Exam (elaborations)
WOCN WOUND EXAM QUESTIONS AND ANSWERS
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WOCN WOUND EXAM QUESTIONS AND ANSWERS
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WOCN WOUNDEXAM QUESTIONS
AND ANSWERS
Goals of wound assessment - Answers -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? - Answers -Impairs leukocyte function
and negatively impacts collagen syntehesis, development of tensile strength, epithelial
resurfacing
What BG parameters should be maintained for wound healing? - Answers -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? - Answers -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 are the components of the dermis? - Answers -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? - Answers -Epidermis and parts of the
dermis
,What structures of the skin heal by scar formation? - Answers -Epidermal appendages,
Subcutaneous tissue/fascia/muscle
How is newborn skin different? - Answers -No scars up to 2nd trimester
30% thinner skin
Faster epidermal turnover
How is premature infant skin different? - Answers -Very thin, increased fluid loss,
functional stratum corneum at 30-32 weeks
What problems may arise with infant skin? - Answers -increased permeability, increased
MARSI risk, extravasation, diaper dermatitis
How do you mitigate MARSI risk in infants/elderly? - Answers -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? - Answers -Hyaluronidase
OR
phentolamine if vasoconstrictor
How do you mitigate diaper dermatitis? - Answers -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? - Answers -<30
weeks bathe with water only for 2 weeks
What are common issues with older skin? - Answers -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? - Answers -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? - Answers -mineral oil, petrolatum, lanolin,
ceramides
What do emollients do? - Answers -penetrates stratum corneum to increase lipid
component and soften
Layer on skin retards water loss to rehydrate
What is dimethicone? - Answers -Moisture barrier that retards water loss
What products are humectants? - Answers -glycerin, urea, propylene glycol, lachydrin,
alpha hydroxy acids
What do humectants do? - Answers -Water attractants - increase strateum corneum
water content
Who are humectants for? - Answers -Only for xerosis - not for macerated and
sometimes not for fragile skin
Which tissue layer is most susceptible to ischemic damage? - Answers -Muscle/fascia
layer
What is a macule - Answers -Flat spot of color change less than 0.5cm in diameter
What is a papule - Answers -Flat spot of color change greater than 0.5cm in diameter
What is a patch? - Answers -Raised spot of color change less than 0.5cm in diameter
What is a plaque? - Answers -Raised spot of color change greater than 0.5cm in
diameter
What is a blister? - Answers -Serous fluid trapped under skin less than 0.5cm in
diameter
What is a bulla? - Answers -Serous fluid trapped under skin greater than 0.5cm in
diameter
What is erythema? - Answers -Generalized redness
What is denudation? - Answers -Loss of superficial skin layer
What is crusting? - Answers -Scab of dried exudate of body fluid, blood, or pus
What is granulation? - Answers -proliferating tissue made of capillary networks,
collagen, and other connective substances
, What is slough? - Answers -Loose, stringy, nonviable tissue
What is eschar? - Answers -Thick, leathery, necrotic tissue
What is undermining? - Answers -Tissue destruction underlying intact skin along wound
margins
What is tunneling? - Answers -Area of tissue loss extending in any direction from edge
of wound
What is the normal water content of the skin? - Answers -10-15%
What is friction skin damage? - Answers -Mechanical disruption of surface layer of skin
Where does friction skin damage occur? - Answers -under restraints, blisters on heels,
surface damage on butt
What precedes friction skin loss? - Answers -Erythema, tenderness
Who commonly gets friction skin damage? - Answers -fragile/macerated skin
What happens with recurrent friction skin damage? - Answers -superficial skin loss
lichenification
How can you prevent friction skin damage? - Answers -soft bathing cloths, gentle skin
care, heel elevation (not just quilted boots), protective dressings, support surface with
low friction low shear cover
What topical treatments can be used for friction skin damage? - Answers -extremity -
nonadherent gauze or foam dressing + wrap
Silicone-based adhesive foam dressing
Strips of impregnated gauze (viscopaste)
Solid glycerin-based gel (if minimal exudate)
perineum - zinc oxide paste or impregnated gauze strips + optional nonadherent plastic
film for bacterial barrier
What effect do low zinc levels have on wound healing? - Answers -compromise
collagen synthesis/crosslinking
What amino acids are essential for collagen synthesis?
What is the effect of stress on these amino acids? - Answers -Glutamine and l-arginine
Not adequately produced during times of physiologic stress
What weight trend suggests nutritional deficiency? - Answers -Unplanned weight loss
=>2.5% of usual weight in 30 days or =>10% within 180 days
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