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wound certification exam questions and answers.
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wound certification exam questions andanswers.
what are 6 risk factor components of Braden Scale for pressure ulcer? -
\sensory perception, moisture, mobility, activity, nutrition, and shear/friction
What is the name of the organization that developed the pressure ulcer staging? -
\NPUAP (national pressure ulcer advisory panel)
pathological effect of excessive pressure on soft tissue can be attributed by 3 factors?
what are they? -
\tissue tolerance, duration of pressure, and intensity of pressure
what are the extrinsic factors that impact pressure ulcers? -
\increase in moisture, friction and shearing
how does friction play a role in shearing which eventually leads to pressure ulcer? -
\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? -
\nutritional debilitation, advanced age, low BP, stress, smoking, elevated body
temperature
Aging skin undergoes what elements affecting risk for pressure ulcer? -
\dermoepidermal junction flattens, less nutrient exchange occurs, less resistance to
shearing, changes in sensory perception, loss of dermal thickness, increased vascular
fragility; ability of soft tisuse 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 erythematic area skin becomes white (blanched), but
once relieved, erythema returns -indicating blood flow; however in nonblanching
erythema, skin does not blanche-indicating impaired blood flow-suggesting tissue
destructon
why does sitting in a chair pose more of a risk in skin break down than lying? -
\deep tissue injury or PU is likely to occur sooner sitting down because tissue offloading
over boney prominences is higher
,Describe what you will see in deep tissue 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 tissue. 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 tissue consistency (firm vs boggy when palpated), sensation
(pain), and warmer or cooler temperature may differ from surrounding area
Describe stage II pressure ulcer? -
\partial-thickness wound where epidermis and tip 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? -
\full-thickness wound where both epidermis and dermis is lost and subcutaneous tissue
may be visible, but deeper structures such as muscle, bone, and tendon are not
exposed; slough my be present but it doesn't obscure depth and tunneling and
undermining may be present
Describe stage IV pressure ulcer? -
\full-thickness wound with exposed bone,tendon, and muscle; slough or eschar may be
seen in some parts of the wound bed. you will often see tunneling and undermining.
Osteomyelitis may be dxed at this stage, since bone is palpable
Describe unstageble ulcers? -
\full-thickness wound where base of the ulcer is covered by slough and/or eschar,
obscuring depth
When should eschars not be removed? -
\when it's stable with dry, adherent, and intact w/out erythema on the heel; this serves
as the body's natural cover and should not be removed.
Therapeutic function of pressure distribution is accomplised by what 2 factors? -
\immersion and envelopement
Define immersion? -
\depth of penetration or skining into surgace allowing pressure to be spread out over
surrounding area rather than directly over boney prominence
Define envelopement? -
\is the ability of support surface to conform to irregularities without causing substantial
increase in pressure
what is bottoming out? -
, \this occurs when depth of penetration or sinking is excessive, allowing increased
pressure to concentrate over boney prominences
what factors contribute to bottoming out? -
\weight, disproportion of weight and size such as amputation, tendency to keep HOB
>30 degrees, inappropriate support surface settings
When should you consider reactive support surface with features and components such
as low air loss, alternating pressure, viscous or air fluids? -
\for patients who cannot effectively position off their wound, have PUs in multiple turning
surfaces, or have PUs that fail to improve despite optimal comprehensive management
When should active support surface be considered? -
\when effective positioning is determined by an MD to be medically contraindicated
What is the difference between an active and reactive support surfaces/ -
\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? -
\when manual frequent repositioning is not possible
when are reactive support surfaces appropriate? -
\for pressure ulcer prevention
what is a benefit in low air loss feature and when is it contraindicated? -
\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? -
\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? -
\pulmonary diseases or unstable spine patients
what are some general guidelines for caring for patients on a support surface? -
\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? -
\for patients with acute respiratory conditions- requiring pulmonary hygience
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