WOCN Wound Exam questions and correct answers latest update

WOCN Wound Exam questions and correct answers latest update Goals of wound assessment 1. Determine etiologic factors 2. Assess systemic factors/comorbidities 3. Assess wound to determine phase of healing 4. Determine goals of topical therapy Why does hyperglycemia affect wound healing? Impairs leukocyte function and negatively impacts collagen syntehesis, development of tensile strength, epithelial resurfacing What BG parameters should be maintained for wound healing? BG 180 for leukocyte function; 140 for healing A1C 7 for most, 8 if hx of severe hypoglycemia, advanced comorbidities, limited life expectancy Why is nutrition relevant to wound healing? Muscle or SubQ wasting increases risk of pressure/shear damage malnourished pt unable to synthesize and cross-link collagen normally protein deficiency increases risk of infection What effect do low zinc levels have on wound healing? compromise collagen synthesis/crosslinking What amino acids are essential for collagen synthesis? What is the effect of stress on these amino acids? Glutamine and l-arginine Not adequately produced during times of physiologic stress What weight trend suggests nutritional deficiency? Unplanned weight loss =2.5% of usual weight in 30 days or =10% within 180 days BMI 18.5 What serum albumin level indicates malnutrition? 3.5 g/dl What serum transferrin level indicates malnutrition? 100mg/dl What serum prealbumin level indicates malnutrition? 19.5 What total lymphocyte count level indicates malnutrition? 1500 What are s/s of nutritional deficits? skin rashes, cracks in mucous membranes, edema, muscle and subQ tissue wasting, nonhealing wounds, dry/pluckable hair, dry flaky itchy skin What is the suggested caloric intake? 30-35 cal/kg body weight What is the suggested protein intake? 1.25-1.5 g/kg body weight What is the suggested fluid intake? 30ml per kg (unless fluid restriction indicated) How do you assess perfusion/oxygenation? capillary refill, pulses, presence/absence of edema, TcpO2 levels (at least 40), color of wound bed (bright pink/red), ABI for lower extremity ulcers, systolic bp/episodes of hypotension, vasopressor administration How do you assess for immunosuppression? Comorbidities/therapies such as HIV, steroid tehrapy in doses 30mg/day for 30 days, and/or chemo resulting in neutropenia; high dose NSAIDs What comorbidities compromise wound healing? renal failure, liver failure, multisystem trauma, smoking, advanced age What are the layers of the skin Epidermis Basement Membrane Zone Dermis Subcutaneous Tissue Muscle/Fascia/Bone What are the layers of the epidermis? Stratum corneum - keratinocytes filled with keratin Stratum lucidum - only in palms/soles, thick areas Stratum granulosum - odland bodies secrete ceramides, lipophilic Stratum spinosum - desmosomes (cell to cell junctions) Stratum germinativum - dermal-epidermal junction What is the Basement Membrane Zone? Dermal-epidermal junction What are the components of the dermis? Papillary dermis: papillae interlock with rete ridges, capillary loops, sensitive to point pressure Reticular dermis: mostly type 1 collagen, vasculars, and lymphatics What structures of the skin can regenerate? Epidermis and parts of the dermis What structures of the skin heal by scar formation? Epidermal appendages, Subcutaneous tissue/fascia/muscle How is newborn skin different? No scars up to 2nd trimester 30% thinner skin Faster epidermal turnover How is premature infant skin different? Very thin, increased fluid loss, functional stratum corneum at 30-32 weeks What problems may arise with infant skin? increased permeability, increased MARSI risk, extravasation, diaper dermatitis How do you mitigate MARSI risk in infants/elderly? avoid tape or use hydrocolloid base or silicone adhesive, no alcohol removers only mineral oil, petroleum, silicone (preferred), and citrus) How do you mitigate extravasation in an infant? Hyaluronidase OR phentolamine if vasoconstrictor How do you mitigate diaper dermatitis? Higher pH Use petroleum base for mild erythema and zinc oxide for denuded skin sever denudation - carboxymethylcellulose/petrolatum/zinc oxide (Ilex) What bathing considerations must you take for premature infants? 30 weeks bathe with water only for 2 weeks What are common issues with older skin? Thinner, collagen shrinks and causes wrinkles Rete ridges and dermal papillae flatten - increased risk for tears/stripping Reduced sebaceous and sweat glands - dry skin Erratic/decreased melanin production Decreased sensation - increased trauma risk Loss of SubQ tissue - increased shear and decreased insulation Increased malignant lesions - refer to derm Reduced blood flow, increased epidermal turnover - slow healing Increased senescense Maybe increased inflammatory mediators, decreased inhibitors Increased capillary fragility (bruises) What strategies keep skin healthy?