Integumentary / wound car

Question 1

What does TIME stand for in wound care

Answer 1

T - tissue - viable or non viable
I - infection and Inflammation
M - moisture nalance
E - epithelial growth around wound edges

Question 2

What should you assess in the skin surrounding a wound?

Answer 2

• stasis
• sensation
• suppleness
• staining
• stria
• sinister

Question 3

What dressings are appropriate for dry wounds?

Answer 3

• hydrogels
• hydrocolloids
• interactive wet dressings

Question 4

What dressings are appropriate for low- exudate dressings?

Answer 4

• semi permeable films
• hydrocolloids
• calcium alginates

Question 5

What dressings are appropriate for moderate- exudate wounds?

Answer 5

• calcium alginates
• hydrofibre
• foams

Question 6

What dressings are appropriate for high-exudate wounds?

Answer 6

• hydrofibre
• foam sheet/cavity
• super-absorbent dry dressing
• wound/ostomy bag
• topical negative-pressurr therapies

Question 7

What are the principles of ANTT?

Answer 7

• only sterile objects may be placed on the sterile field
• a sterile object only remains sterile when touched by another sterile object
• sterile objects/fields must always be kept in eyesight/above waist height
• sterile objects/fields are contaminated if exposed to air too long
• fluid flows in the direction of gravity
• sterile objects are contaminated by the wicking process if waterproof materials aren’t used
• the edges (2.5cm) of the sterile field are contaminated
• skin can not be sterilised
• honesty and alertness is always required

Question 8

What are the principles of ANTT?

Answer 8

• only sterile objects may be placed on the sterile field
• a sterile object only remains sterile when touched by another sterile object
• sterile objects/fields must always be kept in eyesight/above waist height
• sterile objects/fields are contaminated if exposed to air too long
• fluid flows in the direction of gravity
• sterile objects are contaminated by the wicking process if waterproof materials aren’t used
• the edges (2.5cm) of the sterile field are contaminated
• skin can not be sterilised
• honesty and alertness is always required

Question 9

What wound types are suitable for cleaning with tap water/ in the shower?

Answer 9

• surgical wounds healing by primary intention
• lacerations / grazes
• chronic wounds with no undermining or visible underlying structures

Question 10

What wound types are NOT suitable for washing with tap water and should instead be cleaned by normal saline?

Answer 10

• active bleeding
• undermined
• underlying structures in view
• if patient is severley immunocompromised
• if patient has venous access device