Exam (elaborations)
Wound Assessment & Pressure Ulcers: Q’s And A’s
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Wound Assessment & Pressure Ulcers: Q’s And A’s
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Wound Assessment & Pressure Ulcers: Q’s And A’sSlough Right Ans - yellow or white..strings or think clumps
Granulation Right Ans - tissue-pink or beefy red tissue, shiny, moist,
granular appearance
Epithelial tissue Right Ans - new pink shiny tissue grows in from the edges
Necrotic tissue (eschar) Right Ans - black, brown, or tan firmly adheres to
the wound bed
National Pressure Ulcer Advisory Panel (NPUAP) Right Ans - pressure
ulcer staging system, superficial deep tissue injury, Stage I- Stage IV.
Wagner Ulcer Grade Classification Right Ans - 0-5 system for neuropathic,
ischemic, arterial ulcers (diabetic), [not for pressure, vascular, or venous]
Marion Lab (color wound classification) Right Ans - red, yellow, black
NPUAP Stage 1 Right Ans - non-blanchable erythema
NPUAP Stage 2 Right Ans - superficial ulcer, partial thickness
NPUAP Stage 3 Right Ans - deep ulcer, full thinkness, subcutaneous or to
fascia
NPUAP Stage 4 Right Ans - deep ulcer with necrosis, into muscle, tendon,
bone.
Wagner Scale 0 Right Ans - no open lesion, may have cellulites
Wagner Scale 1 Right Ans - superficial ulcer
Wagner Scale 2 Right Ans - deep ulcer to tendon, capsule, bone
Wagner Scale 3 Right Ans - deep ulcer with abscess, osteomyelitis
Wagner Scale 4 Right Ans - localized gangrene
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