Module 4: wound care

Question 1

Tissue trauma

Answer 1

Result of cuts, blows, poor circulation, surgical incision etc

Question 2

Two basic kinds of wounds

Answer 2

Open and closed

Question 3

Open wound

Answer 3

The surface of the skin or mucous membrane is no longer intact

Question 4

Types of open wounds (6)

Answer 4

Incision, laceration, abrasion, avulsion, ulceration, puncture

Question 5

Incision

Answer 5

Clean seperation of skin and tissue with smooth even edges

Question 6

Laceration

Answer 6

Seperation of skin and tissue where edges are torn and irregular

Question 7

Abrasion

Answer 7

Wound where the surface layers of skin are scraped away

Question 8

Avulsion

Answer 8

Stripping away large areas of skin and underlying tissue, leaving cartilage and bone exposed

Question 9

Ulceration

Answer 9

A shallow crater in which skin or mucous membrane is missing

Question 10

Puncture

Answer 10

Opening of skin, underlying tissue, or mucous membrane caused by a sharp pointed narrow object

Question 11

Closed wound

Answer 11

No opening of the skin or mucous membrane usually caused by blunt trauma or pressure

Question 12

Contusion

Answer 12

Injury to soft tissue underlying the skin from the force of contact with a hard object; aka a bruise

Question 13

Systemic condition

Answer 13

Affects the entire body

Question 14

Systemic factors that affect wound healing

Answer 14

Age, nutrition, body build, chronic disease, circulatory problems, weakened immune system, radiation therapy

Question 15

Localized condition

Answer 15

Affects only one system or body part

Question 16

Local factors that affect wound healing

Answer 16

Moist wound environment, infection, necrotic tissue, trauma, edema, etc

Question 17

Necrotic tissue (eschar)

Answer 17

Dead or devitalized tissue; dark in color, usually black, and leathery in appearance; must be removed before wound can heal

Question 18

Purulent

Answer 18

Pus-like

Question 19

Wound observations to report

Answer 19

Redness, drainage, heat, edema, fever, bruising, maceration

Question 20

Maceration

Answer 20

Water logged appearance of wound edges

Question 21

Cytotoxic

Answer 21

Antiseptic cleaning solutions that harm healing tissue

Question 22

Direction to clean wound

Answer 22

Work from clean area near the wound to outward to less clean areas

Question 23

Wet-to-dry dressings

Answer 23

Used for healing surgical incisions; sterile procedure

Question 24

Transparent film dressings

Answer 24

Adhesive membranes of various sizes and thickness; should allow 1.25 inch of dressing surrounding entire wound; waterproof and protect from bacteria; used for minor pressure ulcers and wounds w/ necrotic tissue; for skin tears in elderly; changed every 3-5 days

Question 25

Hydro colloid dressings

Answer 25

Made of gelatin or pectin; provides moist environment for healing; used for pressure ulcers etc; will debride necrotic tissue; left in place for 7 days

Question 26

Debridgement

Answer 26

Medical removal of dead damaged or infected tissue

Question 27

Montgomery straps

Answer 27

Long strips of adhesive attached to skin on either side of wound

Question 28

Decubiti

Answer 28

Bedsore

Question 29

Exudate

Answer 29

Fluid (pus or clear) that leaks out of blood vessels into nearby tissue

Question 30

Fresh tissue

Answer 30

Granulates on the walls of the wound