Mcphs H And P Two, Final Examination

Front 1

These are areas of necrosis and ulceration where tissues are compressed between bony prominences and hard surfaces.

Back 1

Pressure Ulcers

Front 2

Pressure ulcers result from pressure alone or pressure in combination with what?

Back 2

in combination with friction, shearing forces or both.

Front 3

What are the five risk factors for pressure ulcers?

Back 3

Advanced Age

Impaired Circulation

Immobilization

Malnourishment

Incontinence

Front 4

Pressure ulcers develop through an interaction between what two factors?

Back 4

External factors and Host factors

Front 5

What are the four external factors?

Back 5

Pressure
Shear
Friction
Moisture

Front 6

Sustained pressure without repositioning.

Back 6

Pressure-external factor

Front 7

Occurs if patient is placed on an incline.

Back 7

Shear-external factor

Front 8

Dragging patient across external surface.

Back 8

Friction-external factor

Front 9

Sweat, Feces, and/or Urine combined with pressure.

Back 9

Moisture-external factor

Front 10

What are the four host factors?

Back 10

Immobility
Incontinence
Nutritional Status
Cardiovascular disease

Front 11

What are the three things you watch for in order to prevent pressure wounds?

Back 11

1. Identify patients at risk and take preventative measure

2. Norton Scale: Score <14 = High Risk

3. Braden Scale

Front 12

What are the four areas measured on the Norton scale?

Back 12

Physical Condition

Mental Condition

Activity

Mobility

Incontinent

Front 13

The following are measured on what scale?

Sensory perception

Moisture

Activity

Mobility

Nutrition

Friction and Shear

Back 13

Braden Scale

Front 14

With the Braden Scale the pressure sore risk _____ as score ______?

Back 14

With the Braden Scale the pressure sore risk increases as score decreases.

Front 15

What is considered mild risk on the Braden Scale?

Back 15

15-16

Front 16

What is considered moderate risk on the Braden Scale?

Back 16

12-14

Front 17

What is considered serious risk on the Braden Scale?

Back 17

<12

Front 18

What are the most common sites for pressure ulcers?

Back 18

Sacrum

Ischial Tuberosity

Trochanters

Malleoli

Heels

Elsewhere - Behind the ears with cannula, poorly fitting prosthetic devices over bony prominence.

Front 19

How often should you change the position of a patient?

Back 19

Every 2 hours

Front 20

You should place a patient at what angle, or on their side to avoid direct pressure on the lateral decubitus and trochanter?

Back 20

30 Degrees

Front 21

These are static devices that are used with lower risk patients, distribute local pressure over wider BSA. What four things are included?

Back 21

Mattresses or Overlays containing Gel, Foam, Air, Water.

Front 22

The dynamic devices, which are used for higher risk patients, or patients who already have ulcers (stage II-IV), include what?

Back 22

Beds with a power source that alternates air currents to regulate or redistribute pressure against the body.

Front 23

What is something you should not clean the skin with when it is a bed bound patient?

Back 23

Peroxide.

Front 24

What do you follow when watching a bed bound patient's nutritional status?

Back 24

Caloric Intake - Supplement if Necessary

Vitamin/Mineral Supplements - C, E, Zinc

Follow Serum - Albumin, Pre-Albumin

Front 25

What are the nutritional requirements/considerations for a bed bound patient?

Back 25

Protein intake of 1-1.2 g/kg/day

Total Caloric intake of 30 kcal/kg

Supplements

Front 26

Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area.

Back 26

Stage I Pressure Ulcer

Front 27

Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum filled blister.

Back 27

Stage II Pressure Ulcer

Front 28

Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling.

Back 28

Stage III Pressure Ulcer

Front 29

Full thickness tissue loss with exposed bone, tendon or muscle. Slough or escher may be present on some parts of the wound bed. Often include undermining and tunneling.

Back 29

Stage IV Pressure Ulcer

Front 30

Full thickness, but base is covered by slough or eschar, precluding exact determination of stage.

Back 30

Unstagable Pressure Ulcer

Front 31

Intact skin with localized purple or maroon discoloration or blood filled blister. May be difficult to detect in individuals with dark skin tone. These evolve rapidly.

