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Wound Certification Exam, Questions And Answers
2023 A+
what are 6 risk factor components of Braden Scale for pressure ulcer? - ANSWER- sensory perception, moisture, mobility, activity, nutrition, and shear/friction What is the name of the organization that developed the pressure ulcer staging? - ANSWER-NPUAP (national pressure ulcer advisory panel) pathological effect of excessive pressure on soft tissue can be attributed by 3 factors? what are they? - ANSWER-tissue tolerance, duration of pressure, and intensity of pressure what are the extrinsic factors that impact pressure ulcers? - ANSWER-increase in moisture, friction and shearing how does friction play a role in shearing which eventually leads to pressure ulcer? - ANSWER-friction alone causes only superfical abrasion, but with gravity it plays a synergistic effect leading to shearing. When gravity pushes down on the body and resistance (friction) between the patient and surface is exerted, shearing occurs. because skin does not freely move, primary effect of shearing occurs at the deeper fascial level. what are the intrisinc factors of pressur ulcers? - ANSWER-nutritional debilitation, advanced age, low BP, stress, smoking, elevated body temperature Aging skin undergoes what elements affecting risk for pressure ulcer? - ANSWER- dermoepidermal junction flattens, less nutrient exchange occurs, less resistance to shearing, changes in sensory perception, loss of dermal thickness, increased vascular fragility; ability of soft tisuse to distribute mechanical load w/out comprosing blood flow is impaired What does nonblanching erythema indicate in the skin r/t PU? - ANSWER-when pressure is applied to the erythematic area skin becomes white (blanched), but once relieved, erythema returns - indicating blood flow; however in nonblanching erythema, skin does not blanche-indicating impaired blood flow-suggesting tissue destructon why does sitting in a chair pose more of a risk in skin break down than lying? - ANSWER-deep tissue injury or PU is likely to occur sooner sitting down because tissue offloading over boney prominences is higher Describe what you will see in deep tissue injury? - ANSWER-purple or maroon localized area of discolored intact skin skinor blood filled blister; may be preceded by painful, firm, mushy, or boggy; skin may be warmer to cooler in adjacent tissue. In dark skin, thin blister or eschar over a dark wound bed may bee seen
Describe stage I pressure ulcer? - ANSWER-Intact skin with nonblanchable redness of localized area. Will not see blanching in dark skin, but changes in skin tissue consistency (firm vs boggy when palpated), sensation (pain), and warmer or cooler temperature may differ from surrounding area Describe stage II pressure ulcer? - ANSWER-partial-thickness wound where epidermis and tip of dermis is lost with red-pink wound bed w/out slough. may also present as intact or open/ruptured serum - filled blister Describe stage III pressure ulcer? - ANSWER-full-thickness wound where both epidermis and dermis is lost and subcutaneous tissue may be visible, but deeper structures such as muscle, bone, and tendon are not exposed; slough my be present but it doesn't obscure depth and tunneling and undermining may be present Describe stage IV pressure ulcer? - ANSWER-full-thickness wound with exposed bone,tendon, and muscle; slough or eschar may be seen in some parts of the wound bed. you will often see tunneling and undermining. Osteomyelitis may be dxed at this stage, since bone is palpable Describe unstageble ulcers? - ANSWER-full-thickness wound where base of the ulcer is covered by slough and/or eschar, obscuring depth When should eschars not be removed? - ANSWER-when it's stable with dry, adherent, and intact w/out erythema on the heel; this serves as the body's natural cover and should not be removed. Therapeutic function of pressure distribution is accomplised by what 2 factors? - ANSWER-immersion and envelopement Define immersion? - ANSWER-depth of penetration or skining into surgace allowing pressure to be spread out over surrounding area rather than directly over boney prominence Define envelopement? - ANSWER-is the ability of support surface to conform to irregularities without causing substantial increase in pressure what is bottoming out? - ANSWER-this occurs when depth of penetration or sinking is excessive, allowing increased pressure to concentrate over boney prominences what factors contribute to bottoming out? - ANSWER-weight, disproportion of weight and size such as amputation, tendency to keep HOB >30 degrees, inappropriate support surface settings When should you consider reactive support surface with features and components such as low air loss, alternating pressure, viscous or air fluids? - ANSWER-for patients who
