A diabetic foot ulcer that has penetrated through the subcutaneous tissue to involve tendon/ligament/joint capsule w/out abscess or Ostemyelitis (osteoM) is classified as which Wagner grade?
Grade 4
Grade 5
Grade 3
Grade 2
Grade 2
According to the widely used Wagner classification system, diabetic foot ulcers are graded from 0 to 5 based on the depth of tissue involvement & the presence of infection, osteomyelitis, or gangrene. Grade 2 ulcers penetrate the subcutaneous tissue & may expose bone, tendon, ligament, or joint capsule w/out abscess formation or osteoM
Which of the following is not a sign of zinc deficiency?
Slow wound healing
Spoon-shaped nails
Loss of taste
Thin, sparse hair
Spoon-shaped nails
Concave, spoon-shaped nails indicate insufficient iron level in the body. The other symptoms-thin, sparse hair; loss of taste; and slow wound healing- are associated with zinc deficiency.
Thin, sparse hair; loss of taste; and slow wound healing- are associated with____ deficiency.
zinc
What legal documentation is essential to palliative wound care, particularly regarding patient preferences?
Treatment plan
Power of Attorney
Living Will
Consent form
Living will
A living will is legally recognized document that outlines a patient's preferences for medical treatment, including palliative care. It explicitly states which interventions the patient does or does not want, providing clear guidance to healthcare providers. This document is particularly valuable in palliative wound care, as it ensures the treatment plan aligns w/the patient's wishes & respects their autonomy.
What legal documentation designate someone to make healthcare decisions on behalf of the the patient if they become unable to do so themselves. It's a back up measure to the living will, the living will takes precedence for medical treatment.
Power of attorney
What legal documentation gives permission for specific treatment or procedures. They are crucial for informed consent but lack the comprehensive scope of a living will, which details preferences across various medical situations, including palliative care, thus offering broader legal guidance.
Consent forms
Empiric treatment of severe diabetic foot infection involves which of the following antibiotics?
Ampicillin/sulbactam
Cephalexin
Vancomycin
Amoxicillin/clavulanate
Ampicillin/sulbactam
For severely infected ____ ___ ___, initiate antibiotic therapy intravenously, then switch to oral administration once the patient improves.
diabetic foot wound
What are the recommended empiric treatment options for DFU.
Ampicillin/sulbactam 2.1 g IV every 6hrs plus ciprofloxacin 750mg PO BID (twice daily)
This empiric treatment option is for what type of wound?
Ampicillin/sulbactam 2.1 g IV every 6hrs plus ciprofloxacin 750mg PO BID (twice daily)
DFU that is severly infected
Cephalexin & amoxicillin/clavulanate (Augmentin) are indicated for ___ ___ __ __ (oral therapy for the entire course).
mild to moderate infections
What antibiotic is reserved for life threatening infections and requires prolonged IV Therapy?
Vancomycin
Which of the following study designs is considered the gold standard of research?
Case series or case reports
Cohort studies
Case-control studies
Randomized controlled trials
Randomized controlled trials
RCTs are considered the gold standard of research: participants are randomly allocated to either a treatment (intervention) group or a control group (receiving placebo or standard treatment)
Meta-analysis & randomized controlled trials (RCTs) are ranked as the__ __ ___ because their designs minimize the biases and systematic errors.
highest levels of evidence
What type of approach is where neither participants nor researches know assignment-further reduces bias & threats to validity, including the placebo effect
Double-blind approach
A nurse is changing a dressing on a patient and notes red drainage both on the old dressing, and oozing from the wound bed. What type of exudate is this?
Sanguinous
Sanguinous exudate is thin, watery, and bloody (red) in appearance. Its presence indicates new blood vessel growth or disruption of existing vessels, and it is normal during the proliferative phase of wound healing. Propliferative Phase- the third stage of wound healing, generally lasting from day 4 to day 21 post-injury.
What stage of wound healing is the 3rd stage and generally lasts 4 to 21 days, where new blood vessel growth, or disruptions of existing vessels takes place.
Propliferative Phase
____ exudate is thin, clear, to straw-colored, and also normal during the Proliferative phase (3rd phase).
Serous
______ exudate is thin, watery, and pink to light pink; it is normal during the inflammatory and proliferative phases.
Serosanguineous exudate
Common in the Inflammatory (1st / critical stage), and the Proliferative phase (3rd phase).
______ is the critical first phase in the wound healing process. Beginning immediately upon injury, it aims to stop bleeding and clean the wound bed of bacteria and debris. last 2-6 days.
Inflammatory phase
How long does the first / critical phase, the inflammatory phase last?
