Exam (elaborations)
Wound Exam Prep: Questions & Solutions (Solved)
Wound Exam Prep: Questions & Solutions (Solved)
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Wound Exam Prep: Questions & Solutions (Solved)Why is larval therapy used for chronic non-healing wounds? Right Ans -
nonhealing wounds, particularly those infected with (MRSA).
excretions/secretions from the blowfly Lucilia sericata (LS) exhibit potent,
thermally stable, protease-resistant antibacterial activity against in vitro
MRSA. The application of sterile LS larvae to an infected nonhealing wound
results in the removal of necrotic tissue, disinfection, rapid elimination of
infecting microorganisms, and enhancement of the healing process.
What happens when the inflammatory phase is prolonged? Right Ans -
Excessive and prolonged inflammation results in delayed healing and
increased scar formation
What are the 4 stages of wound healing? Right Ans - Hemostasis:
vasodilate, vasoconstrict, thrombus
Inflammation: phagocytosis, edema
Proliferation:
Maturation:
What happens during the inflammatory stage? Right Ans - damaged cells,
pathogens, and bacteria are removed from the wound area. white blood cells,
growth factors, nutrients and enzymes create the swelling, heat, pain and
redness. Neutrophils enter and peak between 24-48 hours. Macrophages
phagocytize debris and secrete growth factors. This phase lasts 4-6 days.
What happens during the proliferative stage? Right Ans - wound is rebuilt
with new tissue made up of collagen and extracellular matrix. wound
contracts as new tissues are built. In addition, new network of blood vessels
must be constructed so that the granulation tissue can be healthy and receive
sufficient oxygen and nutrients. Myofibroblasts cause the wound to contract
by gripping the wound edges and pulling them together using a mechanism
similar to that of smooth muscle cells. In healthy stages of wound healing,
granulation tissue is pink or red and uneven in texture.
What happens during remodeling or maturation phase? Right Ans -
collagen is remodeled from type III to type I and the wound fully closes. The
cells that had been used to repair the wound but which are no longer needed
are removed by apoptosis. When collagen is laid down during the proliferative
,phase, it is disorganized and the wound is thick. During the maturation phase,
collagen is aligned along tension lines and water is reabsorbed so the collagen
fibers can lie closer together and cross-link. Cross-linking of collagen reduces
scar thickness and also makes the skin area of the wound stronger. Generally,
remodeling begins about 21 days after an injury and can continue for a year or
more.
When does remodeling or maturation phase begin? Right Ans - 21 days
after injury and lasts up to 1 year
skin tear with no tissue loss Right Ans - category 1 on Payne-martin scale
skin tear with partial tissue loss Right Ans - category 2
skin tear with complete tissue loss Right Ans - category 3
What kind of product should be avoided in neonates d/t risk for toxicity?
Right Ans - skin sealant
patient has a full thickness ulcer. What are the protein requirements in grams
per kg? Right Ans - 1.25-1.5
what is the normal protein requirement? Right Ans - 0.8g/kg/24hr
Which stage do partial thickness wounds need to go through in order to heal?
Right Ans - epithelialisation
sensitization phase Right Ans - pt exposed to allergen, no reaction occurs.
Lasts 7-10 days.
elicitation phase Right Ans - occurs 48-72 hours after initial exposure.
allergic symptoms are produced. Vesicles or bullae turn to moist
desquamation.
Therapy that is beneficial in venous insufficiency ulcer Right Ans - larval
therapy
What is a Marjolin ulcer? Right Ans - when a chronic wound transforms
into a malignant one
, Which type of patient with a normal braden score, should still have his or her
heels elevated while in bed? Right Ans - diabetic patient with vascular
disease d/t risk of neuropathy and not being able to feel the pressure on the
heels
What does an abnormally high ABI (>1.3) indicate? Right Ans - calcification
of vessel wall, renders ABI test invalid
What treatment should be used on DM ulcers, when topical treatment has
failed? Right Ans - Regranex (becaplermin), which is a growth factor. May
raise risk of CA.
Which class of antibiotics are strongly associated with TEN (toxic epidermal
necrolysis) ? Right Ans - sulfonamides
Best treatment for nonhealing deep wounds? Right Ans - myocutaneous
flap
Grade 1 radiation dermatitis Right Ans - dry desquamation
Grade 2 radiation dermatitis Right Ans - erythema, moist dequamation,
mod edema
Grade 3 radiation dermatitis Right Ans - bleeding skin
What does an ABI of <0.5 indicate? Right Ans - severe ischemia. wound
healing is unlikely.
What is the amount of pressure that is to be exerted in the form of
compression therapy for LEVD? Right Ans - 30-40 mmHg at the ankle
Before applying compression stockings for treatment of LEVD, what should
the patient be assessed for? Right Ans - LEAD. The degree of arterial
disease will determine if compression stocking are contraindicated.
An ABI of _______________ demonstrates LEAD Right Ans - < or = 0.9
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