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nsg 106 exam 2 > Skin Integrity and Wound Care > Flashcards

Skin Integrity and Wound Care Flashcards

1
Q

Alterations in skin integrity can have a tremendous impact on

A

physical and psychological well-being

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2
Q

the skin weight more than

A

6lbs

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3
Q

skin is involded in

A

thermoregulation

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4
Q

how is skin involved in thermoregulation

A

through its ability to dilate and constrict blood vessels, allowing for heat to be released or retained by the body

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5
Q

The skin is involved in the production of vitamin

A

D

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6
Q

Intact skin serves as an effective barrier to

A

environmental hazards

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7
Q

what is the skin’s normal PH?

A

acidic

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8
Q

why is the skin acidic?

A

provides a protective mechanism against pathogens

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9
Q

skin is composed of three main layers:

A

epidermis
dermis
subcutaneous

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10
Q

The epidermis can be subdivided into five more layers:

A

stratum corneum
stratum lucidum
stratum granulosum
stratum spinosum
stratum germinativum or Basale

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11
Q

The outermost of the epidermal layers is the

A

stratum corneum

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12
Q

The innermost layer of epidermal

A

stratum germinativum

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13
Q

the dermis is between

A

epidermis and subcutaneous layer

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14
Q

who is thicker dermis or empidermis

A

dermis

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15
Q

subcutaneous layer delivers

A

blood supply to the dermis, provides insulation, and has a cushioning effect

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16
Q

subcutaneous layer size depends on

A

body location and person’s weight, sex, and age.

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17
Q

Factors Affecting Skin Integrity

A

Wounds
Vascular disease
Diabetes
malnutrition
nonsteroidal antiinflammatory drugs
anticoagulants
excessive moisture
external forces
aging

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18
Q

diabetes also affect

A

the skins PH level

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19
Q

Medical adhesive-related skin injuries (MARSIs) occur when

A

superficial layers of skin are removed by medical adhesive

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20
Q

MARSI not only affects skin integrity but also causes

A

pain, increases risk of infection, potentially increases wound size, and delays healing

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21
Q

Wounds are also classified on the basis of

A

wound depth

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22
Q

superficial, or partial thickness, versus deep, or full thickness are

A

wound calssification

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23
Q

An open wound is

A

an actual break in the skin’s surface

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24
Q

closed wound is

A

bruising

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25
Q

superficial wound involves which skin layer

A

only the epidermis

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26
Q

partial-thickness wound involves which skin layer

A

epidermis and the dermis

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27
Q

full-thickness wound involves which skin layer

A

dermis to the subcutaneous layer and may extend farther, to the muscle, bone, or other underlying structures

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28
Q

wounds can be classified as

A

clean
clean contaminated
contaminated
infected
colonized

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29
Q

clean wound is

A

no infection and the risk of the development of an infection is low

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30
Q

clean contaminated wound is

A

no infection but high risk for infection

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31
Q

Contaminated wounds are a

A

result from a break in sterile technique during surgery higher

higher risk of infection than clean contaminated wound

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32
Q

An infected wound shows

A

clinical signs of infection,

including redness,

warmth,

increased drainage that may or may not be purulent (contain pus),

and has a bacterial count higher than 10^5 per gram

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33
Q

colonized wound happen when

A

one or more organisms are present on the surface of the wound when a swab culture is obtained,

but there is no overt sign of an infection in the tissue below the surface

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34
Q

acute wound is

A

A wound that progresses through the phases of wound healing in a rapid, uncomplicated manner

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35
Q

approximated wounds are

A

surgical incisions or traumatic wounds

they heal by primary intention

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36
Q

chronic wounds are

A

wounds that take longer time to heal

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37
Q

chronic wounds heal by

A

secondary intention

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38
Q

When a wound heals by secondary intention

A

new tissue must fill in from the bottom and sides of the wound until the wound bed is filled with new tissue

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39
Q

When a delay occurs between injury and closure, the wound healing is described as

A

tertiary intention.