Define hemosiderin staining? - ANSWER-leakage of RBCs which have been broken down appears as a purple to brown staining Define lipodermatosclerosis? - ANSWER-hardening of soft tissue where hemosiderin staining evolves into lipodermatosclerosis- found on gaiter and sock areas and has appearance of inverted champagne bottle Define atrophie blanche? - ANSWER-smooth, white plaques of think speckled atrophic tissue with tortous vessels on ankle or foot with hemosiderin pigmented border Define venous dermatitis? - ANSWER-characterized by scaling, crusting, weeping, erythema, erosions, and intense itching. Differentiate dermatitis from cellulitis? - ANSWER-In cellulitis, patients will often exhibit pain, fever, tenderness, one or few bullae, no relevent history, no crusting, blood cxs usually negative, no lesions anywhere else other than localized area, and high WBC count What factors impede healing in venous ulcers? - ANSWER-DM, tobacco, malnutrition, umplanned weight loss, and meds (corticosteroids) What is the most effective managment of CVI? - ANSWER-therapeutic compressions (30-40mmHg) What should you do before deciding to tx with compressions? - ANSWER-rule out LEAD, by obtaing an ABI What are the interpretations of ABI? - ANSWER-ABI of 1.0 is pure LEVD ABI of 0.9 or less is LEAD ABI of 0.5 or less is ischemia When should you obtain an TBI? - ANSWER-when ABI is >1.3 indicating calcification of vessels which in turn reflects invalid data. A TBI of < 0.7 indicates LEAD What is the gold standard for evaluating valve failure and extent of reflux? - ANSWER- duplex ultra sound What are some methods for manaing venous ulcers and CVI - ANSWER-limb elevation-
heart level for 1-2 hours/daily and during sleep, calf pump exercises or referral to PT for shuffling gait, weight control, medications (diuretics, topical corticosteroids, Pentoxifylline (Trental), and compression therapy How does Pentoxifylline work and when is it appropriate? - ANSWER-reduces aggregation of platelets and WBC, reducing capillary plugging and enhances blood flow. ordered when standard therapy is not effective
When are elastic or inelastic compressions indicated? - ANSWER-elastic for patients who are sedenatary vs. inelastic for patients who are amublatory When are high pressure compressions (30-40mmgHg) indicated, when assessing ABI?
- ANSWER-ABI>0.8 can use high compressions when are compressions contraindicated? - ANSWER-venous thrombosis in LE w/ulcers and uncompensated heart failure when is sustained (continuous) compression contraindicated? - ANSWER-in the presene of PVD with an ABI that is < or =0.6 or when ABI is >0.5 but <0.8 is more appropriate when is IPC (intermittent pneumatic compression)-dynamic compression indicated? - ANSWER-for patients with venous insufficiency and ABI< or =0.5, for those who cannot tolerate sustained compression, as an adjunct therapy to sustained therapy, those who are immobile when is modified or lower compressions appropriate (23-30mmHg)? - ANSWER-when coexisting arterial disease is present all patients with leg uclers should be screened for arterial disease using what, initially? - ANSWER-doppler which measures ABI; takes BP in the arm and ankle and compares ratio What are the attributes of short-stretch compression? - ANSWER-it's inelastic, sustained compression and provides a modified to therapeutic level of pressure- reusable What are the attributes of long-stretch compression? - ANSWER-same as short stretch except it's elastic (ex. Surepress) what are the attributes of multi-layer compression? - ANSWER-sustained, elastic, disposable, and provides therapeutic to modified pressure (ex. 3M w/coban) what are the attributes of paste compression and problems associated with it? - ANSWER-sustained, inelastic, disposable, and provides modified level of pressure;lacks absorptive property so skin has tendency to macerate, patients are sensitive to calamine paste, slippage, poor fit, and inablity to bathe. When are compression stockings indicated? - ANSWER-only when venous insufficiency is stable and used as maintenace therapy, since compressions are for "life" to prevent venous ulcers
