Stage That Wound
Dressings
Documentation
Odds 'N Ends
Name That Wound
100
An open area over a bony prominence in which muscle is visible.
What is a Stage IV pressure ulcer
100
1. Xeroform 2. Mepilex Border 3. Viscopaste 4. Polywic
What is the typical dressing for a Skin Tear
100
A risk assessment completed on hospital admission, every shift, and with each change in condition
What is the Braden Scale
100
How many RN's should assess the patient's skin on admission?
What is 2
100
A partial or full thickness wound in which a flap may or may not be present
What is a skin tear
200
A shallow open area, over a bony prominence, involving the epidermis and dermis
What is a Stage II pressure ulcer
200
Can be used prophylactically to help prevent deep tissue injuries?
What is a Mepilex Border dressing
200
When you find a hospital aquired pressure ulcer, what report should you file?
What is a Midas Report
200
White soft tissue surrounding a wound
What is Maceration Tissue
200
Erythema and inflammation of the buttocks which may or may not lead to open lesions
What is Incontinence Associated Dermatitis
300
An unopened, dry, boggy, purple, nonblanchable area on a bony prominence
What is a Deep Tissue Injury
300
This dressing should never be placed on a Skin Tear
What is a Tegaderm and/or Steristrips
300
When should a pressure ulcer risk careplan be initiated?
When the braden score is less than 23.
300
Red rash with satelitte lesions: can be painful, burns or itchy.
What is fungal rash
300
A wound located on the coccyx with < 50% yellow slough
What is a Stage III pressure ulcer
400
A round, dry, black area on the foot or toe which is not painful
What is an arterial ulcer?
400
What type of gauze can not be used with Santyl?
What is AMD dressings (fluffs, kerlix and packing gauze)
400
Where do you add a LDA for an ostomy?
What is Intake/Output Flowsheet
400
The rate of hospital-acquired pressure ulcers measured at a specific point in time
What is prevalence
400
A dry wound typically located on the plantar foot or toes that is surrounded by callus
What is a neuropathic (diabetic) foot ulcer
500
An area over a bony prominence which has dehisced, is open through the subcutaneous tissue, and is draining
What is not a pressure ulcer and therefore not staged...a dehisced surgical wound
500
How often should you check that the settings are as ordered on your patient's wound VAC?
What is at least Q Shift
500
Name three types of wound drainage
What is purulent, serosanguinous, serous, sanguinous, seropurulent
500
When should you change an ostomy pouch? Name three incidences.
What is: if its leaking, if its been 7 days and if the patient has a new burning, itchy or painful sensation.
500
A shallow wound, typically on the lower leg (gaiter area), which is irregular in shape and moist. These wounds are painful.
What is a venous insufficiency ulcer
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