Nursing 150 Exam 2 Prep with Questions and Answers

Nursing 150 Exam 2 Prep with Questions and Answers Pressure Ulcers ANSWER localized injury to the skin or underlying tissue, usually over a bony prominence, caused by pressure with shear or friction; unrelieved pressure reduces blood flow What patients are at risk for pressure ulcers? ANSWER chronically ill, aged, obesity, limited mobility, circulatory impairment, disabled, spinal cord injuries, poor overall nutrition, and incontinent Stage I Pressure Ulcer ANSWER Non-blanchable erythema Non-blanchable ANSWER press down or skin and it does not turn white Stage II Pressure Ulcer ANSWER partial thickness skin loss; could be a blister or have the top layer of skin removed (epidermis and some of the dermis) Stage III Pressure Ulcer ANSWER full thickness loss; epidermis and dermis; subcutaneous tissue may be exposed; may see yellow, gray, tan, or green "slimy" tissue in would called "slough" Stage IV Pressure Ulcer ANSWER full tissue loss; also including muscle, tendon, or bone; slough or eschar may be present; often includes undermining or tunneling Deep Tissue Injury ANSWER caused by underlying soft tissue damage from pressure/shear