<40mmHg=hypoxia w/impaired wound healing When do you use SLP (segmental leg pressure)? - ANSWER-used to determine location of occlusion for surgical intervention. a 30mmHg decrease in pressure between two adjacent levels indicate occlusion when should you not use TBI? - ANSWER-when toes are amputated or toes are col that it's not reliable What conditions cause vasoconstrictive properties which worsens LEAD? - ANSWER- smoking, pain, dehydration, cold temperature, lack of exercise, constrictive clothing when is pulsve volume recordings (PVR) and doppler waveform studies indicated? - ANSWER-it is recommended when ABI >1.3; the wave forms reflect severity of occlusion what tests give you an anatomic roadmap, prior to revascularization? - ANSWER-MRA, angiography, duplex angiography, or computed tomographic angiography when is HBO indicated in arterial ulcers? - ANSWER-patients w/significant ischemia who are not candidates for revascularization and wound healing is impaired Describe the characteristics of a neuropathic wound and periwound? - ANSWER- wounds are usually found on the planatar, dorsum of metatarsal, and lateral sides of foot; wounds are usually red , if no ischemia not present; wound edges are well defined; exudate is moderate to large; callus periwound Describe the grading system and its corresponding symptoms of Wagner Ulcer Classification system? - ANSWER-there are 5 grading categories: 0: intact w/some callus formation, deformities, and redness over pressure point 1: superficial ulcer w/out depth into SQ tissue with or w/out cellulitis 2: full-thickness ulcer exposing tendon and joint w/out abcess or osteomyelitis
- osteomyelitis, absecess, necrotizing fasciitis
- gangrene toes, forefoot, and heel
- amputation, gangrene-unsalvageable what is a traditional tx of Charcot foot? - ANSWER-cast mobilization Why is debridement of callus an important maintenance therapy? - ANSWER-better distributes pressure and reveals possible ulerations and undermining of tissues what are the priorities in managment of neuropathic wounds? - ANSWER-relieve pressure by offloading, aggressively treating infection, revascularization, and improve wound condition
what are the 3 kinds of neuropathy? - ANSWER-motor, sensory, and autonomic neuropathy what happens in motor neuropathy and what do you typically observe? - ANSWER-foot muscles atrophy resulting in deformities of toes and foot structure which leads to eneven weight distribution and pressure points ( hammer and claw toes, charcot foot) what happens in sensory neuropathy and what do you typically observe? - ANSWER- protective sensation is lost and patients lack awareness of pain and temperature which leads to injury and infection what happens in autonomic neuropathy and what do you typically observe? - ANSWER- an involuntary nervous system resulting in loss of sweating and oil production causing skin to be dry. Xerosis leads to fissures, cracks, callus, and ulceration Under the foot risk classification system, what signs connote low risk diabetes and how should you manage the condition to prevent neuropathic ulcers? - ANSWER-intact sensation(neuropathy), intact pulse (vasularity), no foot deformities (motor fx). management includes: education r/t disease control, daily inspection of foot, proper shoe wear, early report of foot injuries; annual foot exam and callus removal and nail care prn Under the foot risk classification system, what signs connote moderate risk diabetes and how should you manage the condition to prevent neuropathic ulcers? - ANSWER- intact sensation(neuropathy), intact pulse (vasularity), foot deformities present (motor fx). management includes: education r/t disease control, daily inspection of foot, proper shoe wear, early report of foot injuries; depth in-lay footwear, foot exam every 6 months; referral to foot/ankle specialist if deformity is causing pressure and conservative measures failed Under the foot risk classification system, what signs connote high risk diabetes and how should you manage the condition to prevent neuropathic ulcers? - ANSWER-absent sensation(neuropathy), absent pulse (vasularity), foot deformities present (motor fx). management includes: education r/t disease control, daily inspection of foot, proper shoe wear, early report of foot injuries; custom footwear, foot exam every 3months; callus maintenance; referral to foot/ankle specialist if deformity is causing pressure and conservative measures failed what are some key things to remember when caring for diabetic foot? - ANSWER-daily inspections of foot and shoes, don't soak in water for prolonged period to avoid maceration, avoid nylon socks bc they don't breathe, avoid chemicals for removing corns, never use razor blades, change shoes often to reduce hotspots, see a professional for trimming nails Describe SSSS (staphylococcal scaled skin syndrome)? - ANSWER-infectious wound caused by toxins from staph and usually affects healthy children 6 yrs or younger.
