Exam (elaborations)
WOCN Wound Exam|444 Questions and Answers|100% Verified
WOCN Wound Exam|444 Questions and Answers|100% Verified
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WOCN Wound Exam|444Questions and Answers|100%
Verified
Goals of wound assessment - -1. Determine etiologic factors
2. Assess systemic factors/comorbidities
3. Assess wound to determine phase of healing
4. Determine goals of topical therapy
-Why does hyperglycemia affect wound healing? - -Impairs leukocyte
function and negatively impacts collagen syntehesis, development of tensile
strength, epithelial resurfacing
-What BG parameters should be maintained for wound healing? - -BG <180
for leukocyte function; <140 for healing
A1C <7 for most, <8 if hx of severe hypoglycemia, advanced comorbidities,
limited life expectancy
-Why is nutrition relevant to wound healing? - -Muscle or SubQ wasting
increases risk of pressure/shear damage
malnourished pt unable to synthesize and cross-link collagen normally
protein deficiency increases risk of infection
-What effect do low zinc levels have on wound healing? - -compromise
collagen synthesis/crosslinking
-What amino acids are essential for collagen synthesis?
What is the effect of stress on these amino acids? - -Glutamine and l-
arginine
Not adequately produced during times of physiologic stress
-What weight trend suggests nutritional deficiency? - -Unplanned weight
loss =>2.5% of usual weight in 30 days or =>10% within 180 days
BMI <18.5
-What serum albumin level indicates malnutrition? - -<3.5 g/dl
-What serum transferrin level indicates malnutrition? - -<100mg/dl
-What serum prealbumin level indicates malnutrition? - -<19.5
-What total lymphocyte count level indicates malnutrition? - -<1500
, -What are s/s of nutritional deficits? - -skin rashes, cracks in mucous
membranes, edema, muscle and subQ tissue wasting, nonhealing wounds,
dry/pluckable hair, dry flaky itchy skin
-What is the suggested caloric intake? - -30-35 cal/kg body weight
-What is the suggested protein intake? - -1.25-1.5 g/kg body weight
-What is the suggested fluid intake? - -30ml per kg (unless fluid restriction
indicated)
-How do you assess perfusion/oxygenation? - -capillary refill, pulses,
presence/absence of edema, TcpO2 levels (at least 40), color of wound bed
(bright pink/red), ABI for lower extremity ulcers, systolic bp/episodes of
hypotension, vasopressor administration
-How do you assess for immunosuppression? - -Comorbidities/therapies
such as HIV, steroid tehrapy in doses >30mg/day for >30 days, and/or
chemo resulting in neutropenia; high dose NSAIDs
-What comorbidities compromise wound healing? - -renal failure, liver
failure, multisystem trauma, smoking, advanced age
-What are the layers of the skin - -Epidermis
Basement Membrane Zone
Dermis
Subcutaneous Tissue
Muscle/Fascia/Bone
-What are the layers of the epidermis? - -Stratum corneum - keratinocytes
filled with keratin
Stratum lucidum - only in palms/soles, thick areas
Stratum granulosum - odland bodies secrete ceramides, lipophilic
Stratum spinosum - desmosomes (cell to cell junctions)
Stratum germinativum - dermal-epidermal junction
-What is the Basement Membrane Zone? - -Dermal-epidermal junction
-What are the components of the dermis? - -Papillary dermis: papillae
interlock with rete ridges, capillary loops, sensitive to point pressure
Reticular dermis: mostly type 1 collagen, vasculars, and lymphatics
-What structures of the skin can regenerate? - -Epidermis and parts of the
dermis
, -What structures of the skin heal by scar formation? - -Epidermal
appendages, Subcutaneous tissue/fascia/muscle
-How is newborn skin different? - -No scars up to 2nd trimester
30% thinner skin
Faster epidermal turnover
-How is premature infant skin different? - -Very thin, increased fluid loss,
functional stratum corneum at 30-32 weeks
-What problems may arise with infant skin? - -increased permeability,
increased MARSI risk, extravasation, diaper dermatitis
-How do you mitigate MARSI risk in infants/elderly? - -avoid tape or use
hydrocolloid base or silicone adhesive, no alcohol removers only mineral oil,
petroleum, silicone (preferred), and citrus)
-How do you mitigate extravasation in an infant? - -Hyaluronidase
OR
phentolamine if vasoconstrictor
-How do you mitigate diaper dermatitis? - -Higher pH
Use petroleum base for mild erythema and zinc oxide for denuded skin
sever denudation - carboxymethylcellulose/petrolatum/zinc oxide (Ilex)
-What bathing considerations must you take for premature infants? - -<30
weeks bathe with water only for 2 weeks
-What are common issues with older skin? - -Thinner, collagen shrinks and
causes wrinkles
Rete ridges and dermal papillae flatten - increased risk for tears/stripping
Reduced sebaceous and sweat glands - dry skin
Erratic/decreased melanin production
Decreased sensation - increased trauma risk
Loss of SubQ tissue - increased shear and decreased insulation
Increased malignant lesions - refer to derm
Reduced blood flow, increased epidermal turnover - slow healing
Increased senescense
Maybe increased inflammatory mediators, decreased inhibitors
Increased capillary fragility (bruises)
-What strategies keep skin healthy? - -pH balanced cleaners - no alkaline
soaps
Superfatted nonalkaline soaps for dry skin
CHG reduces pathogens and sepsis
Individualize bathing schedule
, Apply lubricants, oils, creams to clean slightly damp skin
-What types of products are emollients? - -mineral oil, petrolatum, lanolin,
ceramides
-What do emollients do? - -penetrates stratum corneum to increase lipid
component and soften
Layer on skin retards water loss to rehydrate
-What is dimethicone? - -Moisture barrier that retards water loss
-What products are humectants? - -glycerin, urea, propylene glycol,
lachydrin, alpha hydroxy acids
-What do humectants do? - -Water attractants - increase strateum corneum
water content
-Who are humectants for? - -Only for xerosis - not for macerated and
sometimes not for fragile skin
-Which tissue layer is most susceptible to ischemic damage? -
-Muscle/fascia layer
-What is a macule - -Flat spot of color change less than 0.5cm in diameter
-What is a papule - -Flat spot of color change greater than 0.5cm in
diameter
-What is a patch? - -Raised spot of color change less than 0.5cm in diameter
-What is a plaque? - -Raised spot of color change greater than 0.5cm in
diameter
-What is a blister? - -Serous fluid trapped under skin less than 0.5cm in
diameter
-What is a bulla? - -Serous fluid trapped under skin greater than 0.5cm in
diameter
-What is erythema? - -Generalized redness
-What is denudation? - -Loss of superficial skin layer
-What is crusting? - -Scab of dried exudate of body fluid, blood, or pus
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