Understanding Deep Tissue Injuries & Wound Management: Pressure Ulcers, Neuropathy, Herpes, Exams of Nursing

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QUESTIONS AND ANSWERS EXAM WOUND CERTIFICATION FINAL EXAM Questions and Correct Answers TESTED AND CONFIRMED A+ ANSWERS what are 6 risk factor components of Braden Scale for pressure ulcer? - Answer- sensory perception, moisture, mobility, activity, nutrition, and shear/friction What is the name of the organization that developed the pressure ulcer staging? - Answer-NPUAP (national pressure ulcer advisory panel) pathological effect of excessive pressure on soft tissue can be attributed by 3 factors? what are they? - Answer-tissue tolerance, duration of pressure, and intensity of pressure what are the extrinsic factors that impact pressure ulcers? - Answer-increase in moisture, friction and shearing how does friction play a role in shearing which eventually leads to pressure ulcer? - Answer-friction alone causes only superfical abrasion, but with gravity it plays a synergistic effect leading to shearing. When gravity pushes down on the body and resistance (friction) between the patient 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? - Answer-nutritional debilitation, advanced age, low BP, stress, smoking, elevated body temperature Aging skin undergoes what elements affecting risk for pressure ulcer? - Answer- dermoepidermal junction flattens, less nutrient exchange occurs, less resistance to shearing, changes in sensory perception, loss of dermal thickness, increased vascular surfaces, or have PUs that fail to improve despite optimal comprehensive management When should active support surface be considered? - Answer-when effective positioning is determined by an MD to be medically contraindicated What is the difference between an active and reactive support surfaces/ - Answer- active support surface is a powered mattress or overlay that changes it's load- distribution with or without applied load; pressure is redistributed across the body by inflating and deflating the cells of alternating zones. conversely a reactive support surface moves or changes load-distribution properties only in response to applied load, such as the patient's body. When are active support surfaces appropriate? - Answer-when manual frequent repositioning is not possible when are reactive support surfaces appropriate? - Answer-for pressure ulcer prevention what is a benefit in low air loss feature and when is it contraindicated? - Answer-low air loss assists in managing mositure. It is contraindicated in patients with unstable spine and it puts patients at risk for entrapment when is an air fluidized feature integrated in bed systems appropriate? - Answer-for patients with multiple stage III or Iv pressure ulcers, burns, myocutaneous skin flap for what kind of patients are traditional air-fluidized bed not recommended? - Answer-pulmonary diseases or unstable spine patients what are some general guidelines for caring for patients on a support surface? - Answer-support surfaces alone doe snot prevent or heal PUs, fuctions best with minimal linens and pads under patients, must be able to assume variety of positions to prevent bottoming out, patients should be turned regardless of support surfaces, patients who sit with a risk for PU should have a sitting plan- duration, position, and posture what type of patient is a lateral rotation feature in a supportive surface beneficial? - Answer-for patients with acute respiratory conditions- requiring pulmonary hygience what are the 3 essential physical properties for normal venous function? - Answer- competent valves, venous wall, and calf muscle pump what are the classical characteristic traits seen in venous ulcers? - Answer-shallow, irregular wound eges, with moderate to heavy exudate, dark red or "ruddy" wound base or thin layer of yellow slough, macerated periwound, crusting, scaling and /or hemosiderin staining Define hemosiderin staining? - Answer-leakage of RBCs which have been broken down appears as a purple to brown staining Define lipodermatosclerosis? - Answer-hardening of soft tissue where hemosiderin staining evolves into lipodermatosclerosis- found on gaiter and sock areas and has appearance of inverted champagne bottle Define atrophie blanche? - Answer-smooth, white plaques of think speckled atrophic tissue with tortous vessels on ankle or foot with hemosiderin pigmented border Define venous dermatitis? - Answer-characterized by scaling, crusting, weeping, erythema, erosions, and intense itching. Differentiate dermatitis from cellulitis? - Answer-In cellulitis, patients will often exhibit pain, fever, tenderness, one