WOUND CERTIFICATION EXAM 2024/2025 (ACTUAL QUESTIONS AND ANSWERS), Exams of Pathology

Download WOUND CERTIFICATION EXAM 2024/2025 (ACTUAL QUESTIONS AND ANSWERS) and more Exams Pathology in PDF only on Docsity! What are 6 risk factor components of braden scale for pressure ulcer? Sensory percep9on, moisture, mobility, ac9vity, nutri9on, and shear/fric9on What is the name of the organiza9on that developed the pressure ulcer staging? Npuap (na9onal pressure ulcer advisory panel) Pathological effect of excessive pressure on soE 9ssue can be aFributed by 3 factors? What are they? Tissue tolerance, dura9on of pressure, and intensity of pressure What are the extrinsic factors that impact pressure ulcers? Increase in moisture, fric9on and shearing How does fric9on play a role in shearing which eventually leads to pressure ulcer? Fric9on alone causes only superfical abrasion, but with gravity it plays a synergis9c effect leading to shearing. When gravity pushes down on the body and resistance (fric9on) between the pa9ent and surface is exerted, shearing occurs. Because skin does not freely move, primary effect of shearing occurs at the deeper fascial level. What are the intrisinc factors of pressur ulcers? Nutri9onal debilita9on, advanced age, low bp, stress, smoking, elevated body temperature Aging skin undergoes what elements affec9ng risk for pressure ulcer? WOUND CERTIFICATION EXAM 2024/2025 (ACTUAL QUESTIONS AND ANSWERS) Dermoepidermal junc9on flaFens, less nutrient exchange occurs, less resistance to shearing, changes in sensory percep9on, loss of dermal thickness, increased vascular fragility; ability of soE 9suse to distribute mechanical load w/out comprosing blood flow is impaired What does nonblanching erythema indicate in the skin r/t pu? When pressure is applied to the erythema9c area skin becomes white (blanched), but once relieved, erythema returns -indica9ng blood flow; however in nonblanching erythema, skin does not blanche-indica9ng impaired blood flow-sugges9ng 9ssue destructon Why does siVng in a chair pose more of a risk in skin break down than lying? Deep 9ssue injury or pu is likely to occur sooner siVng down because 9ssue offloading over boney prominences is higher Describe what you will see in deep 9ssue injury? Purple or maroon localized area of discolored intact skin skinor blood filled blister; may be preceded by painful, firm, mushy, or boggy; skin may be warmer to cooler in adjacent 9ssue. In dark skin, thin blister or eschar over a dark wound bed may bee seen Describe stage i pressure ulcer? Intact skin with nonblanchable redness of localized area. Will not see blanching in dark skin, but changes in skin 9ssue consistency (firm vs boggy when palpated), sensa9on (pain), and warmer or cooler temperature may differ from surrounding area Describe stage ii pressure ulcer? Par9al-thickness wound where epidermis and 9p of dermis is lost with red-pink wound bed w/out slough. May also present as intact or open/ruptured serum - filled blister Describe stage iii pressure ulcer? Pulmonary diseases or unstable spine pa9ents What are some general guidelines for caring for pa9ents on a support surface? Support surfaces alone doe snot prevent or heal pus, fuc9ons best with minimal linens and pads under pa9ents, must be able to assume variety of posi9ons to prevent boFoming out, pa9ents should be turned regardless of support surfaces, pa9ents who sit with a risk for pu should have a siVng plan- dura9on, posi9on, and posture What type of pa9ent is a lateral rota9on feature in a suppor9ve surface beneficial? For pa9ents with acute respiratory condi9ons- requiring pulmonary hygience What are the 3 essen9al physical proper9es for normal venous func9on? Competent valves, venous wall, and calf muscle pump What are the classical characteris9c traits seen in venous ulcers? Shallow, irregular wound eges, with moderate to heavy exudate, dark red or "ruddy" wound base or thin layer of yellow slough, macerated periwound, crus9ng, scaling and /or hemosiderin staining Define hemosiderin staining? Leakage of rbcs which have been broken down appears as a purple to brown