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40
Q

Phases of Wound Healing

A

inflammatory phase
proliferative phase
maturation phase

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41
Q

inflammatory phase lasts

A

3 days

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42
Q

During the inflammatory phase, there is an increase in

A

pain,
redness,
warmth
swelling

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43
Q

at the end of inflammatory phase

A

wound bed is clean and ready to begin the actual repair process

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44
Q

proliferative phase of healing are

A

repair of the defect
filling in the wound bed with new tissue
resurfacing the wound with skin
granulation tissue formation

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45
Q

Proliferative Phase lasts

A

several weeks

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46
Q

The proliferative phase involves the development of

A

new blood vessels (angiogenesis)

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47
Q

The key cells in proliferative phase of wound healing are

A

fibroblasts

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48
Q

fibroblasts produce

A

growth factors, synthesize the collagen and proteins

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49
Q

Granulation tissue is

A

the new tissue created to fill the wound

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50
Q

Granulation tissue color is

A

beefy red

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51
Q

Finally, in proliferative phase, epithelial cells

A

proliferate and migrate laterally from the edges of the wound, across the moist granulation tissue, until the wound has been resurfaced

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52
Q

Factors Affecting Wound Healing

A

Oxygenation and Tissue Perfusion
Diabetes
Nutrition
Age
Infection

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53
Q

Dehiscence is

A

connection with surgical incisions, is the partial or complete separation of the tissue layers during the healing process

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54
Q

Evisceration is

A

total separation of the tissue layers, allowing the protrusion of visceral organs through the incision

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55
Q

coughing, vomiting, or straining puts additional stress on

A

healing tissue increasing the risk of dehiscence and evisceration

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56
Q

what indicated a healing wound

A

1-cm-wide ridge, or area of induration, can be palpated next to the incision line (healing ridge)

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57
Q

what does it mean if healing ridge is not felt

A

the wound is at increased risk for dehiscence and evisceration

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58
Q

A fistula is

A

abnormal connection between two internal organs or between an internal organ and, through the skin, the outside of the body

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59
Q

Fistulas usually are the result of

A

specific disease process, such as that in certain cancers and Crohn disease, treatment modalities (such as radiation), or any of the factors implicated in poor wound healing

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60
Q

Fistulas predispose the affected person to

A

fluid and electrolyte loss
nutritional deficits
alterations in skin integrity

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61
Q

Burns can be

A

superficial
Partial-thickness
Full-thickness

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62
Q

three evidence-based practice steps is key to pressure injury prevention

A
  • Determine each patient’s risk level through assessment with a reliable tool.
  • Reduce pressure on bony prominences using nursing interventions discussed in the Intervention and Evaluation section of this chapter.
  • Improve pressure tolerance of the patient’s skin by ensuring that the patient is well nourished, and that the skin is dry, intact, padded, and perfused
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63
Q

pressure injury more closely reflects

A

the underlying etiology of the wound

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64
Q

pressure injury is

A

damage to the skin in an area that may include soft-tissue damage and is usually found over bony prominences

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65
Q

The primary cause of pressure injuries is

A

pressure

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66
Q

The terms capillary closing pressure and critical closing pressure refer to

A

minimum pressure required to collapse a capillary

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67
Q

capillary closing pressure is difficult to achieve, it generally is accepted to be __ to __ mm hg

A

12 to 32 mm Hg

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68
Q

pain is felt when

A

tissue ischemia occurs

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69
Q

subcutaneous and muscle tissues are more susceptible to

A

pressure injury

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70
Q

low levels of pressure over long periods of time can

A

be as damaging to the skin and underlying tissue as high levels of pressure over a short period of time

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71
Q

Patients who have medical devices (such as oxygen tubing, a nasogastric [NG] tube, oxygen sensor probes, a continuous positive airway pressure [CPAP] mask, or trach ties) are at risk for

A

medical device–related pressure injuries

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72
Q

Nurses caring for patients with medical devices followed a protocol described by the acronym CARE which stands for

A
  • Choose a size-appropriate device
  • Assess the skin under the medical device
  • Reposition and Reapply the device, using padding if necessary
  • Empowered to evaluate daily discontinuation
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73
Q

Friction is

A

rubbing together of two surfaces

74
Q

The real danger of friction comes from the relationship between friction and gravity and the resultant phenomenon of