or few bullae, no relevent history, no crusting, blood cxs usually negative, no lesions anywhere else other than localized area, and high WBC count What factors impede healing in venous ulcers? - Answer-DM, tobacco, malnutrition, umplanned weight loss, and meds (corticosteroids) What is the most effective managment of CVI? - Answer-therapeutic compressions (30-40mmHg) What should you do before deciding to tx with compressions? - Answer-rule out LEAD, by obtaing an ABI What are the interpretations of ABI? - Answer-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? - Answer-when ABI is >1.3 indicating calcification of vessels which in turn reflects invalid data. A TBI of < 0.7 indicates LEAD What is the gold standard for evaluating valve failure and extent of reflux? - Answer- duplex ultra sound What are some methods for manaing venous ulcers and CVI - Answer-limb elevation- >heart level for 1-2 hours/daily and during sleep, calf pump exercises or referral to PT for shuffling gait, weight control, medications (diuretics, topical corticosteroids, Pentoxifylline (Trental), and compression therapy How does Pentoxifylline work and when is it appropriate? - Answer-reduces aggregation of platelets and WBC, reducing capillary plugging and enhances blood flow. ordered when standard therapy is not effective When are elastic or inelastic compressions indicated? - Answer-elastic for patients who are sedenatary vs. inelastic for patients who are amublatory and decreased cardiac output- this is relieved by placing limb in dependent position; rest pain occurs in the absence of activity and with legs in dependent position=90% occlusion What are modifiable risk factors for LEAD? what are the lab goals for managing them? - Answer-tobacco: stop smoking diabetes: HbA1c <7.0 and if possible for high risk patients, <6.0 dyslipidemia (elevation of cholesterol and triglycerides): HDL >40, LDL<100, TG <150 HTN: <140/90 (for DM, <130/80) In presence of arterial occlusion, refill time will be longer than what? in seconds? - Answer-will take > 2-3 seconds. what are the ABI values and its indicator? - Answer->1.3=invalid 1.0-1.3=normal range 0.9 or less=LEAD 0.8-0.6=borderline 0.5 or less=severe ischemia and revascularization needed When should you obtain TcPO2 (transcutaneous partial pressure of O2)? - Answer- when ABI or TBI cannot be performed d/t calcification or amputation of ankles or toes What are the values of TcPO2 and its interpretation? - Answer-40 mmHg or greater=normal <40mmHg=hypoxia w/impaired wound healing When do you use SLP (segmental leg pressure)? - Answer-used to determine location of occlusion for surgical intervention. a 30mmHg decrease in pressure between two adjacent levels indicate occlusion when should you not use TBI? - Answer-when toes are amputated or toes are col that it's not reliable What conditions cause vasoconstrictive properties which worsens LEAD? - Answer- smoking, pain, dehydration, cold temperature, lack of exercise, constrictive clothing when is pulsve volume recordings (PVR) and doppler waveform studies indicated? - Answer-it is recommended when ABI >1.3; the wave forms reflect severity of occlusion what tests give you an anatomic roadmap, prior to revascularization? - Answer-MRA, angiography, duplex angiography, or computed tomographic angiography when is HBO indicated in arterial ulcers? - Answer-patients w/significant ischemia who are not candidates for revascularization and wound healing is impaired Describe the characteristics of a neuropathic wound and periwound? - Answer- 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 Classification system? - Answer-there are 5 grading categories: 0: intact w/some callus formation, deformities, and redness over pressure point 1: superficial ulcer w/out depth into SQ tissue with or w/out cellulitis 2: full-thickness ulcer exposing tendon and joint w/out abcess or osteomyelitis 3. osteomyelitis, absecess, necrotizing fasciitis 4. gangrene toes, forefoot, and heel 5. amputation, gangrene-unsalvageable what is a traditional tx of Charcot foot? - Answer-cast mobilization Why is debridement of callus an important maintenance therapy? - Answer-better distributes pressure and reveals possible ulerations and undermining of tissues what are the priorities in managment of neuropathic wounds? - Answer-relieve pressure by offloading, aggressively treating infection, revascularization, and improve wound condition what are the 3 kinds of neuropathy? - Answer-motor, sensory, and autonomic neuropathy what happens in motor neuropathy and what do you typically observe? - Answer- foot muscles atrophy resulting in deformities of toes and foot structure