Wounds

Question 1

Risk factors for wound

Answer 1

Bed bound
Low/high body weight adds pressure
Bony prominences
Poor w/c positioning
Decreased sensation
Decreased mobility

Question 2

Common areas for wounds

Answer 2

Heels, sacral, low back and skin folds

Question 3

Pressure/bed sore

Answer 3

Prolonged pressure on skin, bony prominence

Question 4

Stages of pressure ulcer: stage 1

Answer 4

Skin looks red/pink, darker skin shiny might feel warmer or cooler

Question 5

Stages of pressure ulcer: stage 2

Answer 5

Wound with pink red base, may see skin loss, blisters, changes in skin

Question 6

Stages of pressure ulcer: stage 3

Answer 6

Into the hypodermis

Question 7

Stages of pressure ulcer: stage 4

Answer 7

Penetrate all 3 layers, exposing muscle, tendon, bone

Question 8

Non-blanchable redness

Answer 8

Trigger pressure ulcer plan secondary to increase likelihood of new pressure ulcers, consent obtained for skin check

Question 9

Skin assessment: Best Shot

Answer 9

Buttocks
Elbows/ears
Sacrum
Trochanters

Spine/shoulder
Heels
Occipital
Toes

Question 10

Norton Pressure Score Risk Assessment

Answer 10

Scaled scoring system 1-4
Physical condition, mental condition, activity, mobility, incontinence
>18 low risk
14-18 medium risk
10-14 high risk
<10 very high risk

Question 11

Braden Scale

Answer 11

Used for predicting pressure sore risk
Sensory perception, moisture, activity, mobility, nutrition, friction/shear

Less than or equal to 9 severe
10-12 high risk
13-14 moderate risk
14-18 mild

Question 12

Adverse events

Answer 12

Occur secondary to error or failure to apply accepted strategy for prevention 25% SNF, 29% SNF+IRF, 25% of that t/f to hospital

Question 13

Pressure ulcer intervention

Answer 13

Strong evidence in mattress/cushion choice, positioning education, family
Education, regular screening, patient education

Fall prevention, infection mgmt, pressure injury prevention, feeding/swallowing techniques, med mgmt, self mgmt of conditions

Alternating air mattresses= decreased pressure ulcer, mod evidence

More than 3” foam cushoon f

Question 14

Multi-component pressure ulcer prevention programs

Answer 14

Standardized positioning plan
Algorithm for mattress selection in set up
Agency for healthcare research and quality guidelines
Intensive training
Interdisciplinary leadership team, protocol to reduce pressure ulcer
Eval support surfaces
Skin/wound producs
Simplification of clinical process (EMR, simplified wound care protocol)

Saves $24,000 to facility

Question 15

Medline Pressure Ulcer prevention program

Answer 15

Caregiver education
Provider training in best program
New skin care products
Standardized algorithm
Specialized wound care team

Mod evidence for facility wide oressurew reduction program

Question 16

Wounds

Answer 16

Abrasions, punctures, bites, surgical wound, diabetic ulcer, pressure injuries, traumatic wounds, venous stasis ulcers, arterial ulcers

Question 17

Diabetes

Answer 17

Group of conditions that impact bod’s ability to process/use glucose

Question 18

DMII

Answer 18

Most common develops in 40s
Body doesnt produce enough insulin or resists it

Question 19

DMI

Answer 19

Lifelong, comorbidities depend on glucose control

Sx: frequent urination, vision changes, poor wound healing, irritability, mood changes, peripheral neuropathy

Chronic condition where pancrease produces little or no insulin

Question 20

Interventions for diabetes

Answer 20

Llifestyle mgmt techniques
Healthy eating
Being active
Monitoring glucose levels
Med mgmt
Problem solving/routines
Decrease risk with preventative care
Healthy coping skills

Question 21

AADE 7 self care behaviors

Answer 21

Framework for assessment/intervention/outcome eval for pre diabetes and diabetes

Shift content for outcome driven based on client centered goals

Question 22

AADE7 outcome continuum

Answer 22

Immediate (skill acquisition) to intermediate (behavior change) to post intermediate (improved clinical indicators A1c, BP, lipids, BMI) to long term (improved health status)

Question 23

Multimodal group intervention for diabetes

Answer 23

Strong evidence x 1 month or short duration 1-3
Includes education, group discussion, goal setting, plan development, relaxation strategies

8 week group focused on identifying barriers, CBT for problem solving, behavior change and lifestyle development=improved glucose self
Monitoring

Strong evidence for group/individual combo

Question 24

Individual intervention for diabetes

Answer 24

Strong for 1:1 in person treatment for
Self mgmt

Moderate evidence for telephone based 1:1 multimodal interventions