1245 Wound Care 3Rd Set

Front 1

With the Braden Scale name the 6 categories from top to bottom and the levels go from ?-? except for Friction and Shear which only goes up to ?

Back 1

Sensory Perception, Moisture, Activity, Mobility, Nutrition, Friction/Shear.
1-4 with 1 being the worst
3-no apparent problem

Front 2

What are 2 outcomes for a pt. with a bed sore?

Back 2

Pt. will maintain current skin integrity by the end of shift. AEB Stage1 coccyx wound will not increase in size or Stage 1 coccyx wound will not progress to stage II.
Pt. will maintain current tissue integrity by the end of shift.AEB Surgical incision will remain closed without swelling or drainage.

Front 3

For wound assessment we should measure ?,?,?

Back 3

Size, Depth, Tunneling

Front 4

For wound assessment we inspect ?,?,?,?,?,?

Back 4

Drainage, Drains, Sutures, staples, steri strips, dermabond.

Front 5

What are the 4 levels of drainage that we may see?

Back 5

Serous, Sanguineous, Serosanguineous, Purulent

Front 6

Name the drainage: Clear.

Back 6

Serous

Front 7

Name the drainage: Red/Thick

Back 7

Sanguineous

Front 8

Name the drainage: Thin red

Back 8

Serosanguineous

Front 9

Name the drainage: Yellow, Green, White.

Back 9

Purulent

Front 10

We use the ? scale for predicting pressure sore risk.

Back 10

Braden

Front 11

What can we do as Nurses to prevent pressure ulcers?

Back 11

Turning schedules,
Float heels,
use positioning devices,
Adequate nutrition and hydration,
Manage moisture/incontinence

Front 12

To tell if a pt. has adequate nutrition we can measure ? and ? levels and it takes how long to get these results.

Back 12

Albumin(3-4weeks),
Prealbumin(2-3days)

Front 13

For stage 1 pressure ulcer care we can use ?, ? in the care of the pt. for care.

Back 13

Turning, pressure relieving devices

Front 14

For stage 2 pressure ulcers we can use ? dressings in their care.

Back 14

Occlusive

Front 15

For stageIII pressure ulcers we would use a ?to? dressing or the Dr. may perform ? of eschar(chemical or manual)

Back 15

wet to dry,
debridement

Front 16

For stage IV pressure ulcers we would use a ?to ? dressing, the Dr. may perform ? and a ? graft may be necessary.

Back 16

wet to dry,
debridement,
skin