WOUND PREVENTION
This should be implemented to reduce the risk of a resident developing a wound.
What is an intervention?
This is the MINIMUM requirement of documenting administration of a wound care treatment.
What is signing off the treatment?
You notice a change in the condition of a wound, this is the person you MUST inform.
Who is the DOCTOR?
These are characteristics used for describing the drainage of a wound. (100 points per answer given)
What is are serous, sero sanguinous, sanguinous & purulent?
This is the lowest form of support surface offered for residents and typically not recommended for residents with pressure injuries Stage 2 and higher.
What is a foam cushion or mattress?
This is the GOLD STANDARD intervention for preventing pressure injuries.
What is turning & positioning?
If a resident refuses wound care treatment, you MUST inform this person and document this in your nursing refusal note.
Who is the doctor?
This is the first step in treating a wound that has been staged as Stage 2 or higher.
What is monitor for pain and offer pain medication as needed?
This assessment is utilized to determine the likelihood of a resident developing a pressure injury.
What is Braden Scale?
This type of wheelchair cushion should be used for resident's with a Stage 2 pressure injury.
What is a gel wheelchair cushion?
This technique is performed to prevent wounds to heels.
What is offloading?
This is should be labeled on all dressings applied to wounds.
What are nurse's initials and date?
When applying a wound vac, you must apply this to the periwound area prior to application of the tegaderm dressing.
What is "window pane".
This is a narrow channel extending deep beneath the surface of the skin.
What is tunnelling?
This type of pressure relief mattress should be used for residents who fall under any of these categories:
- fall risk
-hip fracture
-spinal fracture
What is a pumpless air mattress?
If a resident is Hoyer-bound, this intervention should be implemented to prevent wounds.
What is an out of bed schedule?
If a resident refuses a wound care treatment, this information should be given to the resident and included in your nursing refusal note.
What are risks and benefits?
When applying ACE wraps to a resident's leg, this is where it should be applied.
Where is starting just below the knee to the tips of toes?
This method is used to describe the location of certain characteristics of a wound.
What is the clock method?
This type of wheelchair cushion should be used for a resident with a sacral pressure injury staged 3 and higher.
What is a roho wheelchair cushion?
A hip arthroplasty puts the resident's corresponding heel at an increased risk for breakdown, this is the optimal intervention for preventing breakdown to that site.
What are offloading heel boots?
A resident is noted with a new onset wound, you must document notification of this person.
Who is family member or primary contact?
When applying a wound vac dressing, if the site of the wound is located on an area that the resident will lay or sit on (buttock, sacrum, heel) you must implement this style of dressing.
What is a bridge?
These levels of scoring are considered HIGH RISK on a Braden Scale assessment.
What are 10-12?
This type of mattress should NEVER be used for a resident being treated for burns.
What is a low air loss mattress? (Will also accept pump-powered air mattress)