Important Terms

Question 1

abrasion

Answer 1

scraping or rubbing away of epidermis; may result in localized bleeding and later weeping of serous fluid

Question 2

approximated

Answer 2

when edges of a wound are close together

Question 3

blanchable hyperemia

Answer 3

redness of the skin caused by dilation of the superficial capillaries. when pressure is applied to the skin, the area blanches, or turns a lighter color

Question 4

blanching

Answer 4

when you put pressure on an area and it turns a lighter color and then goes back to the original color when pressure is relieved

Question 5

Braden Scale

Answer 5

scale used to measure risk for pressure injuries

Question 6

debridement

Answer 6

removal of dead tissue from a wound

Question 7

dehiscence

Answer 7

separation of the edges of a wound, revealing underlying tissues

Question 8

epithelialization

Answer 8

filling of a wound with granulation tissue, wound contraction, and wound resurfacing

Question 9

eschar

Answer 9

thick layer of dead, dry tissue that covers a pressure injury or thermal burn. it may be allowed to be sloughed off naturally, or it may need to be surgically removed

Question 10

evisceration

Answer 10

protrusion of visceral organs through a surgical wound

Question 11

exudate

Answer 11

fluid, cells, or other substances that have been discharged from cells or blood vessels slowly through small pores or breaks in cell membranes

Question 12

fluctuance

Answer 12

soft, boggy feeling when tissue is palpated; usually a sign of tissue infection

Question 13

friction

Answer 13

effects of rubbing or the resistance that a moving body meets from the surface on which it moves; a force that occurs in the direction to oppose movement

Question 14

granulation tissue

Answer 14

soft, pink, fleshy projections of tissue that form during the healing process in a wound not healing by primary intention

Question 15

hemostasis

Answer 15

termination of bleeding by mechanical or chemical means or the coagulation process of the body

Question 16

induration

Answer 16

hardening of a tissue, particularly the skin, because of edema or inflammation

Question 17

laceration

Answer 17

torn, jagged wound

Question 18

medical adhesive-related skin injury (MARSI)

Answer 18

the presence of erythema and/or other manifestation of cutaneous abnormality that persists 30 minutes or longer after removal of a device or adhesive securing the device

Question 19

medical device-related pressure injury (MDRPI)

Answer 19

occurs when the skin or underlying tissues are subjected to sustained pressure or shear from medical devices or equipment

Question 20

negative-pressure wound therapy (NPWT)

Answer 20

vacuum-assisted closure; the application of subatmospheric pressure to a wound through suction to facilitate healing and collect wound fluid

Question 21

nonblanchable erythema

Answer 21

when the color of a pressure injury remains the same when pressure is applied to it

Question 22

pressure injury

Answer 22

inflammation, sore, or ulcer in the skin over a bony prominence

Question 23

primary intention

Answer 23

primary union of the edges of a wound, progressing to complete scar formation without granulation

Question 24

puncture wound

Answer 24

a small, circular wound with edges coming together towards the center

Question 25

purulent

Answer 25

thick yellow, green, tan, or brown drainage from a wound

Question 26

sanguineous

Answer 26

a wound drainage showing bright red spot surrounded by light red stain; indicates active bleeding

Question 27

secondary intention

Answer 27

wound closure in which the edges are separated; granulation tissue develops to fill the gap; and, finally, epithelium grows in over the granulation, producing a larger scar than results with primary intention

Question 28

serosanguineous

Answer 28

a wound drainage shows pale red and pink fluid completely staining the gauze

Question 29

Serous

Answer 29

a wound drainage shows light colored circular spot with clear, watery plasma

Question 30

shearing force

Answer 30

force exerted against the skin while the skin remains stationary and the bony structures move

Question 31

slough

Answer 31

soft yellow or white stringy substance attached to wound bed

Question 32

tissue ischemia

Answer 32

point at which tissues receive insufficient oxygen and perfusion

Question 33

vacuum-assisted closure (V.A.C.)

Answer 33

a device that helps in wound closure by applying localized negative pressure to draw the edges of a wound together

Question 34

wound

Answer 34

a disruption of the integrity and function of tissues in the body

Question 35

wound drainage evacuators

Answer 35

convenient portable units that connect to tubular drains lying within a wound bed and exert a safe, constant, low-pressure vacuum to remove and collect drainage