Back 31

Suspected Deep Tissue Injury associated with Pressure Ulcers.

Front 32

Wound care is usually non operative for stages _ and _?

Back 32

I and II

Front 33

Stages III and IV Pressure Ulcers may require what for TX?

Back 33

Surgical intervention

Front 34

If you see a pressure ulcer surrounded by infection, you should suspect what?

Back 34

Sinus tract involvement, cellulitis, or malignancy.

Front 35

If you see poor healing associated with a pressure ulcer then you should consider what?

Back 35

Consider atypical lesion (malignancy, pyoderma gangernosa).

Front 36

What can you use to treat Pre-Ulcer and Stages I and II Pressure Ulcers?

Back 36

Emolients

Dressings

Pressure Relief

Front 37

What is used to TX Stages III and IV Pressure Ulcers?

Back 37

Wound Debridement:

Wet to Dry Dressing

Surgical Debridement

Mechanical Debridement

Chemical Debridement - Autolytic, Enzymatic

Front 38

This is aimed at removing all devitalized tissue that serves as a reservoir for ongoing bacterial contamination and possible infection.

Back 38

Debridement

Front 39

What are the primary principles of wound closure?

Back 39

Identifying potential injury to underlying structure

Local/Regional Anesthesia

Clean Wound

Wound Exploration

Wound Closure

Dressing

Front 40

What are the five main reasons for closure?

Back 40

Decrease time required to heal

Reduce risk of infection

Decrease scar tissue formation

Repair the function or structure

Improve the cosmetic appearance

Front 41

This is a wound made during a surgical procedure with proper aseptic technique. No involvement of respiratory, GU or GI tract contaminant.

Back 41

Clean Wound

Front 42

This is a wound that is a surgical incision with involvement of respiratory, GU or GI tract contaminant.

Back 42

Clean-contaminated Wound

Front 43

This is a wound that has gross spillage of bodily content into wounds (i.e. stool, bile). Traumatic wounds, including laceration are in this category.

Back 43

Contaminated Wound

Front 44

This is a wound with established infection before wound is made (abscess) or heavily contaminated wounds (e.g. bowel content).

Back 44

Infected Wound

Front 45

Wounds should be close within _ hours of injury?

Back 45

8 hours

Front 46

What are three contraindications to laceration repair?

Back 46

1. Wounds that have a high likelihood of contamination.

2. Animal or human bites on extremities and torso (exceptions made for face).

3. High pressure injection injuries (i.e. auto mechanics)

Front 47

When would you consider delayed closure of a wound?

Back 47

Consider with contaminated wounds or delayed presentation of patient for treatment.

Front 48

What are the four steps in preparing a wound?

Back 48

Anesthesia

Irrigation

Debridement

Cleaning

Front 49

What are the topical anesthetics used?

Back 49

Benzocaine

Tetracaine

Cocaine

Lidocaine

Front 50

What are the injectable injections used for anesthesia?

Back 50

Lidocaine

Mepivacaine

Prilocaine

Bupivacine

Procaine

Tetracaine

Front 51

Local anesthetic acts to block the conduction of nerve impulses by selectively binding to?

Back 51

Sodium channels

Front 52

Epinephrine is more effective with what, compared to what?

Back 52

Epinephrine is more effective with lidocaine than with bupivacaine.

Front 53

What are the absolute contraindications for using epinephrine?

Back 53

Untreated hyperthyroidism or phenochromocytoma.

Administration to areas of the body with single dependent blood supply: fingers, toes, penis, nose, and pinna of ear.

Front 54

Buffering anesthetic with this will eliminate burning sensation and increase onset of action.

Back 54

10% sodium bicarbonate

Front 55

Anesthetic will be less effective in what kind of tissue?

Back 55

Infected tissue

Front 56

If you are using a topical solution that contains epinephrine, what will happen at the site?

Back 56

It will blanch when the solution has been absorbed (may take 15-30 minutes for lidocaine).

Front 57

This is used to anesthetize adult nasal mucosa?

Back 57

Cocaine

Front 58

Adding this to 1% lidocaine achieves same effect as using plain 2% lidocaine.

