Wound Healing & Debridement Techniques: Bringman's Exam 1 Notes (Day 2), Exams of Nursing

Download Wound Healing & Debridement Techniques: Bringman's Exam 1 Notes (Day 2) and more Exams Nursing in PDF only on Docsity! Bringman’s Exam 1 (Day 2 Notes) Questions With Complete Solutions What are some wound characteristics we should document? - correct answerLocation Size (depth, width, length) Shape Edges Tunneling, undermining, sinus tracts (presence and depth) Base (necrosis, exudate, granulation tissue, epithelialization, exposed structures) Periwound area (edema, induration, maceration) Pain Quantity of bacteria What is primary intention? - correct answerSurgeon closes wound by approximating edges together with stitches, glue, staples, skin graft, etc immediately after What is dehiscence? - correct answerWhen the doc tries primary closure, but it gets infected and the wound pops back open What is secondary intention? - correct answerLetting a wound heal on its own (edges not brought together) A surgeon will not close it if infection has already begun What is contact inhibition? - correct answerWhen epithelial cells meet at the center of the wound, the wound is covered with new skin, migration ends, and cells will stop dividing What is tertiary intention? What is it AKA? - correct answerA wound is allowed to heal by secondary intention and then is closed by primary intention as the final treatment Aka: delayed primary When is tertiary intention commonly used? - correct answerIf there's a problem/infection or so much swelling that you let the wound stay open to heal and then they close it up later Common with head wounds and abdominal surgeries What are 2 types of necrotic tissue? - correct answerEschar and slough What is undermining? - correct answer"Shadow" area, like a cave where the depth continues beyond/under the skin border What is tunneling? - correct answerLonger, and narrower undermining that becomes like a tube/tunnel How does tunneling need to heal? Why? - correct answerWant to heal from basement up because a closed off tunnel may cause an abscess What is a fistula? - correct answerTunnel that has gone between 2 parts of our body that aren't supposed to be connected Bringman’s Exam 1 (Day 2 Notes) Questions With Complete Solutions What is the periwound? - correct answerArea of skin around the wound What is maceration? What could lead to this? - correct answerWeak/soft tissue, lost its ability to stay in place; like a wet callus coming off Prolonged and excessive exposure to moisture can result in this skin damage and softening What is dessicrated periwound? - correct answerWound is too dry What should the periwound look like during the inflammation phase? - correct answerRed, warm, swollen, localized (same amount all the way around) What is exudate? - correct answerDischarge/drainage What is streaking of periwound? - correct answerInfection traveling through a vein What are normal exudate? - correct answerSerous, fibrinous, serosanguinous, sanguinous What are abnormal exudate? - correct answerPurulant, seropurulant, hemopurulant What is serous exudate? - correct answerNormal, yellowish clear What is fibrinous exudate? - correct answerCloudy, greyish (more fibrin in it) What is serosanguinous exudate? - correct answerPresence of blood, slight red/pink What is sanguinous exudate? - correct answerBleeding What is purulent exudate? - correct answerYellow, green, gray (infection) What is seropurulant exudate? - correct answerMurky, thicker (infection) What is hemopurulent exudate? - correct answerDark, viscous blood What happens to drainage if wound is getting better? Worse? - correct answerBetter: from thick to THIN and more to LESS Worse: from thin to THICK and less to MORE What is turgor? - correct answerElasticity of the skin; we lose it and it becomes weaker as we get older What is the goal of debridement? - correct answerGet rid of necrotic tissue