Skin Assessment and Wounds

Question 1

Itching

Answer 1

Pruritus

Question 2

How to palpate temperature of skin

Answer 2

Back of hands

Question 3

Pale skin

Answer 3

Pallor

Question 4

Bluish tone, deoxygenated blood

Answer 4

Cyanosis

Question 5

Intense red color of skin

Answer 5

Erythema

Question 6

Yellowish tone, increased bilirubin

Answer 6

Jaundice

Question 7

Liver spots

Answer 7

Senile lentigines

Question 8

Dry skin

Answer 8

Xerosis

Question 9

Skin tags

Answer 9

Acrohordons

Question 10

No thickness, less than 1 cm (eg. freckle)

Answer 10

Macule

Question 11

No thickness, greater than 1 cm

Answer 11

Patch

Question 12

Palpable elevations < 1 cm (moles, warts)

Answer 12

Papule

Question 13

Papules combining > 1 cm

Answer 13

Plaque

Question 14

Solid, elevated mass larger than 1 cm (extends deeper into dermis)

Answer 14

Nodule

Question 15

Mass greater than a few cm in diameter (deeper into dermis)

Answer 15

Tumor

Question 16

Superficial, raised, transient (eg. mosquito bites)

Answer 16

Wheal

Question 17

Hives

Answer 17

Uticaria

Question 18

Blisters

Answer 18

Vesicle + bulla

Question 19

Fluid cavity in dermis/subq

Answer 19

Cyst

Question 20

ABCDE for mole inspection

Answer 20

Asymmetry, border, color, diameter, evolving

Question 21

Stage 1 pressure injury

Answer 21

Non-blanchable, intact skin

Question 22

Stage 2 pressure injury

Answer 22

Partial-thickness skin loss, exposed dermis

Question 23

Stage 3 pressure injury

Answer 23

Full thickness skin loss (down to subq)

Question 24

Stage 4 pressure injury

Answer 24

Full thickness skin loss, loss of tissue (down to bone or muscle)

Question 25

Unstageable

Answer 25

Black and can't see how deep, use ultrasound

Question 26

What does the braden scale measure?

Answer 26

Moisture, sensory, mobility, nutritional status, friction and shear

Question 27

Score of ___ or less represents high risk on the Braden scale

Answer 27

12

Question 28

BYR classification

Answer 28

Black - needs debridement Yellow - needs to be cleaned Red - needs to be protected

Question 29

Incision pops open

Answer 29

Dehiscence

Question 30

Incision pops open, contents spill out

Answer 30

Evisceration

Question 31

What to do in case of evisceration

Answer 31

Semi-fowlers position, cover in sterile saline, call code

Question 32

How to obtain a specimen of wound?

Answer 32

Swab red, healthy tissue

Question 33

How early do you premedicate before dressing change?

Answer 33

Pain

Question 34

Do dressing changes need to be sterile?

Answer 34

Yes, usually use normal saline (check the order!)

Question 35

Food that promotes wound healing

Answer 35

Protein, vitamin C, calcium, magnesium, zinc