Wound stuvia 2024 - Study guides, Class notes & Summaries

53 yo F hit by car. Unresponsive w/ deformity to the left femur and pelvic instability. Diminished lung sounds on L side. You should? Immobilize long backboard 28 yo M, blunt trauma to R anterior chest. Pale, cool, diaphoretic and responsive to verbal. R 38 and shallow with paradoxical movement. What should you do? 02 with positive pressure ventilations What is the most likely cause of periorbital echymosis? Basilar skull fracture 30 yo M shot in mid thigh. Bleeding continues after ...

what are 6 risk factor components of Braden Scale for pressure ulcer? - ANSWERsensory perception, moisture, mobility, activity, nutrition, and shear/friction What is the name of the organization that developed the pressure ulcer staging? - ANSWERNPUAP (national pressure ulcer advisory panel) pathological effect of excessive pressure on soft tissue can be attributed by 3 factors? what are they? - ANSWERtissue tolerance, duration of pressure, and intensity of pressure what are the extrins...

What is an oral side effect of Prozac? - ANSWERxerostomia How do steroids effect wound healing? - ANSWERcauses delayed wound healing What should be done with a patient with a previous history of high blood pressure and comes in for their appointment with reading of 160/116? - ANSWERrefer the patient to their physician immediately Premedication regimine - ANSWER2g Amoxicillin 600 mg Clindamycin Patient comes in for appointment who needs premed, and they took 300 mg 1 hour prior to th...

what is force acting tangentially on an area of an object? - ANSWERshear force skin remains stationary and the tissues below the skin (fat/muscle) are deformed or distorted is an example of: ____________ - ANSWERshear force what do shear stresses on a tissue do? - ANSWERdecrease the ability to withstand normal loads -tissue subjected to shear force can suffer ischemia at only HALF the pressure than without shear the resistance to motion in a parallel direction relative to the common bo...

Venous Insufficiency History - ANSWER-Advanced Age -CHF -Lymphedema -Obesity -Orthopedic Procedures -Pain reduced by elevation -Pregnancy -Previous DVT with Phlebitis -Pulmonary Embolus -Reduced mobility -Sedentary Lifestyle -Traumatic Injury -Vascular Ulcers -Work History Venous Insufficiency Location - ANSWERMalleolus - medial Medial aspect of leg superior to medial malleolus Venous Insufficiency Assessment of Wound - ANSWERBase: ruddy red; yellow adherent or loose slough; ...

In assessing a surgical wound for healing, the WOC nurse suspects impending fistula development. Which of the following would be a definitive indicator? - ANSWERPassage of GI secretions or urine into an open wound bed. A patient with a chronic wound demonstrates stalled healing. The list of meds include an anti-hypertensive, a corticosteroid, and a mutlivitamin. Which of the following would best address this problem? - ANSWERApplication of vitamin A to the wound bed. What is the best metho...

TEWL - ANSWERTransepidermal water loss What is the most common type of skin cancer? - ANSWERbasal cell carcinoma (BCC) How does basal cell carcinoma present? - ANSWER"pearl like" translucent papule with central ulceration What is the second most common type of skin cancer? - ANSWERSquamous cell carcinoma (SCC) How does squamous cell carcinoma present? - ANSWEREnlarging keratotic papule ABCDEs of melanoma - ANSWERAsymmetric, border irregular, color variance, diameter >0.6 cm, ...

The nurse assesses a patient's surgical wound on the first postoperative day and notes redness and warmth around the incision. Which action by the nurse is most appropriate? a. Obtain wound cultures. b. Document the assessment. c. Notify the health care provider. d. Assess the wound every 2 hours. - ANSWERb. Document the assessment. The incisional redness and warmth are indicators of the normal initial (inflammatory) stage of wound healing by primary intention. The nurse should documen...

The new vegetative organisms in the tissues of the wound, especially in muscles, release exotoxins causing the fermentation of the muscle sugar with such vigor that the presence of accumulated gas tears the tissue apart - ANSWERgas gangrene Aerobes in the wound facilitate the germination of clostridial spores and their vegetative growth by reducing the oxygen in the wound. - ANSWERgas gangrene Marked by pus production - ANSWERpyogenic Pyogenic Cocci (5) - ANSWERStaphylococcus Aureus, St...

Steps to heal by Secondary Intention - ANSWERFormation of granulation tissue, contraction of the wound bed edges, and epithelialization Partial thickness repair - ANSWERInflammatory response, epithelial proliferation and migration, epidermal reestablishment and differentiation What characterizes a chronic wound healing environment - ANSWERLow levels of growth factors and receptor sites. They are needed to move cells out of the inflammatory phase and into the proliferative/Rebuilding Phase ...