S: stay as inpatient prolonger >14 days How are surgical wounds usually closed? - ANSWER-by primary or secondary intention what solution is usually used in traumatic wounds to decrease contamination? - ANSWER-Dakin's solution or sodium hypochlorite; should have limited use bc it also kills healthy cells when is TCC contraindicated in treating neuropathic ulcers? - ANSWER-patient with acute deep infection, sepsis, or gangrene. may not be indicated for those who are noncompliant, would be unstable to stand or walk, exessive edema, fragile skin and who have ulcers that have depth >size of width what is used as an adjunct therapy to surgical shoe, healing shoe, or walking splint and when TCC is not warranted? - ANSWER-foam felt dressing (FFD) what surgical procedure is used for those with peripheral neuropathy and equinus contractures? - ANSWER-tedon-achilles lengthening (TAL) what are the clinical manifestations of incontinence associated dermatitis (IAD)? - ANSWER-areas of body where incontinence will be spread to is observed; risk factors are associated w/urinary or bowel incontinence (abx, carthartics, hypoalbumina, fecal impaction, IBS, infection, radiation, fat malabsorption); blistering, shallow irregular patches that's red and denuded and/or macerated; painful what are the clinical manifestations of Candidiasis? - ANSWER-occurs in skin folds where moisture is bountiful (intertrigo, pendulous breasts, groin, perineum, inner thighs - like IAD); associated w/moisture and immunosuppresion; confluent patchy rash or erythematous papules (raised discoloration) with cheesy-white exudate; pustules and satellite lesions also seen; itchy, burning discomfort; Potassium hydroxide preparation scraping (KOH) done for testing What are the clinical manifestations of Herpes Simplex? - ANSWER-viral condition affecting the genitalia areas (perianal, buttocks, genitals); isolated vesicles rupture and crusts over Differentiate IAD, Cutaneous Candidiasis, and Herpes Simplex from pressure ulcer? - ANSWER-types of lesions, medical hx and location of the conditions assist in diagnosing. Whereas IAD and Cadidiasis occurs in skin fold areas, Herpes is found in genitalia while PUs occur over boney prominences. IAD is incontinence related, Candidiasis is associated with moisture issues and Herpes is a STD. Uniqueness of lesions also depicts type of condition. IAD is irregular, denuded, blistering; Candidiasis is confluent, patchy, papular, pustular, cheesy-like exudate; Herpes is isolated blister which eventually ruptures into crust; PUs in stage II may be confused with the alluded conditions in that it's superficial, partial thickness wound that's red w/serous blister
whys is albumin and prealbumin an important lab value to know in wound management and healing? - ANSWER-lab values indicate potential risk for malnutrition. Protein is needed in growth factors to promote healing. Becasue albumin has a long half life, it foretells muscle wasting/malnourishement which has been chronic. Albumin level <3. is malnourished (normal is 3.5-5). Conversely, prealbumin has a short half life of 2 days and indicates acute stage. <19.5 is malnourished (19.5-35.8 normal). What does transferrin lab value a good indicator of? - ANSWER-iron deficiency Are the the interpretations of BMI for underweight, normal, overweight, and obesity? - ANSWER-> 18.5kg =underweight 18.5-24.9=normal 25 - 29.9=overweight 30 and > is obesity What % of body weight is considered significant weight loss? - ANSWER-5 % or greater w/in 30 days (1 month) or 10% or greater w/in 180 days (6 months) Which nutritional element is needed for angeogenesis, collagen synthesis/remodeling, immune fx and serves as precursor to nitric oxide and wound contraction? - ANSWER- protein How much protein is necessary per kg, for wound healing? - ANSWER-1.25-1.5kg/body weight which vitamin assists in angiogenesis and epithealization? - ANSWER-Vitamin A; this also helps with collagen synthesis which vitamin assists in collagen synthesis, immune function, fibroblast function, and enchances activation of leukocytes and macrophages and essential in cell wall integrity? - ANSWER-Vitamin C which mineral is needed for protein synthesis? - ANSWER-zinc how many calories are needed per kg for sufficiency? - ANSWER- 30 - 35kcal/body weight what lab values help identify patients who are malnourished and need nutritional support for wound healing? - ANSWER-weight(<18.5 is underweight, need 30- 35kcal/weight, significant weight loss =5% w/in 30 days or 10% w/in 180 days); prealbumin (<19.5=malnourished and 19.5-35.8=normal), and albumin(<3. =malnourished and 3.5-5=normal) What the the acroynm TIME used for? - ANSWER-used as principle for wound bed preparation
which debridement method is nonselective - ANSWER-surgical, hydrotherapy, wet-to- gauze, surgical sharp Which debridement methods are selective? - ANSWER-autolysis, enzymatic (collagenase, Dakins, silver nitrate), conservative sharp debridement, biosurgical, and ultrasonic mist what is the difference between selective and nonselective debridement? - ANSWER-in selective, only necrotic tissue is removed what are some things to consider when using Dakin's solution? - ANSWER-It is used for cleaning, debriding, and controling odor; but it should be used short-term; stop use when infection and odor is under control; viable tissue exposed; used 2x/day; use barrier ointment over periwound what caution should you take in considering conservative sharp or surgical sharp wound debridement? - ANSWER-there is potential for transient bacteremia after debridement, particularly wounds that are infected; risk for bleeding, pain what are the 3 general parameter guides for selecting appropriate wound debridement?