staining Define lipodermatosclerosis? Hardening of soE 9ssue where hemosiderin staining evolves into lipodermatosclerosis- found on gaiter and sock areas and has appearance of inverted champagne boFle Define atrophie blanche? Smooth, white plaques of think speckled atrophic 9ssue with tortous vessels on ankle or foot with hemosiderin pigmented border Define venous derma99s? Characterized by scaling, crus9ng, weeping, erythema, erosions, and intense itching. Differen9ate derma99s from celluli9s? In celluli9s, pa9ents will oEen exhibit pain, fever, tenderness, one or few bullae, no relevent history, no crus9ng, blood cxs usually nega9ve, no lesions anywhere else other than localized area, and high wbc count What factors impede healing in venous ulcers? Dm, tobacco, malnutri9on, umplanned weight loss, and meds (cor9costeroids) What is the most effec9ve managment of cvi? Therapeu9c compressions (30-40mmhg) What should you do before deciding to tx with compressions? Rule out lead, by obtaing an abi What are the interpreta9ons of abi? Abi of 1.0 is pure levd abi of 0.9 or less is lead abi of 0.5 or less is ischemia When should you obtain an tbi? When abi is >1.3 indica9ng calcifica9on of vessels which in turn reflects invalid data. A tbi of < 0.7 indicates lead What is the gold standard for evalua9ng valve failure and extent of reflux? Duplex ultra sound What are some methods for manaing venous ulcers and cvi Limb eleva9on- >heart level for 1-2 hours/daily and during sleep, calf pump exercises or referral to pt for shuffling gait, weight control, medica9ons (diure9cs, topical cor9costeroids, pentoxifylline (trental), and compression therapy How does pentoxifylline work and when is it appropriate? Reduces aggrega9on of platelets and wbc, reducing capillary plugging and enhances blood flow. Ordered when standard therapy is not effec9ve When are elas9c or inelas9c compressions indicated? Elas9c for pa9ents who are sedenatary vs. Inelas9c for pa9ents who are amublatory When are high pressure compressions (30-40mmghg) indicated, when assessing abi? Abi>0.8 can use high compressions When are compressions contraindicated? Venous thrombosis in le w/ulcers and uncompensated heart failure When is sustained (con9nuous) compression contraindicated? In the presene of pvd with an abi that is < or =0.6 or when abi is >0.5 but <0.8 is more appropriate When is ipc (intermiFent pneuma9c compression)-dynamic compression indicated? For pa9ents with venous insufficiency and abi< or =0.5, for those who cannot tolerate sustained compression, as an adjunct therapy to sustained therapy, those who are immobile When is modified or lower compressions appropriate (23-30mmhg)? When coexis9ng arterial disease is present All pa9ents with leg uclers should be screened for arterial disease using what, ini9ally? Doppler which measures abi; takes bp in the arm and ankle and compares ra9o What are the aFributes of short-stretch compression? It's inelas9c, sustained compression and provides a modified to therapeu9c level of pressure-reusable What are the aFributes of long-stretch compression? When should you obtain tcpo2 (transcutaneous par9al pressure of o2)? When abi or tbi cannot be performed d/t calcifica9on or amputa9on of ankles or toes What are the values of tcpo2 and its interpreta9on? 40 mmhg or greater=normal <40mmhg=hypoxia w/impaired wound healing When do you use slp (segmental leg pressure)? Used to determine loca9on of occlusion for surgical interven9on. A 30mmhg decrease in pressure between two adjacent levels indicate occlusion When should you not use tbi? When toes are amputated or toes are col that it's not reliable What condi9ons cause vasoconstric9ve proper9es which worsens lead? Smoking, pain, dehydra9on, cold temperature, lack of exercise, constric9ve clothing When is pulsve volume recordings (pvr) and doppler waveform studies indicated? It is recommended when abi >1.3; the wave forms reflect severity of occlusion What tests give you an anatomic roadmap, prior to revasculariza9on? Mra, angiography, duplex angiography, or computed tomographic angiography When is hbo indicated in arterial