which leads to eneven weight distribution and pressure points ( hammer and claw toes, charcot foot) what happens in sensory neuropathy and what do you typically observe? - Answer- protective sensation is lost and patients lack awareness of pain and temperature which leads to injury and infection If you need a professional to complete your college homework at a small fee, then reach out to Datedhomeworks.com what happens in autonomic neuropathy and what do you typically observe? - Answer-an involuntary nervous system resulting in loss of sweating and oil production causing skin to be dry. Xerosis leads to fissures, cracks, callus, and ulceration Under the foot risk classification system, what signs connote low risk diabetes and how should you manage the condition to prevent neuropathic ulcers? - Answer- intact sensation(neuropathy), intact pulse (vasularity), no foot deformities (motor fx). management includes: education r/t disease control, daily inspection of foot, proper shoe wear, early report of foot injuries; annual foot exam and callus removal and nail care prn A: abx S: serous discharge E: erythema P: purulent drainage S: separation of tissue I: isolation of bacteria S: stay as inpatient prolonger >14 days How are surgical wounds usually closed? - Answer-by primary or secondary intention what solution is usually used in traumatic wounds to decrease contamination? - Answer-Dakin's solution or sodium hypochlorite; should have limited use bc it also kills healthy cells when is TCC contraindicated in treating neuropathic ulcers? - Answer-patient with acute deep infection, 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? - Answer-foam felt dressing (FFD) what surgical procedure is used for those with peripheral neuropathy and equinus contractures? - Answer-tedon-achilles lengthening (TAL) what are the clinical manifestations of incontinence associated dermatitis (IAD)? - Answer-areas of body where incontinence will be spread to is observed; risk factors are associated w/urinary or bowel incontinence (abx, carthartics, hypoalbumina, fecal impaction, IBS, infection, radiation, fat malabsorption); blistering, shallow irregular patches that's red and denuded and/or macerated; painful what are the clinical manifestations of Candidiasis? - Answer-occurs in skin folds where moisture is bountiful (intertrigo, pendulous breasts, groin, perineum, inner thighs -like IAD); associated w/moisture and immunosuppresion; confluent patchy rash or erythematous papules (raised discoloration) with cheesy-white exudate; pustules and satellite lesions also seen; itchy, burning discomfort; Potassium hydroxide preparation scraping (KOH) done for testing What are the clinical manifestations of Herpes Simplex? - Answer-viral condition affecting the genitalia areas (perianal, buttocks, genitals); isolated vesicles rupture and crusts over Differentiate IAD, Cutaneous Candidiasis, and Herpes Simplex from pressure ulcer? - Answer-types of lesions, medical hx and location of the conditions 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 incontinence related, Candidiasis is associated with moisture issues and Herpes is a STD. Uniqueness of lesions also depicts type of condition. 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 conditions in that it's superficial, partial thickness wound that's red w/serous blister whys is albumin and prealbumin an important lab value to know in wound management and healing? - Answer-lab values indicate potential risk for malnutrition. Protein is needed in growth factors to promote healing. Becasue albumin has a long half life, it foretells muscle wasting/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? - Answer-iron deficiency Are the the interpretations of BMI for underweight, normal, overweight, and obesity? - Answer-> 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? - Answer-5 % or greater w/in 30 days (1 month) or 10% or greater w/in 180 days (6 months) Which nutritional element is needed for angeogenesis, collagen synthesis/remodeling, immune fx and serves as precursor to nitric oxide and wound contraction? - Answer-protein How much protein is necessary per kg, for wound healing? - Answer-1.25-1.5kg/body weight which vitamin assists in angiogenesis and epithealization? - Answer-Vitamin A; this also helps with collagen synthesis If you need a professional to complete your college homework at a small fee, then reach out to Datedhomeworks.com which vitamin assists in collagen synthesis, immune function, fibroblast function, and enchances activation of leukocytes and macrophages and essential in cell wall integrity? - Answer-Vitamin C which mineral is needed for protein