Picture This!
What can I take for this?
DANGER!
I'm coming home...
Bedside Ca
100
The Yellow area that can provide nturients to bacteria and may need to be removed. 
Slough. The body may rid of this naturally (neutrophils), but in chronic wounds, patients may need to have this manually removed to promote healing. This consists of devitalized tissue and dead skin cells and other wound components.
100
A 13 year old patient presents to clinic with an abcess that requires drainage and packing. What medication should the nurse prepare prior to the procedure?
What is a localized anesthetic such as lidocaine.
100
An area susceptible to moisture trapping that can lead to a fungal infection.
*Bonus Part* Patients that are at risk
What are skin folds?
Who are obese/overweight patients...and babies!
100
An essential macronutrient that is necessary for cellular activity and immune response activation. Ironically, especially in chronic patients, it is also lost through wound exudate, raising the nutritional need in this population by 250%.
What is protein?
100
These are the classic symptoms of inflammation and infection and should be addressed immediately.
What is increased reddness, localized temperature, and sensitivity (pain)?
Thick discharge, foul odor are also acceptable answers.
200
Pressure Ulcer image
What is Stage IV?
Presents with full thickness loss and damage to underlying structure such as bone. Often tunneling around the wound is involved.
200
The provider orders placement of silver nitrate sticks for a patient with hypergranulation of wound tissue. When observing the nurse, what step indicates the nurse needs further teaching?
a. The nurse leaves the applicator in place for 5 minutes to allow adequate contact time.
b. The nurse encircles the area with petroleum jelly.
c. The nurse activates the medication with water.
d. The nurse does not check the tip by touching it to ensure adequate activation.
a. 2 minutes is often sufficient. This is a chemical reaction that can damage or burn skin if left on a surface for too long.
200
A chronic lung disease that drastically affects the oxygen levels, a crucial component in wound healing.
What is COPD?
200
Citrus fruits, dark leafy veggies, and kiwis are all high in this essential vitamin that promotes collagen development, and therefore crucial to wound healing.
What is Vitamin C?
200
A negative pressure device designed to use suction to encourage proper wound closure.
What is a wound vac?
300
Most concerning areas for wound development, name three
PICTURE
300
Presents in a powder, cream or ointment form, and is commonly used for the presence of yeast in wounds.
What is Nystatin?
300
How does coronary heart disease affect wounds?
Insufficient pump! Decreased flow causes less nutrients, less oxygen, less blood to the wound.
300
During a routine check up with a diabetic patient, which phrase indicates they have a clear understanding of wound prevention?
a. I should check my feet every few days for possible cuts or scrapes.
b. I should wash my feet every 2 days in order to prevent infection. More than that will likely cause them to dry out.
c. Would you tell my daughter I would like a large fry with my lunch please?
d. My very nice friend is taking me to a new store to buy snug and comfortable shoes tomorrow.
d.
d.
a and b- feet should be washed every day and inspected every day to keep them clean and less susceptible to infection.
c. Carbs raise BS! A controlled diabetic diet is the best chance for less nerve damage.
300
Name three interventions that nurses can do to prevent wounds
What is:
Skin assessment upon admission and every 8-12 hours. (more often if wounds are present) (Braden)
Repositioning patients every 2 hours.
Adequate hydration
Adequate nutrition.
Keep dry!
Saline.... :), pillow placement
400
PICTURE
These are the four stages of wound healing.
What is hemostasis, inflammatory, proliferative, and remodeling?
400
You are working with a patient in clinic regarding correct procedure in taking their antibiotic for an infected wound. What phrase indicates this patient needs further teaching?
a. This medication is expensive. I have another bottle at home. I'll take that.
b. I should stop by the store and pick up some yogurt on the way home.
c. If I experience slight swelling on my face, I should immediately stop the medication and call my doctor.
d. I should take the complete course of antibiotic, even if the wound is no longer painful.
a. The patient should never take medication prescribed for a previous reason or for another patient...you'd be surprised how often this happens.
b. diarrhea is a common side effect. Yogurt replaces healthy bacteria that will help this resolve quicker. c. swelling, esp facial indicates an adverse possibly anaphylactic reaction. d. Not taking the full dose could cause the body to build up immunity and then stronger doses or antibiotics may be required.