ulcers? Pa9ents w/significant ischemia who are not candidates for revasculariza9on and wound healing is impaired Describe the characteris9cs of a neuropathic wound and periwound? Wounds are usually found on the planatar, dorsum of metatarsal, and lateral sides of foot; wounds are usually red , if no ischemia not present; wound edges are well defined; exudate is moderate to large; callus periwound Describe the grading system and its corresponding symptoms of wagner ulcer classifica9on system? There are 5 grading categories: 0: intact w/some callus forma9on, deformi9es, and redness over pressure point 1: superficial ulcer w/out depth into sq 9ssue with or w/out celluli9s 2: full-thickness ulcer exposing tendon and joint w/out abcess or osteomyeli9s 3. Osteomyeli9s, absecess, necro9zing fascii9s 4. Gangrene toes, forefoot, and heel 5. Amputa9on, gangrene-unsalvageable What is a tradi9onal tx of charcot foot? Cast mobiliza9on Why is debridement of callus an important maintenance therapy? BeFer distributes pressure and reveals possible ulera9ons and undermining of 9ssues What are the priori9es in managment of neuropathic wounds? Relieve pressure by offloading, aggressively trea9ng infec9on, revasculariza9on, and improve wound condi9on What are the 3 kinds of neuropathy? Motor, sensory, and autonomic neuropathy What happens in motor neuropathy and what do you typically observe? Foot muscles atrophy resul9ng in deformi9es of toes and foot structure which leads to eneven weight distribu9on and pressure points ( hammer and claw toes, charcot foot) What happens in sensory neuropathy and what do you typically observe? Protec9ve sensa9on is lost and pa9ents lack awareness of pain and temperature which leads to injury and infec9on What happens in autonomic neuropathy and what do you typically observe? An involuntary nervous system resul9ng in loss of swea9ng and oil produc9on causing skin to be dry. Xerosis leads to fissures, cracks, callus, and ulcera9on Under the foot risk classifica9on system, what signs connote low risk diabetes and how should you manage the condi9on to prevent neuropathic ulcers? Intact sensa9on(neuropathy), intact pulse (vasularity), no foot deformi9es (motor fx). Management includes: educa9on r/t disease control, daily inspec9on of foot, proper shoe wear, early report of foot injuries; annual foot exam and callus removal and nail care prn Under the foot risk classifica9on system, what signs connote moderate risk diabetes and how should you manage the condi9on to prevent neuropathic ulcers? Intact sensa9on(neuropathy), intact pulse (vasularity), foot deformi9es present (motor fx). Management includes: educa9on r/t disease control, daily inspec9on of foot, proper shoe wear, early report of foot injuries; depth in-lay footwear, foot exam every 6 months; referral to foot/ankle specialist if deformity is causing pressure and conserva9ve measures failed Under the foot risk classifica9on system, what signs connote high risk diabetes and how should you manage the condi9on to prevent neuropathic ulcers? Absent sensa9on(neuropathy), absent pulse (vasularity), foot deformi9es present (motor fx). Management includes: educa9on r/t disease control, daily inspec9on of foot, proper shoe wear, early report of foot injuries; custom footwear, foot exam every 3months; callus maintenance; referral to foot/ankle specialist if deformity is causing pressure and conserva9ve measures failed What are some key things to remember when caring for diabe9c foot? Daily inspec9ons of foot and shoes, don't soak in water for prolonged period to avoid macera9on, avoid nylon socks bc they don't breathe, avoid chemicals for What solu9on is usually used in trauma9c wounds to decrease contamina9on? Dakin's solu9on or sodium hypochlorite; should have limited use bc it also kills healthy cells When is tcc contraindicated in trea9ng neuropathic ulcers? Pa9ent with acute deep infec9on, sepsis, or gangrene. May not be indicated for those who are noncompliant, would be unstable to stand or walk, exessive edema, fragile skin and who have ulcers that have depth >size of width What is used as