A

shear

75
Q

Sensory Loss or Immobility patients are at risk for

A

spinal cord injury or advanced multiple sclerosis

76
Q

Moisture-associated skin damage (MASD) is

A

general term for inflammation or skin erosion caused by prolonged exposure to a source of moisture

77
Q

Moisture-associated skin damage (MASD) is caused by

A

urine, stool, sweat, wound drainage, saliva, or mucus

78
Q

maceration iss

A

a condition in which excessive moisture causes a softening of the skin

79
Q

incontinence-associated dermatitis (IAD) is

A

skin irratation and breakdown

80
Q

deficiencies in vitamins A, C, and E and the minerals zinc and copper; and protein-calorie malnutrition, weakens

A

the ability of the tissue to withstand the forces of pressure and shear and to combat infectious agents

81
Q

Classification of Pressure Injuries

A

Stage 1 Pressure Injury: Nonblanchable Erythema of Intact Skin

Stage 2 Pressure Injury: Partial-Thickness Skin Loss With Exposed Dermis

Stage 3 Pressure Injury: Full-Thickness Skin Loss

Stage 4 Pressure Injury: Full-Thickness Skin and Tissue Loss

Unstageable Pressure Injury: Obscured Full-Thickness Skin and Tissue Loss

Deep-Tissue Pressure Injury: Persistent Nonblanchable Deep-Red, Maroon, or Purple Discoloration

82
Q

A stage 1 pressure injury is characterized by

A

intact, nonblistered skin with nonblanchable erythema, or persistent redness, in the area that has been exposed to pressure

83
Q

stage 2 pressure injury is

A

shallow and superficial, with a red-pink wound bed, Intact or ruptured blisters

84
Q

Undermining is

A

an area of tissue loss present under intact skin, usually along the edges of the wound, forming a “lip” around the wound

85
Q

A tunnel or sinus tract is

A

similar to an undermining but is a narrower passageway extending outward from the edge of the wound.

86
Q

Stage 4 Pressure Injury: Full-Thickness Skin and Tissue Loss involves exposure of

A

muscle, bone, or connective tissue

87
Q

in stage 4 pressure injury the bone is

A

palpable

88
Q

unstageable pressure injury is

A

full-thickness wound in which the amount of necrotic tissue, or eschar, in the wound bed makes it impossible to assess the depth of the wound or the involvement of underlying structures

89
Q

Suspected deep-tissue pressure injury injuries can

A

progress rapidly, exposing deeper layers of tissue even if treated quickly and appropriately

90
Q

Patients with disabilities that cause difficulty with mobility or sensory perception are at risk for

A

development of pressure injuries

91
Q

Obesity is a risk factor for

A

poor wound healing

92
Q

thorough skin assessment by the nurse should occur on every patient upon

A

admission,

every shift

with transfer of the patient to another unit facility

when the patient is discharged

93
Q

assessment of the skin includes

A

skin’s temperature, overall color and local variations in that color, presence of excessive moisture or dryness, odor, texture, turgor, and integrity

94
Q

General Skin Assessment Questions

A
  • How would you describe your overall skin condition?
  • Have you ever had problems with your skin? What kind of problems? Location? When?
  • Describe your usual skin care regimen.
  • Describe your usual diet. Have you experienced any recent unintended weight loss?
  • Are you ever incontinent of urine or stool?
  • Have you been told that you have diabetes or problems with your circulation?
  • Do you smoke?
  • Do you drink alcohol or use illicit drugs?
  • Have you noticed any numbness or tingling in your feet?
  • Has it seemed to take a long time for a wound to heal in the past?
95
Q

Focused Wound Assessment

A
  • How long has this wound been present? What do you think caused this wound? Have you ever had a wound like this before?
  • What are you doing for this wound at home? What are you using to clean the wound? What have you put on it?
  • Have you noticed any changes in the appearance of the wound or the skin around it?
  • How much wound drainage is there? Has the amount, color, or odor of the drainage changed? How often do you need to change the bandage at home?
  • Do you live alone? Do you have anyone who helps you at home?
  • Is the cost of caring for this wound difficult for you to manage?
96
Q

