Wound Care

Question 1

Arterial wound location:

Answer 1

Toes, feet, lower 1/3 leg

Question 2

Venous wound location:

Answer 2

Medial malleolus

Question 3

Neuropathic ulcer location:

Answer 3

Plantar foot

Question 4

Arterial wound details:

Answer 4

Arterial pulse decreases
Trophic changes
Most painful

Question 5

Venous wound details:

Answer 5

Edema increases

Question 6

Stage 1:

Answer 6

Non-blanchable erythema

Epidermis and dermis intact

Question 7

Stage 2:

Answer 7

Complete loss of epidermis, partial loss of dermis

Question 8

Stage 3:

Answer 8

Complete loss of dermis & epidermis, extends to but not through the fascia

Question 9

Stage 4:

Answer 9

Complete loss of dermis, epidermis, and destruction of fascia

Question 10

Arterial wound pain:

Answer 10

Intermittent claudication; pain with activity & elevation

Question 11

Arterial wound presentation:

Answer 11

Trophic changes: thin, shiny skin with absence of hair, cold

Question 12

Venous wound pain:

Answer 12

Dull, aching

Question 13

Venous wound presentation:

Answer 13

Superficial, irregular in shape, macerated edges with drainage, hemosiderin stain

Question 14

Neuropathic ulcer pain:

Answer 14

None

Question 15

Neuropathic ulcer presentation:

Answer 15

Deep and infected, callus, tunneling & undermining

Question 16

Ideal wound dressing:

Answer 16

1 Moist for collagen production
2 Allows gas exchange
3 Impermeable to microorganisms
4 non-adherent

Question 17

Primary polycythemia (p. vera)

Answer 17

Excessive production of ALL cells secondary to improper signal to the bone marrow which over produces

Question 18

Secondary polycythemia

Answer 18

Decreased oxygen causes an increase in RBCs

Question 19

Relative polycythemia

Answer 19

Appears that there are more RBCs in the hematocrit, but actually plasma is low

Question 20

Hemoglobin level for anemia

Answer 20

< 12% g/dL for females

< 14% g/dL for males

Question 21

Hematocrit level for anemia

Answer 21

< 37% for females

< 41% for males

Question 22

Hemolytic anemia

Answer 22

Red blood cells are destroyed and removed from the bloodstream before their normal lifespan is over

Question 23

Post hemorrhagic anemia

Answer 23

Acute blood loss results in decreased RBCs

Question 24

Aplastic anemia

Answer 24

The bone marrow does not make enough new blood cells

Question 25

Iron, B12, & folic acid deficiency anemia

Answer 25

A decrease in any of these nutrients causes abnormal production of RBCs that do not function properly

Question 26

Importance of albumin?

Answer 26

Holds H20 in the vessels so is needed to maintain blood pressure

Question 27

Febrile reaction

Answer 27

Occurs during transfusion or up to 24 hrs post

Question 28

Allergic reaction

Answer 28

Occurs within minutes of transfusion

Question 29

Septic reaction

Answer 29

Occurs within 30 minutes post

Question 30

Acute hemolytic reaction

Answer 30

Occurs within minutes to hours post

Question 31

Anaphylactic reaction

Answer 31

Occurs within a few seconds

Question 32

Thrombocytosis

Answer 32

Increased platelets; increased blood viscosity so blood flow is lessened. May form clots easily

Question 33

Thrombocytopenia

Answer 33

Decreased platelets; increased risk of bleeding since there are decreased platelets to clot

Question 34

Disseminated intravascular coagulation

Answer 34

Overactivity of the coagulation cascade; excessive clotting & hemorrhage occur simultaneously

Question 35

Pernicious anemia

Answer 35

Absence of intrinsic factor to bind Vit B12; RBC cannot form properly making the pt weak and tired until a shot is given

Question 36

Thalassemia

Answer 36

Chronic hemolytic anemia; fragile & thin erythrocytes

Question 37

Sickle cell anemia

Answer 37

Abnormal hemoglobin (lack of O2 carrying capacity) present that causes sickling of the cells; chronic hemolytic anemia occurs

Question 38

Hemophilia

Answer 38

Cannot make enough factor 8 in the liver, which is vital in making a clot