an adjunct therapy to surgical shoe, healing shoe, or walking splint and when tcc is not warranted? Foam felt dressing (ffd) What surgical procedure is used for those with peripheral neuropathy and equinus contractures? Tedon-achilles lengthening (tal) What are the clinical manifesta9ons of incon9nence associated derma99s (iad)? Areas of body where incon9nence will be spread to is observed; risk factors are associated w/urinary or bowel incon9nence (abx, carthar9cs, hypoalbumina, fecal impac9on, ibs, infec9on, radia9on, fat malabsorp9on); blistering, shallow irregular patches that's red and denuded and/or macerated; painful What are the clinical manifesta9ons of candidiasis? Occurs in skin folds where moisture is boun9ful (intertrigo, pendulous breasts, groin, perineum, inner thighs -like iad); associated w/moisture and immunosuppresion; confluent patchy rash or erythematous papules (raised discolora9on) with cheesy-white exudate; pustules and satellite lesions also seen; itchy, burning discomfort; potassium hydroxide prepara9on scraping (koh) done for tes9ng What are the clinical manifesta9ons of herpes simplex? Viral condi9on affec9ng the genitalia areas (perianal, buFocks, genitals); isolated vesicles rupture and crusts over Differen9ate iad, cutaneous candidiasis, and herpes simplex from pressure ulcer? Types of lesions, medical hx and loca9on of the condi9ons assist in diagnosing. Whereas iad and cadidiasis occurs in skin fold areas, herpes is found in genitalia while pus occur over boney prominences. Iad is incon9nence related, candidiasis is associated with moisture issues and herpes is a std. Uniqueness of lesions also depicts type of condi9on. Iad is irregular, denuded, blistering; candidiasis is confluent, patchy, papular, pustular, cheesy-like exudate; herpes is isolated blister which eventually ruptures into crust; pus in stage ii may be confused with the alluded condi9ons in that it's superficial, par9al thickness wound that's red w/serous blister Whys is albumin and prealbumin an important lab value to know in wound management and healing? Lab values indicate poten9al risk for malnutri9on. Protein is needed in growth factors to promote healing. Becasue albumin has a long half life, it foretells muscle was9ng/malnourishement which has been chronic. Albumin level <3.5 is malnourished (normal is 3.5-5). Conversely, prealbumin has a short half life of 2 days and indicates acute stage. <19.5 is malnourished (19.5-35.8 normal). What does transferrin lab value a good indicator of? Iron deficiency Are the the interpreta9ons of bmi for underweight, normal, overweight, and obesity? > 18.5kg =underweight 18.5-24.9=normal 25-29.9=overweight 30 and > is obesity What % of body weight is considered significant weight loss? 5 % or greater w/in 30 days (1 month) or 10% or greater w/in 180 days (6 months) Which nutri9onal element is needed for angeogenesis, collagen synthesis/remodeling, immune fx and serves as precursor to nitric oxide and wound contrac9on? Protein How much protein is necessary per kg, for wound healing? 1.25-1.5kg/body weight Which vitamin assists in angiogenesis and epithealiza9on? Vitamin a; this also helps with collagen synthesis Which vitamin assists in collagen synthesis, immune func9on, fibroblast func9on, and enchances ac9va9on of leukocytes and macrophages and essen9al in cell wall integrity? Vitamin c Which mineral is needed for protein synthesis? Zinc How many calories are needed per kg for sufficiency? 30-35kcal/body weight What lab values help iden9fy pa9ents who are malnourished and need nutri9onal support for wound healing? Weight(<18.5 is underweight, need 30-35kcal/weight, significant weight loss =5% w/in 30 days or 10% w/in 180 days); prealbumin (<19.5=malnourished and 19.5-35.8=normal), and albumin(<3.5 =malnourished and 3.5-5=normal) What the the acroynm 9me used for? There is poten9al for transient bacteremia aEer debridement, par9cularly wounds that are infected; risk for bleeding, pain What are the 3 general parameter guides for selec9ng appropriate wound debridement? Overall condi9on and goal of pa9ent; status of wound and