In each blank, try to type in the
word that is missing. If you've
typed in the correct word, the
blank will turn green.
If your not sure what answer should be entered, press the space bar and the next missing letter will be displayed. When you are all done, you should look back over all your answers and review the ones in red. These ones in red are the ones which you needed help on. Question: 2 of woundsAnswer: open & wounds Question: Answer: a separation of skin & tissue wit smooth, even edges Question: LacerationAnswer: separation of skin & in which the edges are torn & irregular Question: AbrasionAnswer: a in which the surface layers of skin are scraped away. Question: AvulsionAnswer: Stripping away of large areas of skin & underlying tissue, leaving & bone exposed. Question: UlcerationAnswer: shallow crater in which skin or membrane is missing Question: PunctureAnswer: an opening of skin, underlying tissue, or mucous membrane caused by a sharp, pointed object. Question: ContusionAnswer: Also called a BRUISE, Injury to soft tissue underlying the skin from the force of w/ a hard object. Question: Answer: damaged skin or soft results from trauma. Question: Answer: term referring to injury. Question: Open Answer: the surface of the skin or mucous membrane is no longer . Question: woundAnswer: there is no in the skin or mucous membrane occur from blunt trauma or pressure. Question: Granulation Answer: combination of new vessels, fibroblast & epithelial cells. Question: DehiscenceAnswer: the parting of the sutured lips of a wound. Question: Answer: protrusion of contents. Question: Three sequential Answer: , proliferation, remodeling. Question: InflammationAnswer: Starts immediately after injury, last 2-5 days, local damage, prepares wound for healing. Question: of InflammationAnswer: 1st stage-local , inflammation (edema), 2nd stage-phagocytosis, redness & warmth, cleaning of the injured area, 3rd pain 4th decrease function. Question: Normal Answer: 0.9% sodium . Question: Measure Answer: use qtip (does no hurt pt). Question: ProliferationAnswer: New cells fill & seal the wound, 2 days-3 wks after phase, Granulation tissue appear. Question: RemodelingAnswer: follows proliferation phase, may last 6mths to 2yrs, wound , scar shrinks. Question: Factors affecting wound Answer: type of wound injury, expanse or depth of wound, quality of circulation, amt of debris, presence of infection, status of the pt’s health. Question: 1st intention/Primary healingAnswer: wound edges are next to each other, small amt of scar tissue, surgical wound closely approx. ex:paper cut. Question: 2nd healing1Answer: wound edges are widely separated, margins are not in contact, a scar generally forms, presence of body fluid. Question: 2nd healing2Answer: wound debris w/in the wound will prolong the healing; disrupted granulation tissue will the healing process. Question: 3rd intention/tertiary Answer: Widely separated margins, closure material to bring edges 2gether,broad deep scar formation, usually deep, extensive drainage & tissue debris, may contain drains, may pack w/ absorbent gauze. Question: managementAnswer: promotes healing, goal is to reapproximate the tissue to integrity. Question: SerousAnswer: clear watery (ex. Blister) Question: SerosanguineousAnswer: pink, composed of & blood drainage. Question: SanguineousAnswer: Red, relating to . Question: Answer: Pus Question: Answer: keep wound clean, absorb drainage, controls bleeding, protection from further injury, holds medication in , maintains a moist environment. Question: Npo pain Answer: take 45 mins to work in body. Question: Sq pain Answer: take 30-35 mins to work in body. Question: pain medsAnswer: take 15-30 mins to work in body. Question: IV pain Answer: take 5-10 mins to work in body. Question: Pain Answer: Most analgesics have a 4-6 hr to work. Question: dressingsAnswer: woven fibers, highly absorbent, wound assessment can be difficult, granulation may adhere (stick), secured w/tape. Question: strapsAnswer: strips of tape w/eye lids that have a shoe lace it. Question: of gauze dressingsAnswer: for , to address wound drainage. Question: for uncovered woundAnswer: to irritation. Question: dressingAnswer: clear wound covering (opsite), assessment w/o removal, less bulky, no tape, non absorbent , common use: IV site. Question: dressingAnswer: self adhering, Opaque, air & water occlusive (duoderm), Keep wounds moist, intact for up to 1 wk, size generously. Question: Dressing Answer: wound nds assessment, requires care, dressing is , saturation, physician may assume responsibility for 1st change Question: Answer: means for removing blood & drainage, promotes healing, placement insertion, separate location besides the wound. Question: Open Answer: flat, flexible tubes, pathway for drainage the dressing, drains passively by gravity & capillary action secured w/ safety pin or clip, may shorten drainage decrease. Question: Closed Answer: tubes terminate into a (ie: Hemovac & Jackson-Pratt (jp) drain, more efficient than open drains, vacuum or negative pressure. Question: Answer: clean using circular motions, drain sponge or gauze. Question: of closuresAnswer: Sutures, , steri-strips/butterflies. Question: Answer: hold an incision 2gether, silk or synthetic (nylon), encircles the wound. Question: StaplesAnswer: wide metal clips, form a holding 2 wound margins 2gether. Question: -strips/butterfliesAnswer: closure of superficial lacerations, holds weak 2gether temporarily. Question: of staples over suturesAnswer: sutures will not compress the if it swells, & it does not encircle the wound. Question: BandagesAnswer: strip or roll of wrapped around a body part (ex: ace wrap). Question: BindersAnswer: type of bandage applied to a body part (ex: abd or breast). Question: /binders1Answer: hold dressings in place especially when tape cannot be used or the dressing is extremely . Question: /binders2Answer: Support the area around a or injury to reduce pain. Question: /binders3Answer: Limit movement in the area to promote healing. Question: of roller bandages1Answer: elevate/support the limb, wrap from closet (distal) to farthest (proximal), avoid gaps between each turn of the bandages, Exert equal but not , tension w/each turn. Question: Principles of bandages2Answer: keep bandage free of wrinkles, secure end of roller bandage w/metal , check the color/sensation of exposed fingers or toes often, remove bandage for hygiene/replace twice a day. Question: Styles of applicationAnswer: circular turn-wrap, spiral turn-cylindrical, spiral reverse turn, figure 8 turn-joints, turn-variation, Recurrent turn-beneficial. Question: Binder Answer: not commonly used, replaced by commercial devices, T-binder, used to secure a dressing to anus or perineum or w/in the . Question: Answer: removal of dead tissue, healing, 4 methods: sharp, enzymatic, autolytic, mechanical. Question: Sharp Answer: removal or necrotic tissue, sterile scissors, forceps or instruments, preferred for infected wound, preformed @ bedside or in surgery, Painful, Bleeding may occur. Question: Answer: hard necrotic tissue (black) on location & Dr.’s order may be removed. Question: debridementAnswer: topically chemical substances; wound debris is broken down & liquefied, dressing keeps enzyme in contact w/ wound, uninfected wounds, poor tolerance to sharp debridement. Question: Autolytic Answer: small wound, infection free, prolonged time to results, painless, natural physiological process, occlusive or semi-occlusive dressing, monitor for s/s of infection. Question: Mechanical Answer: Wet to dry dressing, remove after 4-6 hrs, dead adheres to gauze mesh work, painful, disrupts or removes healthy tissue. Question: Mechanical Answer: Hydrotherapy, submerged in a whirl pool tank, antiseptic solution, agitation softens dead tissue, sharp debridement for debris. Question: Mechanical Answer: Irrigation (uses normal to clean out area), flushing debris, wound care, cleaning eyes, ears & vaginal. Question: irrigationAnswer: used before applying new dressing, tissue has formed. Question: irrigationAnswer: also know as douche, sometimes necessary to treat an . Question: Eye Answer: flushes toxic chemical from one or both eyes, dried mucous or other drainage, warm solution to body temp. Question: Ear Answer: Removes debris, perform gross inspection 1st, contraindicated w/ a perforated ear drum, avoid occluding ear canal w/ syringe, trapped can cause rupture of ear drum, loose cotton ball to absorb drainage. Question: Heat Answer: Provides warmth, promotes circulation, speeds healing, relieves muscle spasm, pain. Question: Cold Answer: Reduces fevers, swelling, controls bleeding, relieves pain, numbs sensation. Question: Cold Answer: Ice bag/ice : containers for holding ice, improvised version, reduce swelling, applied after tonsil removal, small injures. Question: Chemical Answer: strike or crush to , included in 1st aid kits, commercial cold packs 1 time use, gel packs for hot or cold are reusable, store in freezer/heat in microwave. Question: CompressesAnswer: moist, warm, or cool cloth, appropriate temp, plastic wrap, remove excess moisture, gloves if to draining wound, aseptic surgical technique if open wound. Question: Aquathermia Pad (k-pad) Answer: electrical heating or cooling device, use alone or cover over a compress, temp by thermostat, altered body temps. Question: Aquathermia Pad (k-pad) Answer: Nurse responsibility, assess skin freq, remove device , cover pad to prevent thermal skin damage, monitor Vs closely pt w/ altered body temp. Question: & moist packsAnswer: body part to warm or apply medication, keep temp constant, never use pack on unresponsive or paralyzed pt, potential for burn, freq assessment, remove park periodically. Question: Therapeutic Answer: Non hygienic purpose, fever reducer, application of medicated substances, reduce discomfort, soda, cornstarch or oatmeal paste bath, most common is sitz bath. Question: Therapeutic Answer: Nurse responsibility: assess temp of application freq, monitor skin condition, avoid direct contact between skin & heating device, exposure of skin to extremes of temp can in injures, use cautiously in children younger than 2 & older adults, pt w/ Question: ulcers(decubitus ulcers)/bedsoresAnswer: caused by prolonged capillary compression, resulting in impaired circulation to skin & underlying tissue, reddened area over bony prominence that go back to normal color when pressure is released. Question: ulcer risk factors1Answer: Inactivity, immobility, malnutrition, emaciation, diaphoresis, sweating, really thin. Question: Pressure risk factors2Answer: Incontinence, vascular disease, localized edema, sedation. Question: Pressure Answer: May also develop over elbows, shoulder blades, back of head, & places of unrelieved pressure d/t infreq movement, primary goal: , nursing measure: reduce size & restore integrity. Question: Prevention of pressure Answer: identify pt w/ risk factors. Reduce under which pressure ulcers are likely to form. Question: Pressure ulcers 1Answer: but red skin. Question: Pressure stage2Answer: red, . Question: Pressure ulcers Answer: shallow skin crater extends sq tissue, yellowing of cells called slough. Question: Pressure ulcers stage Answer: life threatening, deeply ulcerated, bone & muscle exposure, dead tissue may cause sepsis. Question: Nursing diagnosis r/t Answer: Acute pain, impaired skin integrity, ineffective tissue perfusion, tissue integrity, risk for infection. Question: considerations1Answer: wound healing delayed in older adults d/t diminished collagen, blood supply, decreased quality of elastin, dermal layer becomes thinner, decreased amt of sq . Question: Gerontologic considerations Answer: immune response increases risk for infection, absorbent under garments may contribute to skin break down, co morbidities may delay wound healing diminished mobility. |
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