Beginning immediately upon injury, it aims to stop bleeding and clean the wound bed of bacteria and debris. Typically lasts for the first 2 to 6 days and is characterized by swelling, redness, pain, and heat
_____ ______ is medical treatment started based on clinical experience and an "educated guess" before a definitive diagnosis or test result is confirmed.
Empiric treatment (or empiric therapy)
Empiric treatment (or empiric therapy)
A treatment that is initiated based off of an educated guess, or clinical experience?
A patient has a surgical wound resulting from a skin tissue biopsy. Which surgical wound classification does this wound receive?
Class II
Class III
Class I
Class IV
Class I
A surgical wound from skin tissue biopsy is considered a Class 1 (clean) wound. The biopsy specimen is obtained from clean tissue using a scapel or punch bipsy, and the bleeding is controlled. There is no traumatic injury or inflammation during the procedure, and steril technique is maintained throughout.
A 69 year old male patient w/diabetes present w/foot ulcer. He reports a mild allergy to latex and is concerned about the cost of treament. Which dressing is most appropriate?
Latex gauze dressing
Latex-containing hydrocolloid dressing
Alginate dressing
Silicone foam dressing
Silicone foam dressing
Silicone foam dressing is the most appropriate choice for this patient. It is latex-free, avoiding any risk of allergic reaction-and offers effective exudate management and wound protection at a reasonable cost.
RE: A male pt. worried about cost w/DFU and latex allergy. Which dressing option describles the below dressing type. Read thoroughly!
___ __ are excellent for high exudate wounds such a DFUs, they can be more expensive and do not address the patient's latex allergy.
Alginate dressing
What is the standard treatment for chronic venous insufficiency?
Pharmacologic management
Exercise
Compression therapy
Weight control & dietary modifications
Compression Therapy
Compression therapy is the standard treatment for chronic venous insufficiency. Because venous insufficiency is associated w/increased hydrostatic pressure in the leg veins, compression therapy reduces that pressure & aids venous return.
____ ___ in leg veins is the physical force exerted by the weight of the blood column against the vein walls, heavily influenced by gravity.
Hydrostatic pressure
A patient has been prescribed silver sulfadiazine cream for a burn wound. Pt. education regarding this topical agent should include which of the following?
Do not use it for longer than 2 weeks
This medication penetrates burn eschar well, making it useful when an infections is suspected or vascular supply is limited
This medication is safe for use during pregnancy
There may be some pain associated w/the application of this cream
Do not use it for longer than 2 weeks
___ _____ is a topical antibiotic effective against both grampositive and gram-negative organisms, as well as some fungi. It is the indicated for second-and thrid degree burns.
Silver Sulfadiazine
Key teaching points for ____ _____
- Limit use to no more than 2 weeks
- Do not use in pregnant women, neonates, or pts w/sulfonamid allergy
- Application is usually comfortable & soothing; pain is NOT typically associated w/its use.
Silver sulfadiazine
___ ___ not silver sulfadiazine- penetrates eschar more effectively and is preferred when infection is suspected or vascular supply is minimal.
Mafenide acetate
Which classification of pressure ulcer is characterized by wound presenting w/non-blanchable erythema of intact skin?
Suspected deep tissue injury (sDTI)
Unstageable
Stage I
Stage II
Stage I
Stage I pressure ulcers present as intact skin w/non-blanchable erythema localized over a bony prominence.
What stage ulcer presents with intact skin, and with non blanchable erythema localized over a bony prominence?
Stage I
A suspected ___ ___ __ looks like an area of intact or non-intact skin with localized purple or maroon discoloration, or a blood-filled blister. The affected area often feels different from the surrounding skin—it can be painful, firm, mushy, boggy, warmer, or cooler to the touch.
deep tissue injury (sDTI)
Which of the following conditions is not an acute complication of major burns?
Pneumonia
Wound infection
Acute renal failure (ARF)
Cellulitis
Acute renal failure (ARF)
Can you guess the top 5 without looking?
The top acute complications of major burns include:
Pneumonia
Wound infection
Cellulitis
Respiratory failure
Urinary tract infection
Which of the following statements about herpes simple virus (HSV) is false?
Vesicles are uniformly shaped and grouped
HSV-1 is associated w/cold sores, while HSV-2 causes genital and perianal herpes
Erythema indicates a secondary infection
HSV infections occur in two phases; primary & secondary
Erythema indicates a secondary infection
HSV 1
Oral herpes
HSV has two phases: Primary infection & a secondary phase
During the primary infection-
Your body’s very first encounter with the virus (HSV-1 or HSV-2)
Significant inflammatory response extends from the base of the lesions into the dermis, resulting in the classic presentation of uniform, grouped vesicles on an erythematous base. Can also cause fatigue, flu-like symptoms, swollen lymphnodes that can last up to 3 weeks.
