Skin Integrity and Wound Care

Question 1

___ is the word that describes clear, watery wound drainage.

Answer 1

Serous drainage. It is made up of the serous portion of the blood and the membranous lining of internal body cavities.

Latin word origin:
Serum = watery, milky fluid

Question 2

___ is the word that describes wound drainage that contains a large amount of red-blood cells. Bright-red drainage indicates fresh bleeding and dark-red drainage indicates older, clotted bleeding.

Answer 2

Sanguineous drainage

Latin word origin:
Sanguine = bloody

Question 3

___ is the word that describes drainage that is made up of a mixture of serum and red blood cells. It is a light pink color or appears blood tinged.

Answer 3

Serosanguineous drainage

Latin word origin:
Serum = watery, milky fluid
Sanguine = bloody

Question 4

___ is the word that describes drainage that is made up of white blood cells, dead tissue debris, and bacteria. It is thick and often has a musty odor. It may be white due to the white blood cells or a variety of colors (yellow, green, etc.) due to the bacteria.

Answer 4

Purulent drainage

Latin word origin:
Purulent = full of pus

Question 5

___ is when the layers of a surgical wound separate. It may be a partial, superficial, or a complete disruption of the surgical wound. It is a serious postoperative wound complication that is considered a medical emergency.

Answer 5

Dehiscense

Latin word origin:
Dehisce = gaping, spit open

Question 6

___ is when the abdominal wound completely separates, with protrusion of viscera (internal organs) through the incisional area. It is a medical emergency and is the most serious complication of dehiscence.

Answer 6

Evisceration

Latin word origin:
Ex = removal
Viscera = internal organs
(Removal of internal organs)

Question 7

___ ___ is a practice designed to reduce the number and transfer of pathogens; it is a synonym for clean technique. Procedures include performing hand hygiene and wearing gloves.

Answer 7

Medical asepsis

Latin word origin:
A = not
Sepsis = to rot
(To not rot)

Question 8

___ ___ is a practice to render and keep objects and areas free from microorganisms; it is a synonym for sterile technique. You use this technique when procedures when inserting an indwelling urinary catheter or inserting an IV catheter.

Answer 8

Surgical asepsis

Latin word origin:
A = not
Sepsis = to rot
(To not rot)

Question 9

The introduction of pathogens or infectious material into or on normally clean or sterile spaces.

Answer 9

Contamination

Question 10

A microorganism capable of producing a disease. Example: a bacteria or a virus.

Answer 10

Pathogen

Question 11

When a microorganism causes a disease process, this disease is called an ____.

Answer 11

Infection

Question 12

A process by which neutrophils, monocytes, and macrophages identify, engulf, and destroy microorganisms, other foreign antigens, and cell debris.

Answer 12

Phagocytosis

Greek word origin:
Phago = to eat
cyto = cell
osis = process
(the process of cells eating)

Question 13

____ is a protective response by the body to eliminate an invading pathogen and start tissue repair. This process is marked by increases in regional blood flow, immigration of white blood cells, and release of chemical toxins. Clinical hallmarks are redness, heat, swelling, pain, and loss of function of a body part.

Answer 13

Inflammation

Question 14

____ is the most commonly observed infection-causing agents in health care institutions. They either require oxygen (aerobic) or don’t (anaerobic). They are gram negative or gram positive. The type depending on the best drug of choice to treat the infection.

Answer 14

Bacteria

Question 15

____ is the smallest microorganism. Examples: HIV, Hep B, influenza. Some of these infections can be treated with medications. Some of these infections can be prevented with immunizations.

Answer 15

Virus

Question 16

____ precautions means washing your hands before / after each patient contact, cleaning non-disposable equipment before reuse with another patient, and wearing gloves when coming in contact with body fluids.

Answer 16

Standard

Question 17

____ precautions should be used with patients with body fluids like vomiting, diarrhea, bleeding, draining wounds, pressure ulcers, etc. Precautions include gloves, gowns, mask, glasses. Depending on infection (like c. diff), patient will be in a private room.

Answer 17

Contact

Question 18

____ precautions should be used when a patient has a microorganism that can travel three feet or less (like influenza). The patient should be their room with their door closed or wear a face mask out of their room. Nurse should use contact precautions.

Answer 18

Droplet

Question 19

____ precautions require special ventilation to prevent transmission. Nurse must wear a fitted N95 mask when in the patient’s negative pressure room. Example disease: tuberculosis.

Answer 19

Airborne

Question 20

____ field principles include:
The field is below the shoulder and above the waist. The edges of the field, anything draping down, and anything out of eyesight is considered contaminated. Do not reach over the field. Do not turn back to field.

Answer 20

Sterile

Question 21

Wound ____ is looking at the pain, appearance (size, shape, location), tissue (epithelial, granulation, slough, eschar), drainage (amount and color of exudation), and odor (after cleaning) of a wound.

Answer 21

Wound Assessment

Question 22

What type of wound requires a sterile dressing change?

Answer 22

A healing surgical wound. Pressure ulcers, skin tears, punctures, chronic wounds, etc. often just need clean technique.

Question 23

When do you wash your hands or use alcohol hand sanitizer?

Answer 23

Before and after touching a patient. Before and after donning and doffing gloves. After touching objects in patient’s environment. If your hands are soiled (ex: contact with body fluid) you need to wash your hands. Handwashing is also required before eating and after using the restroom. Alcohol does not kill C. diff.