NSE211 Clinical Placement Exam Questions
And Verified Answers Graded A+
Types of Wound Healing:
Primary intention
Secondary intention
Tertiary intention
Primary intention
Healing takes place when wound margins are neatly approximated or closed and risk for infection is
low - surgical wound or paper cut
Inflammatory Phase:
The granulation (proliferative/reconstruction) phase:
Maturation phase and scar contraction
Secondary intention
Wounds with wide or irregular wound margins that cannot be approximated with deal by secondary
intention
Tertiary intention
Delayed primary intention
Wounds that have become infected so they are sutured at a later date when infection is controlled
Adhesions
Bands of scar tissue that form between or around organ - abdominal cavity or between lungs and
pleural
Contractures
Shortening of muscle or scar tissues specifically over joints result of excessive fibrous tissue formation
Contracture often occur in burn injuries
Dehiscence
Dehiscence is the separation and disruption of previously joined wound edges - occurs usually when
primary healing site bursts open
Evisceration
Evisceration wound edges separate to the extent that intestines protrude through wound
Infection
Increased risk when it contains necrotic tissue, decreased blood supply, immune function depressed,
malnourished, multiple stressors or diabetic
Hemorrhage
Blood loss caused by suture failure, clotting abnormalities, dislodged clot, infection, or erosion of
blood vessel by foreign object (tubing, drains) or infection process
Scars
,Hypertrophic scar - form when body produces excess collagen is inappropriately large, red, raised,
and hard - confined to wound edges and regresses in time
Keloid - protrusion old scar tissue that extend beyond wound edges and could form tumor-like masses
- does not subside
Fistula
Abnormal passage that forms between organs or a hollow organ and skin
RICE
rest, ice, compression, elevation
Calories role in wound healing
Fuel for cell energy "protein protection"
Protein role in wound healing
Fibroplasia, angiogenesis (new blood vessel formation), collagen formation, and wound remodeling,
immune function
Vitamin C (ascorbic acid)
Collagen synthesis, capillary wall integrity, fibroblast function, immunological function, antioxidant
Vitamin A
Epithelialization, wound closure, inflammatory response, angiogenesis, collagen formation
Can reverse steroid effects on skin and delayed healing
Vitamin E
No known role in wound healing, antioxidant
Zinc
Collagen formation, protein synthesis, cell membrane and host defenses
Fluid
Essential fluid environment for all cell functions
Factors delaying wound healing:
Absorption problem (crohn's liver disease), high energy demand (sepsis, fever, malignancy, trauma),
Aging skin (thinning epidermis)
Smoking and its impact on wound healing
Nicotine is a potent vasoconstrictor and impedes blood flow to healing areas, which results in tissue
ischemia and impairs wound healing
Corticosteroid drugs and its impact on wound healing
Impair phagocytosis by WBCs, inhibit fibroblast proliferation and function, depress formation of
granulation tissue, inhibit wound contraction
,Infection and its impact on wound healing
Increases inflammatory response and tissue destruction
Anemia and its impact on wound healing
Reduces supply of oxygen to tissues
Advanced age and its impact on wound healing
Slows collagen synthesis by fibroblasts, impairs circulation, imposes need for longer time for
epithelialization of skin
Obesity and its impact on wound healing
Decreases blood supply in fatty tissue
Diabetes melitus and its impact on wound healing
Decreases collagen synthesis retards early capillary growth, impairs phagocytosis (result of
hyperglycemia), reduces supply of O2 and nutrients as a result of vascular disease
Poor general health and its impact on wound healing
Causes generalized absence of factors necessary to promote wound healing
Mechanical friction on wound and its impact on wound healing
Destroys granulation tissue, prevents apposition of wound edges
Cold temperature and its impact on wound healing
Decreases cellular activity and fibroblast proliferation
Excessive moisture and its impact on wound healing
Promotes formation of hypergranulation tissue, which prevents migration of epithelial cells
Hypertonic
Go on dry and are of benefit to draining wet wounds
Contains sodium which pulls out interstitial fluid, decreases edema to improve blood flow to tissue
surrounding the wound and establishes a negative environment for bacteria growth
Come in ribbon, sheet, or gel form and must be changed 24-48 hours
Cadexomer (Iodosorb)
Available in sheets or tube provide toxicity of iodine in starch matrix
Iodine goes into the wound bed in controlled fashion targeting bacteria
Silver dressings
Antimicrobial effects against 150 different pathogens
, Require moisture to be activated either from wound bed exudate or with hydrogel laid down on base
of wound
Honey (medical-grade)
Comes in paste, colloid, alginate, gel
Has antimicrobial properties and is effective as it changes wound pH creating negative environment
for bacteria proliferation and produces hydrogen peroxide
Also decrease wound odor - may be used in pilonidal cyst
Cause increase in drainage requiring more frequent dressing changes
Gentian violet/methylene blue
Provides bacteriostatic coverage to help manage wound bioburden and protect against infection -
MRSA, VRE and Candida
Effectiveness is indicated by change in color and moisture in dressing will become white
Negative pressure wound therapy
Machine applies localized negative pressure to surface and margins of wound pulling up base of
wound and enhancing healing rates
Good for wounds that need rapid healing
Woven gauze dressing
Provides minimal absorption of exudate
Supports debridement if applied and kept moist and can be used as filler dressing in sinus tracts -
clean and pack a wound
When packing dry wound saturate it in hydrogel to hydrate dry wound
Gauze island dressing can be used to over clean wound with little or no drainage
Island dressing is Gauze pad + adhesive fabric
Acute wound packed with saline-moistened nonwoven gauze
Transparent film dressing
Semipermeable membrane that permits gaseous exchange between the bed and environment
Minimally absorbent so that environment is kept moist in presence of exudate - trap wounds
moisture of the wound
Bacteria does not penetrate membrane
Used for dry, noninfected wound, wound with minimal drainage or stage 1 pressure ulcer to prevent
friction and shear
Useful to secure IV lines and other tubing b/c provide occlusive barrier
Difficult to remove require lateral pull (press one hand down on it and pull)
Can be used to affix gauze, secondary dressing, provide autolysis for small wounds
Non-adherent dressing
Woven or nonwoven dressing may be impregnated with petrolatum or antimicrobial medications,
minimally absorbent.
