisters that are caused by shoes rubbing against the foot. Some of our clinicians consider these "trauma wounds" and others consider them

"stage pressure ulcers", Please advise. - ✔✔✔ - the cause of wound is solely friction force which leads to visihle skin impairment, such as the serum filled blister cited in the sconario, it would NOT be categorized as pressure ulcer. The 2009 International NPUAP-FPUAP Pressure Ulcer Prevention and Treatment Clinical Practice Cuideline eliminated reference to friction as a primary factor in pressure development. M1306-M1324. If a Stage 3 pressure ulcer is closed with a muscle flap, what is recorded? What if the muscle flap begins to break down due to pressure? - ✔✔✔ - A94. If pressure ulcer is closed with muscle flap Idefined as full thickness skin and subcutancous tissue partially attached to the body by a narrow strip of tissue so that it retains its blood supply), the new tissue completely replaces the pressure ulcer. In this scenario, the pressure ulcer "goes away" and replaced by a surgical wound. If the muscle flap healed complelely, but then began to break down due pressure, it would be considered a new pressure ulcer. If the flap had never healed completely, would be considered a non-healing surgical wound. M1306-M1322. On SoC, the RN assesses a scar from closed pressure ulcer. Upon further interview and assessment, the patient's family states that the patient had a pressure ulcer but they are not able give the RN any staging information. How would this pressure ulcer be documented M1311, Current Number of Unhealed Pressure Ulcers/Injuries Stage? - ✔✔✔ - If the assessing clinician becomes awere that observable scar is the resuit healed pressure ulcer, do not report as a pressure ulcer on the OASIS. 239 M1306. the patient had a pressure ulcer and the post-op surgical report states it was surgically excised and closed without placement of muscle flap, do we still have a Stage 4 pressure ulcer- the original etiology or did this become surgical incision? - ✔✔✔ - Il all the lissue damaged by pressure is reoved surgically, 2.g amputation er surgi cal excision, there is no lerger a pressure ulcer, it becomes a sLrgical wound until healed. M1306-M1324. If single pressure ulcer partially granulated to the surface, leaving the ulcer open in more than one area, how many pressure ulcers are present? - ✔✔✔ - Only one pressure ulcer is present. M1306-M1324. Can a previously observable Stage 4 pressure ulcer that is now covered with slough or eschar be categorized as Stage 4? - ✔✔✔ - Nc. crcer lo stace :he pressure ulcer as Stage 4, bone, muscle, tendciI, cr joint capsule IStage structuresl must visible or directly palpable.

OASIS reporting. A surgical procedure that involves excision of necrotic tissue beyond general debridement Isuch excision of a necrotic mass), excision of mesh or other appliances structures goes beyond a simple I&D and would be reported as a surgical wound for M1340 re-epithelialization has been present for 30 days. M1340. Is a chest tube site surgical wound? - ✔✔✔ - A chest tube site is ia thoracostomy. Ostomies are excluded as surgical wounds in the OASIS. A chest tube site is not a surgical wound evenilachest tube or drain is present. M1340. A surgical incision was created to perform exploratory surgery. When closing the wound, the surgeon inserted a chest tube utilizing the opening created for the surgery. Can this closed incision with a chest tube be counted as a surgical wound when completing M1340? - ✔✔✔ - The wound describec should be considered a thoracostomy and not considered surgica. wound when completing the OASIS data set item M1340. Are burr holes on the head following an evacuation of a subdural hematoma which still have tightly adhered scabs considered surgical wound for M1340? - ✔✔✔ - For the purposes of the CASIS Integumentary Status items, a burr holo is hole that is surgically p.aced in the skull, or cranium and is considered a surgical wound. It remains a current surgical wound until the site is completely epithelialized and is without signs/ symptoms of inlection for approximately 30 cays, at which time it becomes a scar. M1340 & M1342. Is a mediport "nonobservable" because it is under the skin? - ✔✔✔ - Please refer to the definition of "not observable" used in the OASIS surgical wound items in the current OASIS Guidance Manual "not observable" is an appropriate response ONLY when a non- removable dressing is present. This is not the case with a mediport. As long as the mediport is present, whether it is being accessed or not, the patient is considered as having a current surgical wound. M1342 - Wounds healing by primary intention - ✔✔✔ - only options 0 - newly epithlialized or 3 - not healing apply M1400 Do you assess SOB using prescribed oxygen or what the patient actually uses? - ✔✔✔ - what the pt actually uses

M1400 SOB time consideration - ✔✔✔ - day of assessment (24h immediately preceding the home visit) M1400. Patient currently sleeps in the recliner or currently sleeps with 2 pillows to keep from being SOB. They are currently not SOB because they have already taken measures abate Would you mark M1400, 4 - At Rest or 0, - Not SOB? - ✔✔✔ - M1400 reports what true on the day of the assessment Ithe 24 hours immediately preceding the home visit and the lime spent ty the clinician the home). If the palient has mol demonstrated or reported shortness of orealh during that timeirame, the correct resporse would be "0-Not short of orealh" oven though the environment or patient activities were moaified in order to avoid shortness pi breath. M1600. My patient has an order for Sulfa BID x5 days, during the first five days of every month. Upon my S0C assessment on 11/1, the patient complained of s/s of UTI. The physician was notified, but no order was obtained for a urinalysis since the patient was just beginning prophylactic treatment that day. How should I answer M1600? - ✔✔✔ - M1600, Urinary Tract Infection, asking if the patient has been treated for a urinary tract infection (UTI) in the past 14 days. the patient was ordered to take Sulfa during the first five days of each month as prophylactic treatment and developed UTI, Response "1-Yes", would be the appropriate response. The physician must determine the diagnosis of a UTI, in order to select Response "1-Yes". A UTI is not assumed to be present based on the presentation of a symptom[s). In the scenario above, the appropriate response would be "NA-Patient on prophylactic treatment" absence of a physician diagnosis of UTI. True or False: M1800, Grooming includes getting to the area where grooming takes place - ✔✔✔ - true True or False: M1800, Grooming includes shampooing hair - ✔✔✔ - false True or False: Prosthetic and orthoric devices (upper extremity prosthesis, cervical collar, sling, TED hose) are considered when answering M1810 and M1820.1 - ✔✔✔ - true M1810/1820 dressing is answered based on ability to perform A. majority of tasks