400
Your pediatric patient is post-op day zero from a ventricular septal defect repair (VSD). You are performing your routine vitals and notice a core temperature of 105 degrees. What is your next step?
a. retake the temperature using a different thermometer
b. Call the surgeon.
c. Use ice packs and a cooling blanket to reduce the fever.
d. Give the ordered dose of anti-inflammatory.
C.
A is wasting time. Core temps are reliable. B. Yes, you need to do this, but it won't help drop that temperature down. D. will take too long to kick in, but this is ok to do as well.
400
A patient has just called the clinic you work at regarding their surgical incision. What statement indicates the patient needs to come in?
a. There is some drainage on the dressing. It is a clear color, maybe some yellow?
b. There are red lines streaks coming from it and moving up my body. I don't think I scratched it.
c. It's really itchy.
d. It's swollen, about the same size as yesterday.
Red streaks could be a possible sign of lymphangitis and the patient should be brought in. Itching, mild soreness and swelling, and even some clear drainage are normal and expected.
400
Which patient is not a suitable candidate for a wound vac?
a. A 50 year-old with diabetic neuropathy who has a stage 2 pressure ulcer on her heal.
b. A 72 year old with severe peripheral vascular insufficiency who has a wound on her lower leg.
c. A 14 year old with third degree burns to their arms.
d. A 20 year old obese patient who has a wound above his saccral area.
B. Wound vacs should not be used:
on areas of poor circulation
loose or weak skin
cancer wounds
infected wounds
near joints
500
PICTURE
What type of wound closure is this an example of?
Primary
500
When admitting your patient suffering from a traumatic wound due to an MVA, the family member hands you a list of their current medication list. Which of the following medications causes alarm?
a. Lisinopril
b. Lovastatin
c. Eliquis
d. Mupirocin
Eliquis is an anticoagulant, and would therefore delay wound healing and increase bleeding risk
Immunosuppressants, corticosteroids, anticoagulants, NSAIDS
500
Which patient is at risk for wound development? Select all that apply
a. a 46 year old post-op patient ambulating 3x a day.
b. a 78 year old with Alzheimers on soft restraints
c. a 65 year old with incontinence
d. a 54 year old newly diabetic patient who washes her feet daily
e. a 27 year old with in liver failure who is constantly sweating.
b, c, e.
Confusion, moisture, immobility are all risk factors.
500
You are instructing a family member on proper post surgical wound care. Which of the following statements indicates they are ready for discharge?
a. If the wound dressing is saturated, I can change it before the 5-7 days.
b. I should avoid letting them shower until the wound is completely healed because the moisture will cause an infection.
c. My sister has a home remedy cream that I can place on the wound so it will heal faster.
d. If scabs start to form, I should rub the area gently with alcohol to get it to come off.
A. Keep the wound clean and dry as best as possible. Showers are typically ok after 1-2 days, no baths. We don't know what is in the cream or if it will interact with anything. Stick to prescribed medications only. Let scabs fall. Do not pick them. Alcohol does not cause anything to dry or heal faster.
500
You are caring for a patient with an open wound when a provider orders a wet to dry dressing change every 4-6 hours. Which response is accurate regarding wet to dry dressing changes?
a. They lower the temperature of the wound bed and decrease healing time.
b. They promote a thriving moist environment that helps wounds heal properly.
c. They protect the skin against bacteria without pulling off healthy viable tissue.
d. It removes moisture from the wound bed and increases succeptability to infection.
D.
Despite the long term recommendation of wet to dry dressings, new evidence based practice discourages the use, opting for other alternatives such as hydragel and petroleum.