HSV can be confirmed with a ___ ___.
Tzanck smear
HSV I Secondary phase :
Refers to latency, the dormant period that follows the initial outbreak. During this phase, the virus retreats into the nerve cells near the spine (the trigeminal ganglion for oral herpes) where it remains inactive, causing no symptoms but staying in the body permanently
HSV secondary phase:
the blistering stage of a standard outbreak (the second localized stage after initial tingling), or a recurrent outbreak (subsequent outbreaks after the initial primary infection)
What should be emphasized as the primary goal when educating a new physician about wound care?
Applying evidence-based practices.
This is the primary goal when educating a new physician about wound care. Without evidence, clinical practice rapidly becomes outdated. Evidence based wound care ensures that treatment decisions are informed by the latest & most effective research.
Evidence based practice integrates:
Individual clinical experience, the best available evidence, and patient preferences to guide decision-making.
In management of the second-degree burn (superficial dermal injury), which of the following interventions is not appropriate?
Cleanse & debride broken blisters
Perform early surgical grafting
Apply nonadherent dressings or CTPs
Leave intact blisters alone unless they interfere w/movement
Perform early surgical grafting
Surgical grafting is reserved for deep dermal second-degree injuries & third-degree burns; it is not indicated for superficial dermal (superficial second-degree) burns.
Surgical grafting is for deep dermal second degree injuries & third degree burns
True or false
True
In management of a second-degree burn (superficial dermal injury), are the following interventions appropriate?
Cleanse & debride broken blisters
Apply nonadherent dressings or CTPs
Leave intact blisters alone unless they interfere w/movement
Yes
Which of the following is not a sign of zinc deficiency?
Loss of taste
Slow wound healing
Thin, sparse hair
Spoon-shaped nails
Spoon-shaped nails
This indicates insufficient iron levels
What is the primary function of fibroblasts?
To participate in the biosynthesis of collagen to form the extracellular matrix (ECM)
To promote cell migration, proliferation, and angiogenesis
To facilitate the reepithelialization & formation of granulation tissue
To control infection as long as the wound remains open
To participate in the biosynthesis of collagen to form the extracellular matrix (ECM)
Fibroblasts migrate to the wound area along fibrin strands of the wound clot & synthesize ground substance and collagen to form the ECM.
____ are involved in the cell adhesion & signaling during wound healing, play a critical role in reepithelialization & granulation tissue formation.
Intergrins
___ ___ promote cell migration, proliferation, and angiogenesis
Growth factors
Growth factors are: naturally occurring proteins that act as chemical messengers in the body
Which of the following indicators would most effectively help a wound care nurse evaluate a patient's adherence to a wound dressing regimen?
Improvement in healing rate & wound appearance
Patient's verbal confirmation of adherence
Prescription refill frequency
Number of missed appointments.
Improvement in healing rate & wound appearance
This is the most objective / direct objective evidence that the treatment plan is both followed and effective.
How soon after a patient is diagnosed w/malnutrition should they receive a malnutrition care plan?
Immediately
Within 24hrs
Within 48hrs
Within 12hrs
Immediately
Why delay?
What primarily occurs during the first phase of wound healing?
Granulation
Angiogensis
Inflammation
Clotting
Clotting
During the __ __ __ ____ hemostasis-platelets adhere to the injured vessel wall, forming a platelet plug & generating thrombin to initiate the coagulation cascade. * This clot formation stops bleeding & creates a provisional ECM that supports subsequent inflammatory & repairative processes.
first phase of wound healing
What do the phases below represent?
1. Hemostatis (clotting)
2. Inflammation (erythema, edema, and neutrophil-mediated debris removal)
3. Proliferation/granulation (fibroblast-driven collagen synthesis & new tissue formation.
4. Maturation/remodeling (collagen reorganiztion and scar contaction)
The four primary phases of wound healing
Which intervention is most appropriate for a patient w/a high risk of skin breakdown due to incontinence?
Application of an antimicrobial ointment
Frequent repositioning
Increased use of absorbent pads
Application of moisture barrier
Application of moisture barrier
Protect against irritants such as urine, feces, and sweat. Moisture barriers are creams, ointments, or films that create a protective layer over the skin, preventing moisture-induced irritation & breakdown.
What is the recommended daily allowance (RDA) of protein for a healthy person?
0.5 g/kg/day
2.2 g/kg/day
0.8 g/kg/day
1.2 g/kg/day
0.8 g/kg/day
This is the RDA for protein per kilogram of body weight per day. After injury or during periods of catabolic stress, protein needs may increase to approx. 1.5 g/kg/day.
True / False
Older adults often require LESS protein than younger individuals.
False
* they often require more.