Chapter 5 - Integumentary

Question 1

What ointments are used immediately following a burn injury?

Answer 1

• Bacitracin
• Polymyxin B
• Neomycin

Question 2

What are the contraindications for silver sulfadiazine?

Answer 2

• at term pregnancy
• on infants less than 2 months
• those with sulfa drug allergy

Question 3

What are the contraindications for sulfamylon?

Answer 3

penetrates through eschar; avoid with sulfa drug allergies

Question 4

What are examples of temporary grafts?

Answer 4

• allograft

- xenograft

Question 5

What are examples of permanent grafts?

Answer 5

• biosynthetics
• cultured skin
• autograft (split-thickness or full-thickness)

Question 6

Z-plasty

Answer 6

surgical excision of scar contracture

Question 7

What factors are associated with healing of burn injuries?

Answer 7

• nutrition
• infection
• associated illnesses
• cytotoxic treatments

Question 8

What are the examples of wound debridement?

Answer 8

• autolytic
• surgical/sharp debridement
• enzymatic
• mechanical

Question 9

What is the most common position for contracture of the hand?

Answer 9

claw hand (intrinsic minus position); stress wrist extension to 15˚, MCP flexion (70˚), PIP, and DIP extension

Question 10

What is the most common position for contracture of the foot?

Answer 10

the deformity is plantar flexion; ankle stress DF with foot-ankle in neutral with splint or plastic ankle-foot orthosis..

Question 11

Stage I pressure injury

Answer 11

nonblanchable erythema of intact skin. May include changes in skin temperature (warm or cool), tissue consistency (firm or boggy), and/or sensation (pain, itching)

Question 12

Stage 2 pressure injury

Answer 12

partial-thickness skin loss: involves the epidermis, dermis, or both. The ulcer is superficial. Presents clinically as an abrasion, blister, or shallow crater.

Question 13

Stage 3 pressure injury

Answer 13

full-thickness skin loss: involves damage to or necrosis of subcutaneous tissue. May extend down to, but not through, underlying fascia. Presents clinically as a deep crater.

Question 14

Stage 4 pressure injury

Answer 14

Full-thickness skin loss: involves extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures. Undermining and sinus tracts may be present.

Question 15

Unstageable

Answer 15

tissue depth is obscured due to slough or eschar and extent of damage cannot be determined

Question 16

Deep Tissue Injury

Answer 16

discolored area of tissue (e.g. bruise) that is not reversible and will likely progress to a full-thickness injury

Question 17

How often should wounds be cleansed?

Answer 17

At the initial evaluation and with each dressing change

Question 18

It is recommended that most wounds be cleaned with:

Answer 18

Normal saline: 0.9% NaCl solution

Question 19

Why should povidone-iodine solution, sodium hypochlorite, Dakin’s solution, acetic acid solution, and hydrogen peroxide not be used in wound care?

Answer 19

They are toxic to healing granulation tissues

Question 20

What are the mechanical delivery systems from most gentle to harshest?

Answer 20

• minimal mechanical force: cleansing with gauze, cloth, or sponge
• irrigation: recommended pressures range from 4-15 psi
• whirlpool therapy

Question 21

What are the different types of irrigation?

Answer 21

• squeeze bottle, bulb syringe, or piston syringe
• pulsed lavage: delivery of irrigating solution under pressure that is produced by an electrically powered device. Pulsed lavage with vacuum assists in removal of wound debris.

Question 22

An ideal wound dressing does what?

Answer 22

• maintains a moist environment
• allows gas exchange
• controls exudate
• insulates and prevents contamination
• is non-traumatic to the wound

Question 23

What is normal albumin? Why is that important for wound healing?

Answer 23

3.5 - 5.5 mg/dl; less than 3.5 mg/dl is indicative of malnutrition and poor wound healing

Question 24

T/F: Individuals with wounds require 5 liters or more water per day

Answer 24

False. Individuals require 3 or more liters per day; patients on air-fluidized beds will require greater hydration (40-60 ml/kg per day)