synthesis? - Answer-zinc how many calories are needed per kg for sufficiency? - Answer-30-35kcal/body weight what lab values help identify patients who are malnourished and need nutritional support for wound healing? - Answer-weight(<18.5 is underweight, need 30- 35kcal/weight, significant weight loss =5% w/in 30 days or 10% w/in 180 days); use when infection and odor is under control; viable tissue exposed; used 2x/day; use barrier ointment over periwound what caution should you take in considering conservative sharp or surgical sharp wound debridement? - Answer-there is potential for transient bacteremia after debridement, particularly wounds that are infected; risk for bleeding, pain what are the 3 general parameter guides for selecting appropriate wound debridement? - Answer-overall condition and goal of patient; 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? - Answer-hyaluronic acid cream when should petrolatum jelly-based products not be used? - Answer-for prevention or treatment of radiation dermatitis what are some ways to manage radiation dermatitis? - Answer-use lanolin-free hydrophillic moisturizer, normal saline soaks to provide cooling sensation and loosen crusting, nonadherent dressings What are the characteristic manifestation of Herpes Zoster? - Answer-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 diagnostic feature in Candidiasis? - Answer- satellite lesion If you need a professional to complete your college homework at a small fee, then reach out to Datedhomeworks.com what are the 2 mechanims for wound healing? - Answer-regeneration (replacement of damaged or lost tissue with more of the same) or scar formation (replacement of damaged or lost tissue by connective tissue that lacks some fx of original tissue wounds that are confined to epidermal and superficial dermal layers heal by what mechanism and why? - Answer-regeneration; epithelial, endothelial, and connective tissue can be reproduced wounds that occur deep in the dermal structures, SQ tissue, muscle, tendon, ligaments, and bone heal by what mechanism and why? - Answer-scar formation; these layers lack capacity to regenerate and therefore loss of these structures are permanent Explain wound healing by primary intention and give an example? - Answer-In primary intention, wound edges are well approximated and heals by epithealization and connective tissue deposition. surgical incision secured w/staples, surtures, or adhesive tape explain wound healing by secondary intention and give and example? - Answer- wound edges are not approximated and healing occurs by granulation tissue formation, contraction of wound edges, and epithelialization. chronic wounds such as PU and dehisced incisions explain wound healing by tertiary intentions and give examples? - Answer-aka delayed primary intention. wound is kept open for several days. superficial wound eges then are approximated, and center of wound heals by granulation tissue formation. abdominla incision complicated by significant infection (deep tissue is healing by graulation and superficial layer of skin is sutured) "red islets" represent what part of the skin layer? - Answer-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 migration in wound healing delayed when wound is covered w/ a scab? - Answer-in order to create a moist envinroment, epithelial cells secrete enzymes knwon as MMP (metallproteinases) to lift the scab what are the major components of partial-thickness repair include? - Answer-1. inflammatory response to injury 2. epithelial proliferation and migration (resurfacing) 3. differentiation of the epidermal layers to restore barrier fx of skin what happens in wound healing, if wound involves dermal loss - Answer-granulation formation or connective tissue repair will precede concurrently with reepithealization when do you know complete healing has occured in epithelial resurfacing or healing by regeneration? - Answer-when skin pigmenation matches the individual's normal skin tone what must be restored in partial dermal loss in wound healing? - Answer-rete ridges/dermal papillae what are the key components of proliferative phase? - Answer-epithealization, neoangiogenesis, and matrix deposition/collagen synthesis what are the 4 major phases in full-thickness repair? - Answer-1. hemostasis (platelets degranulate and release growth factors) 2. inflammatory (leakage of neutrophils, macrophages ) 3. proliferative/rebuilding (cont recruitment of growth factors, granulation formation, contraction of wound edges, epithelial resurfacing) 4. maturation/remodeling (collagen synthesis) granulation tissue is often referred to as - Answer-extracellular matrix (ECM)