Two available tools for risk assessment of presure injurys are

A

Braden Scale
Norton Scale

97
Q

With both the Braden and Norton scales, the lower the score, the

A

greater the overall risk

98
Q

Braden and Norton scales
usually under or over predict risk assessment

A

over predict

99
Q

A focused wound assessment includes an evaluation of

A

location

size, and color

presence of drainage

condition of the wound edges

characteristics of the wound bed

patient’s response to the wound or wound treatment

100
Q

Undermining is often seen when

A

the wound is a result of pressure and shear forces

101
Q

During wound assessment, note whether drainage is present if it is note

A

amount of drainage
color
consistency
odor

102
Q

Serous drainage is

A

clear, watery fluid from plasma

103
Q

Serosanguineous drainage is

A

pink to pale red and contains a mix of serous fluid and red (bloody fluid)

104
Q

Sanguineous drainage is

A

bleeding and is bright red

105
Q

Increases in the amount of drainage and the presence of purulence or a foul odor can indicate

A

infection or the presence of a fistula

106
Q

Common organisms causing wound infections include

A

Staphylococcus aureus and Streptococcus pyogenes

107
Q

wounds heal from the ______ _______

A

edges inward

108
Q

A lack of epithelial tissue is an indication that

A

something is preventing the wound from healing

109
Q

The surrounding tissue is inspected for

A

maceration
signs of infection
tissue breakdown
the development of new wounds

110
Q

maceration looks

A

pale, soft, or wrinkled skin

111
Q

signs of infection of wound

A

redness, warmth, induration

112
Q

Wounds are usually classified as what color

A

Red Yellow Black (RYB)

113
Q

The wound bed should be

A

beefy red and shiny or moist in appearance.

114
Q

Yellow wound bed is

A

a type of slough tissue

115
Q

necrotic tissue looks

A

black

116
Q

The wound will need debridement if

A

yellow and/or black tissue are present

117
Q

inflammation and infection in the wound, can cause

A

intense pain

118
Q

Treatments used in the care of wounds can be additional sources of

A

pain and anxiety

119
Q

what is used to asses open wound

A

Wound Characteristic Instrument

120
Q

what are the two pressure injuries assessment tool

A

Pressure Sore Status Tool (PSST) and the Pressure Ulcer Scale for Healing (PUSH)

121
Q

The PSST assigns a numerical score based on __ wound attributes

A

13

122
Q

the PUSH tool’s score is based on

A

wound size, wound bed tissue type, and fluid amount

123
Q

Implementation of consistent use of the Braden Scale along with prevention strategies resulted in a __% reduction in pressure injuries

A

25%

124
Q

how often should you turn a patient

A

every 2 hours

125
Q

The head of the bed of an at-risk patient should be elevated no more than __ degrees

A

30

126
Q

When side-lying, patients should be positioned at __ degrees

A

30

127
Q

The skin over the heels is

A

at a particularly high risk for breakdown

128
Q

All support surfaces work to reduce pressure by

A

redistributing or “spreading out” the body’s weight over a greater surface area

129
Q

Wound care depends on

A

the type of wound
amount of drainage
presence of infection
resources available

130
Q

antiseptic solutions are

A

harmful to the cells needed for wound healing

131
Q

what is the good temperature that is good for irrigation solutions

A

room temperature or warmer

132
Q

Debridement is

A

the removal of necrotic tissue/ devitalized tissue

133
Q

The removal of necrotic tissue is

A

necessary for wound healing and for the wound to be assessed adequately for viable tissue and staged in the case of pressure injuries

134
Q

debridement is not usually recommended if

A

necrotic tissue is dry and stable, with no evidence of infection

135
Q

Sharp debridement is

A

the use of a sharp instrument (scalpel, curette, or scissors)

136
Q

Caution is used in patients with bleeding disorders, and the procedure can be painful. Thus ________ __ ____________

A

premedication is recomended

137
Q

Mechanical debridement is

A

nonselective form of debridement in that it not only removes the necrotic tissue but also can remove or disturb exposed viable tissue that may be in the wound

138
Q

The main forms of mechanical debridement are

A

/damp-to-dry dressings and whirlpools

139
Q

Enzymatic debridement is

A

achieved through the application of topical agents containing enzymes that work by breaking down the fibrin, collagen, or elastin present in devitalized tissue

140
Q

Enzymatic debridement is used for

A

nonviable tissue

141
Q

Occlusive dressings are used for

A

autolytic debridement

142
Q

Autolytic debridement is based on

A

the principle that wounds have an innate ability to clean themselves of debris and necrotic tissue through the action of the body’s own enzymes and phagocytic cells

143
Q

Biologic debridement involves

A

the use of sterile, medicinal larvae from green bottle flies (maggots), which secrete proteolytic enzymes that break down necrotic tissue, digest bacteria, and stimulate the formation of granulation tissue

144
Q

No single dressing type is ideal for all wounds

A. TRUE
B. FALSE

A

A. TRUE

145
Q

Gauze is used for

A

Packing in all types of wounds.