- ANSWER-overall condition and goal of patient; status of wound and urgency in need of debridment; skill level of care provider what product is used for tx of very dry, scaly skin? - ANSWER-hyaluronic acid cream when should petrolatum jelly-based products not be used? - ANSWER-for prevention or treatment of radiation dermatitis what are some ways to manage radiation dermatitis? - ANSWER-use lanolin-free hydrophillic moisturizer, normal saline soaks to provide cooling sensation and loosen crusting, nonadherent dressings What are the characteristic manifestation of Herpes Zoster? - ANSWER-begins w/buring pain, followed by erythema that evolves into a grouped unilateral vesicular rash along one or two dermatomes. Pustules form, rupture, and then becomes crusty. Of note, dermatomes are specific skin surface areas innervated by a single spinal nerve group what kind of lesion is an important diagnostic feature in Candidiasis? - ANSWER- satellite lesion what are the 2 mechanims for wound healing? - ANSWER-regeneration (replacement of damaged or lost tissue with more of the same) or scar formation (replacement of damaged or lost tissue by connective tissue that lacks some fx of original tissue
wounds that are confined to epidermal and superficial dermal layers heal by what mechanism and why? - ANSWER-regeneration; epithelial, endothelial, and connective tissue can be reproduced wounds that occur deep in the dermal structures, SQ tissue, muscle, tendon, ligaments, and bone heal by what mechanism and why? - ANSWER-scar formation; these layers lack capacity to regenerate and therefore loss of these structures are permanent Explain wound healing by primary intention and give an example? - ANSWER-In primary intention, wound edges are well approximated and heals by epithealization and connective tissue deposition. surgical incision secured w/staples, surtures, or adhesive tape explain wound healing by secondary intention and give and example? - ANSWER- wound edges are not approximated and healing occurs by granulation tissue formation, contraction of wound edges, and epithelialization. chronic wounds such as PU and dehisced incisions explain wound healing by tertiary intentions and give examples? - ANSWER-aka delayed primary intention. wound is kept open for several days. superficial wound eges then are approximated, and center of wound heals by granulation tissue formation. abdominla incision complicated by significant infection (deep tissue is healing by graulation and superficial layer of skin is sutured) "red islets" represent what part of the skin layer? - ANSWER-basement membrance of the epidermis, which projects deep into the dermis to line the epidermal appendages. Each islets serves as a source of new epithelium why is migration in wound healing delayed when wound is covered w/ a scab? - ANSWER-in order to create a moist envinroment, epithelial cells secrete enzymes knwon as MMP (metallproteinases) to lift the scab what are the major components of partial-thickness repair include? - ANSWER-1. inflammatory response to injury
- epithelial proliferation and migration (resurfacing)
- differentiation of the epidermal layers to restore barrier fx of skin what happens in wound healing, if wound involves dermal loss - ANSWER-granulation formation or connective tissue repair will precede concurrently with reepithealization when do you know complete healing has occured in epithelial resurfacing or healing by regeneration? - ANSWER-when skin pigmenation matches the individual's normal skin tone what must be restored in partial dermal loss in wound healing? - ANSWER-rete ridges/dermal papillae
