Base covers full thickness tissue loss with slough
What is an unstageable ulcer
100
Used for wounds with minimal drainage, wounds that are small, partial thickness such as Stage I pressure ulcers
What is a transparent film dressing
100
Black, brown, or tan tissue that adheres firmly to the wound bed or ulcer edges
What is necrotic (Eschar) tissue
100
Cutting or sharp instrument around edges in close approximation and aligned
What is an incision
100
clean wound in full or half circles, beginning in the center and working toward the outside; moisten sterile gauze or swab with prescribed solution using new gauze or swab for each circle
What is cleansing a unapproximated edge wound
200
Intant, nonblanchable redness of localized area
What is a Stage 1 Ulcer
200
Used for exuding, and nonhealing wounds to protect from bacterial contamination and reduce bacterial contamination
What is an antimicrobial dressing
200
Yellow or white tissue that adheres to the ulcer bed in strings or thick clumps or is mucinous
What is Slough tissue
200
Ultraviolet light or radiation exposure
What is irradiation
200
Working outward from the incision in lines parallel to it using a sterile gauze or swab, clean from top to bottom using a new gauze or swab for each stroke
What is cleansing an approximated edge wound
300
Partial thickness tissue loss of dermis pressuring as a shallow open ulcer with a red pink wound bed, without slough
What is a Stage II ulcer
300
Maintains a moist wound environment, minimal absorption of drainage, facilitates autolytic debridement
What is a hydogel dressing
300
Pink or beefy red tissue with a shiny, moist, granular appearance
What is Granulation tissue
300
Tearing of skin and tissue with blunt or irregular instrument; tissue not aligned often with loose flaps of skin and tissue.
What is a laceration
300
Moisten a sterile flexible applicator swab with saline and insert gently into wound at 90 degree angle
What is measuring the depth of a wound
400
Full-thickness tissue loss with exposed bone, tendon, or muscle.
What is a Stage IV Ulcer
400
Absorbs exudate, maintains a moist wound environment, facilitates autolytic debridement
What is an Alginate dressing
400
new pink or shiny tissue (skin) that grows in from the edges or as islands on the ulcer surface
What is Epithelial tissue
400
Foreign object entering the skin or mucous membrane and lodging in underlying tissue, fragments possibly scattering throughout tissues.
What is penetrating wound
400
Position a sterile basin below the wound and gently direct a stream of prescribed solution into the wound
What is irrigating a wound
500
Full-thickness tissue loss, may have visible subcutaneous fat tissue loss. Slough may be visible.
What is a Stage III Ulcer
500
Absorbent, Maintains a moist wound environment, does not adhere to wound
What is a Collagen wound dressing
500
Wound is completely covered with epithelium, new skin
What is closed/resurfaced tissue
500
Tearing a structure from normal anatomic position; possible damage to blood vessels, nerves, and other structures
What is an avulsion
500
Squeeze excess fluid from from the gauze and gently press to loosely pack the moistened sterile gauze into the wound.
What is applying a saline moistened sterile dressing