146
Q

Transparent film, adhesive-backed polyurethane is used for

A

Wounds that have minimal or no drainage

147
Q

Hydrocolloids, occlusive, adhesive dressings composed of gelling agents and carboxymethyl-cellulose is used for

A

clean, uninfected wounds with small to moderate amounts of drainage.

148
Q

Foams is used for

A

Wounds producing moderate to heavy amounts of exudates.

149
Q

Alginates, made from brown seaweed fiber is used for

A

Highly exudative wounds.
Use on bleeding wounds

150
Q

Gels are used for

A

Wounds that have minimal or no drainage

151
Q

The placement of drains in or around surgical sites is thought to reduce the chance of

A

infection by preventing excess blood, serum, or pus from collecting in the surgical area

152
Q

with a drain assess for

A

The amount, color, consistency, and odor

153
Q

The skin around the drain is assessed for

A

signs of infection
damage from the drainage

154
Q

Drainage from the small intestine, gallbladder, stomach, and pancreas is

A

damaging to the skin

155
Q

Effective strategies to prevent chemical damage to the skin from drainage include

A

the use of barrier ointments designed for incontinence

156
Q

Closed drainage systems include

A

Jackson-Pratt (JP) drains and Hemovac drains

157
Q

Jackson-Pratt (JP) drains and Hemovac drains, are

A

soft drains attached to a bulblike (JP) or springlike (Hemovac) suction device

158
Q

Closed drainage systems allow for

A

more accurate assessment of the drainage and prevent bacteria on the dressing

158
Q

Penrose drain is

A

an open drain that is a flexible piece of tubing, usually is not sutured into place

158
Q

Negative-Pressure Wound Therapy or vacuum-assisted closure (VAC) is for

A

remove excess wound fluid, stabilize the wound edges, and stimulate granulation tissue

158
Q

Negative-Pressure Wound Therapy or vacuum-assisted closure (VAC) reduce

A

bacteria

158
Q

The combination dressing usually is changed every

A

3 days but can be changed more frequently, depending on the wound assessment

159
Q

Suture and Staple Care used to

A

bring the edges of a wound together in order to speed wound healing and reduce scar formation

159
Q

The combination dressing usually is used for

A

acute and chronic wounds

160
Q

The timing of suture or staple removal

A

7 to 14 days after insertion

161
Q

Bandages and Binders are

A

placed over wound dressings to secure a dressing or splint

162
Q

When a bandage is applied to an extremity, the nurse assesses ___ ____ __ __ __________ within 30 minutes of application

A

the five Ps of circulation

163
Q

what are the 5 P’s of circulation?

A

pain
pallor
pulselessness
paresthesia
paralysis

164
Q

The therapeutic application of heat or cold requires _______ order

A

doctor order

165
Q

hydrocolloid dressings are

A

dressing that forms a gel

166
Q

if an area becomes lighter on fingertip touch it indicated

A

blanching hyperemia

167
Q

serous fluid looks

A

clear and watery

168
Q

when there is less drainage than expacted when using collecting device it means

A

there is a blockage

169
Q

stuture are

A

tied and knotted individually

170
Q

if patent has lower limb injjury you should

A

elevate the patient legs for 30 minutes

171
Q

gnasc tool is used to assess

A

stage 1 pressue injury in patient with dark skin tone

172
Q

bates-jensen tool is used to assess

A

wund status

173
Q

stab wounds are what type of injury

A

open, full thinkness

174
Q

purulent drainage is usually ______ and indicates ________ infection

A

think, bacterial

175
Q
A

nsg 106 exam 2 (10 decks)

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