Back 58

Epinephrine

Front 59

What is the maximum dose of lidocaine?

Back 59

3-5mg/kg

Front 60

What is the level of lidocaine where toxicities can be noticed?

Back 60

May be observed at 6 mcg/mL, but more commonly occur once levels exceed 10 mcg/mL

Front 61

What are the local complications associated with injections?

Back 61

Bruising

Edema

Infection

Prolonged or permanent nerve damage

Temporary motor nerve paralysis

Front 62

When the lidocaine dose is increased from __ to __ the risk of CNS toxicity increases from 10% to 80% symptoms.

Back 62

1mg/kg to 1.5mg/kg

Front 63

Method of anesthetic administration:

This is appropriate for small wounds. There is a rapid onset of action.

Back 63

Direct infiltration of wound

Front 64

Method of anesthetic administration:

Appropriate for procedures (LP, skin biopsy, abscess without surrounding infection).

Back 64

Direct infiltration of intact skin

Front 65

Method of anesthetic administration:

Larger areas, contaminated wounds

Back 65

Field Block

Front 66

What do you use to irrigate a wound with?

Back 66

Saline

Front 67

This closure material cannot be used on an area with hair, or on an area of tension.

Back 67

Dermabond

Front 68

This is similar strength to sutures, good for superficial wounds or skin tears.

Back 68

Steri strips

Front 69

This is good for scalp lacerations or large surgical incisions, this should NEVER be used on the face.

Back 69

Staples

Front 70

These sutures are absorbable and can be used for mucosal areas and deep sutures.

Back 70

gut, vicrayl, chromic

Front 71

What are the local complications associated with injections?

Back 71

Bruising

Edema

Infection

Prolonged or permanent nerve damage

Temporary motor nerve paralysis

Front 72

When the lidocaine dose is increased from __ to __ the risk of CNS toxicity increases from 10% to 80% symptoms.

Back 72

1mg/kg to 1.5mg/kg

Front 73

Method of anesthetic administration:

This is appropriate for small wounds. There is a rapid onset of action.

Back 73

Direct infiltration of wound

Front 74

Method of anesthetic administration:

Appropriate for procedures (LP, skin biopsy, abscess without surrounding infection).

Back 74

Direct infiltration of intact skin

Front 75

Method of anesthetic administration:

Larger areas, contaminated wounds

Back 75

Field Block

Front 76

What do you use to irrigate a wound with?

Back 76

Saline

Front 77

This closure material cannot be used on an area with hair, or on an area of tension.

Back 77

Dermabond

Front 78

This is similar strength to sutures, good for superficial wounds or skin tears.

Back 78

Steri strips

Front 79

This is good for scalp lacerations or large surgical incisions, this should NEVER be used on the face.

Back 79

Staples

Front 80

These sutures are absorbable and can be used for mucosal areas and deep sutures.

Back 80

gut, vicrayl, chromic

Front 81

These are nonabsorbable suture materials that are primarily used to close the skin.

Back 81

Silk, nylon, prolene

Front 82

What are the contraindications for dressing a wound?

Back 82

Skin allergy to adhesive material

Dressing that impairs circulation

Dry dressing that may stick to wound and cause loss of granulation tissue

Tape directly to skin (may cause skin tears in elderly)

Front 83

Scalp sutures should be removed when?

Back 83

6-8 days

Front 84

Face and Ear sutures should be removed when?

Back 84

4-5 days

Front 85

Chest/Abdomen, Arm/Leg, and Hand sutures should be removed when?

Back 85

8-10 days

Front 86

Back and Foot sutures should be removed when?

Back 86

12-14 days

Front 87

Fingertip sutures should be removed when?

Back 87

10-12 days

Front 88

You add 2-3 days to the time when a suture should be removed if?

Back 88

It is over a joint surface

Front 89

This is particularly important for the aftercare in extremity wounds.

Back 89

Elevation

Front 90

What body location uses the smallest suture size for repair?

Back 90

Eyelid percutaneous 7.0/6.0 monofilament

Front 91

What uses the largest suture material for repair?

Back 91

Foot/Sole percutaneous 4.0/3.0 monofilament