Wounds, Pain, and First Aid

Question 1

Epidermis

Answer 1

The outer layer of the skin is the epidermis, consisting of live and dead cells

Question 2

Dermis

Answer 2

he second layer, called the dermis, contains the nerves, blood vessels and more

Question 3

subcutaneous

Answer 3

there is a layer of fat called the subcutaneous layer that provides cushioning and further protection

Question 4

puncture wound

Answer 4

an object pierces the skin, usually including underlying tissues

Question 5

abrasion

Answer 5

a friction wound where the top layers of skin are rubbed off. This may be a partial thickness wound, meaning it does not extend through all of the layers of the skin

Question 6

laceration

Answer 6

a wound through the skin with jagged edges

Question 7

incision

Answer 7

a medically created wound with clean, straight edges

Question 8

contusion

Answer 8

a bruise, which can be deep and severe. This is bleeding underneath this skin

Question 9

stasis ulcer (venous ulcer)

Answer 9

skin breakdown resulting from poor blood return to the heart through the veins. Edema is usually present.

Question 10

arterial ulcer

Answer 10

caused by lack of blood flow to an area. The area is usually cyanotic in color

Question 11

pressure (decubitus) ulcer

Answer 11

caused by pressure on the skin. These generally occur over bony prominences (where bones are close to the surface of the body) and can also occur in skin folds (especially abdominal folds), where two areas of skin put pressure on each other and moisture is often trapped

Question 12

preventing wound (4)

Answer 12

1. minimizing risk of falls and other injury by reducing clutter, ensuring no sharp objects are present and more
2. repositioning clients who cannot move themselves every 2 hours is crucial to preventing pressure ulcers. Promoting adequate fluid, nutrition and exercise is also beneficial
3. monitor for reddened areas that do not disappear and avoid pressure to that area
   f4. or skin folds, ensure that areas inside the folds are properly cleaned and thoroughly patted dry

Question 13

wound care

Answer 13

1. avoid pressure to the area that will impede blood flow needed for healing
2. keep the area clean and dry to prevent infection. This may involve a dressing. PSWs cannot change sterile dressings (a surgical wound for example) and rarely are responsible for changing non-sterile dressings.
3. However, if you are required to change a dressing, be certain that you have the knowledge required. Never touch the inside of a dressing and be certain that tape is secure, but does not fully encircle any body part.
4. watch for signs of infection: redness, unusual warmth, inflammation, discharge. Discharge or drainage may be serous (clear), sanguineous (bloody), serosanguinous (blood mixed with clear) or purulent (green, yellow or brown in color, thicker consistency)

Question 14

serous

Answer 14

clear discharge

Question 15

sanguineous

Answer 15

bloody discharge

Question 16

serosanguinous

Answer 16

clear and bloody discharge

Question 17

purulent

Answer 17

thick green/yellow/brown discharge

Question 18

choking

Answer 18

if there is complete airway obstruction it is common for the person to clutch their throat. If a nurse is present in the setting, call them immediately and do not try to handle this on your own. Many LTCFs do not allow a PSW to use emergency measure for this. If airway obstruction (during which the person in unable to breath) is not resolved, it can lead to cardiac arrest (heart stops beating)

Question 19

cardiac arrest

Answer 19

heart stops beating. Know the DNR wishes of the client, seek immediate assistance and initiate CPR if appropriate (in some LTCFs only the nurse is allowed to initiate this)

Question 20

bleeding

Answer 20

or external bleeding, apply pressure to stop the bleeding. If internal bleeding is suspected, you do not apply pressure, but seek immediate medical assistance (in LTC, notify the nurse, in community you will call the supervisor and likely 911)

Question 21

fractures

Answer 21

do not move the person or area of possible fracture, seek medical assistance

Question 22

burns

Answer 22

prevent further burning by removing from the source of heat if safe to do so, then cool the burn with cool water (do not use cold water). Seek assistance if necessary. Do not apply anything to the burn, especially butter or oil that will result in further burning

Question 23

hypothermia

Answer 23

very low body temperature, generally after exposure to cold weather or submersion in cold water. Warm the person to increase the body temperature

Question 24

seizures

Answer 24

protect from injury. If on the floor, place a soft item under the head. Time the seizure, if it does not resolve within 5 minutes or the person does not have a known condition causing the seizure, call 911. In a healthcare facility, always call the nurse immediately. Do not attempt to restrain the person to control the seizure or for any other reason.

Question 25

acute pain

Answer 25

is new, often sudden, pain that lasts less than 6 months, although if it is not expected to resolve it may be considered chronic before 6 months has passed

Question 26

analgesic medication

Answer 26

these are given and documented by a nurse. A PSW will monitor for pain improvement and let the nurse know if the person is still experiencing pain in one hour (or if there are significant changes prior to that time)

Question 27

ways to help pain

Answer 27

1. analgesic medications: these are given and documented by a nurse. A PSW will monitor for pain improvement and let the nurse know if the person is still experiencing pain in one hour (or if there are significant changes prior to that time)
2. repositioning
3. rest and relaxation
4. hot or cold applications, if listed on the care plan. Heat applications will increase circulation to an area and may be used to relax muscles and decrease joint stiffness to help with pain. Heat should not be applied longer than indicated on the care plan, generally no longer than 15-20 minutes at a time. Cold applications decrease blood flow to the area, so might be beneficial in minimizing inflammation which can cause pain.

Question 28

how long should heat be applied for?

Answer 28

15 to 20 minutes

Question 29

vital signs

Answer 29

Temperature, pulse, respirations, blood pressure and oxygen saturation are commonly referred to as vital signs. Weight is included by some.

Question 30

temperature

Answer 30

normal oral temperature is 37 C on average. Generally oral temperature is considered most accurate, but temperature may be taken axillary (armpit), tympanic (ear), or using a wand pointed toward the forehead as well.

Question 31

pulse

Answer 31

normal pulse, or heart rate for an adult is 60-100 bpm (beats per minute). The pulse is most often assessed in the wrist above the radial artery. Fast heart rate (tachycardia) may be due to fever, exercise, fear, excess blood loss, problems with heart or breathing functions and more. A low heart rate (bradycardia) may be normal for some in great physical shape, caused by medications, or a sign of a serious medical condition.

Question 32

respiration

Answer 32

normal adult rate is 12-20 per minute. Respirations should be counted immediately after taking the pulse when the client is not aware you are counting. Respirations can be increased for many of the same reason as the pulse increases. Decreased respiration could indicate a medical emergency.

Question 33

blood pressure

Answer 33

: this is measured with a blood pressure cuff placed directly on the skin (not over clothing) and listening to the pressure against the walls of the brachial artery near the elbow. A blood pressure should not be measure in an arm that has an injury, on IV present, or on the side that a person has had a mastectomy. Sustained BP above 140/90 is called hypertension. Blood pressure below 90/60 at any time is called hypotension. Always check for symptoms and ensure safety (sit them down if they feel dizzy for example)

Question 34

hypertension

Answer 34

140/90

Question 35

hypotension

Answer 35

90/60

Question 36

oxygen saturation

Answer 36

this is a measure of how much oxygen is in the blood. Report any number below 92 immediately, along with other symptoms you have observed, such as cyanosis, SOB, pain, or confusion

Question 37

weight

Answer 37

should be measured in the morning after emptying the bladder. In a facility, weights are generally completed in a tub chair (in which case the client is not wearing clothing) or in a mechanical lift. Sometimes weights are measured daily as an indication of the amount of fluid being retained in the body, or weekly to monitor weight loss. Unless otherwise indicated, all people are weighed monthly in a LTCF.