urgency in need of debridment; skill level of care provider What product is used for tx of very dry, scaly skin? Hyaluronic acid cream When should petrolatum jelly-based products not be used? For preven9on or treatment of radia9on derma99s What are some ways to manage radia9on derma99s? Use lanolin-free hydrophillic moisturizer, normal saline soaks to provide cooling sensa9on and loosen crus9ng, nonadherent dressings What are the characteris9c manifesta9on of herpes zoster? Begins w/buring pain, followed by erythema that evolves into a grouped unilateral vesicular rash along one or two dermatomes. Pustules form, rupture, and then becomes crusty. Of note, dermatomes are specific skin surface areas innervated by a single spinal nerve group What kind of lesion is an important diagnos9c feature in candidiasis? Satellite lesion What are the 2 mechanims for wound healing? Regenera9on (replacement of damaged or lost 9ssue with more of the same) or scar forma9on (replacement of damaged or lost 9ssue by connec9ve 9ssue that lacks some fx of original 9ssue Wounds that are confined to epidermal and superficial dermal layers heal by what mechanism and why? Regenera9on; epithelial, endothelial, and connec9ve 9ssue can be reproduced Wounds that occur deep in the dermal structures, sq 9ssue, muscle, tendon, ligaments, and bone heal by what mechanism and why? Scar forma9on; these layers lack capacity to regenerate and therefore loss of these structures are permanent Explain wound healing by primary inten9on and give an example? In primary inten9on, wound edges are well approximated and heals by epithealiza9on and connec9ve 9ssue deposi9on. Surgical incision secured w/staples, surtures, or adhesive tape Explain wound healing by secondary inten9on and give and example? Wound edges are not approximated and healing occurs by granula9on 9ssue forma9on, contrac9on of wound edges, and epithelializa9on. Chronic wounds such as pu and dehisced incisions Explain wound healing by ter9ary inten9ons and give examples? Aka delayed primary inten9on. Wound is kept open for several days. Superficial wound eges then are approximated, and center of wound heals by granula9on 9ssue forma9on. Abdominla incision complicated by significant infec9on (deep 9ssue is healing by graula9on and superficial layer of skin is sutured) "red islets" represent what part of the skin layer? Basement membrance of the epidermis, which projects deep into the dermis to line the epidermal appendages. Each islets serves as a source of new epithelium Why is migra9on in wound healing delayed when wound is covered w/ a scab? In order to create a moist envinroment, epithelial cells secrete enzymes knwon as mmp (metallproteinases) to liE the scab What are the major components of par9al-thickness repair include? 1. Inflammatory response to injury 2. Epithelial prolifera9on and migra9on (resurfacing) 3. Differen9a9on of the epidermal layers to restore barrier fx of skin What happens in wound healing, if wound involves dermal loss Granula9on forma9on or connec9ve 9ssue repair will precede concurrently with reepithealiza9on When do you know complete healing has occured in epithelial resurfacing or healing by regenera9on? When skin pigmena9on matches the individual's normal skin tone What must be restored in par9al dermal loss in wound healing? Rete ridges/dermal papillae What are the key components of prolifera9ve phase? Epithealiza9on, neoangiogenesis, and matrix deposi9on/collagen synthesis What are the 4 major phases in full-thickness repair? 1. Hemostasis (platelets degranulate and release growth factors) 2. Inflammatory (leakage of neutrophils, macrophages ) 3. Prolifera9ve/rebuilding (cont recruitment of growth factors, granula9on forma9on, contrac9on of wound edges, epithelial resurfacing) 4. Matura9on/remodeling (collagen synthesis) Granula9on 9ssue is oEen referred to as Extracellular matrix (ecm) In full-thickness wounds, why is the new epidermis slightly thinner than original epidermis? Ret pegs that normall dip into dermis is lacking In chronic wounds where wound is healing by secondary inten9on, why is healing delayed?