Provide protection to fragile granulating tissue while allowing interstitial fluid and moisture from
wound to evaporate - provide moist healing
Used on minor wounds or skin tears
Soft silicone dressing
Composed of silicone that functions as an atraumatic wound contact layer
And Verified Answers Graded A+
Types of Wound Healing:
Primary intention
Secondary intention
Tertiary intention
Primary intention
Healing takes place when wound margins are neatly approximated or closed and risk for infection is
low - surgical wound or paper cut
Inflammatory Phase:
The granulation (proliferative/reconstruction) phase:
Maturation phase and scar contraction
Secondary intention
Wounds with wide or irregular wound margins that cannot be approximated with deal by secondary
intention
Tertiary intention
Delayed primary intention
Wounds that have become infected so they are sutured at a later date when infection is controlled
Adhesions
Bands of scar tissue that form between or around organ - abdominal cavity or between lungs and
pleural
Contractures
Shortening of muscle or scar tissues specifically over joints result of excessive fibrous tissue formation
Contracture often occur in burn injuries
Dehiscence
Dehiscence is the separation and disruption of previously joined wound edges - occurs usually when
primary healing site bursts open
Evisceration
Evisceration wound edges separate to the extent that intestines protrude through wound
Infection
Increased risk when it contains necrotic tissue, decreased blood supply, immune function depressed,
malnourished, multiple stressors or diabetic
Hemorrhage
Blood loss caused by suture failure, clotting abnormalities, dislodged clot, infection, or erosion of
blood vessel by foreign object (tubing, drains) or infection process
Scars
,Hypertrophic scar - form when body produces excess collagen is inappropriately large, red, raised,
and hard - confined to wound edges and regresses in time
Keloid - protrusion old scar tissue that extend beyond wound edges and could form tumor-like masses
- does not subside
Fistula
Abnormal passage that forms between organs or a hollow organ and skin
RICE
rest, ice, compression, elevation
Calories role in wound healing
Fuel for cell energy "protein protection"
Protein role in wound healing
Fibroplasia, angiogenesis (new blood vessel formation), collagen formation, and wound remodeling,
immune function
Vitamin C (ascorbic acid)
Collagen synthesis, capillary wall integrity, fibroblast function, immunological function, antioxidant
Vitamin A
Epithelialization, wound closure, inflammatory response, angiogenesis, collagen formation
Can reverse steroid effects on skin and delayed healing
Vitamin E
No known role in wound healing, antioxidant
Zinc
Collagen formation, protein synthesis, cell membrane and host defenses
Fluid
Essential fluid environment for all cell functions
Factors delaying wound healing:
Absorption problem (crohn's liver disease), high energy demand (sepsis, fever, malignancy, trauma),
Aging skin (thinning epidermis)
Smoking and its impact on wound healing
Nicotine is a potent vasoconstrictor and impedes blood flow to healing areas, which results in tissue
ischemia and impairs wound healing
Corticosteroid drugs and its impact on wound healing
Impair phagocytosis by WBCs, inhibit fibroblast proliferation and function, depress formation of
granulation tissue, inhibit wound contraction
,Infection and its impact on wound healing
Increases inflammatory response and tissue destruction
Anemia and its impact on wound healing
Reduces supply of oxygen to tissues
Advanced age and its impact on wound healing
Slows collagen synthesis by fibroblasts, impairs circulation, imposes need for longer time for
epithelialization of skin
Obesity and its impact on wound healing
Decreases blood supply in fatty tissue
Diabetes melitus and its impact on wound healing
Decreases collagen synthesis retards early capillary growth, impairs phagocytosis (result of
hyperglycemia), reduces supply of O2 and nutrients as a result of vascular disease
Poor general health and its impact on wound healing
Causes generalized absence of factors necessary to promote wound healing
Mechanical friction on wound and its impact on wound healing
Destroys granulation tissue, prevents apposition of wound edges
Cold temperature and its impact on wound healing
Decreases cellular activity and fibroblast proliferation
Excessive moisture and its impact on wound healing
Promotes formation of hypergranulation tissue, which prevents migration of epithelial cells
Hypertonic
Go on dry and are of benefit to draining wet wounds
Contains sodium which pulls out interstitial fluid, decreases edema to improve blood flow to tissue
surrounding the wound and establishes a negative environment for bacteria growth
Come in ribbon, sheet, or gel form and must be changed 24-48 hours
Cadexomer (Iodosorb)
Available in sheets or tube provide toxicity of iodine in starch matrix
Iodine goes into the wound bed in controlled fashion targeting bacteria
Silver dressings
Antimicrobial effects against 150 different pathogens
, Require moisture to be activated either from wound bed exudate or with hydrogel laid down on base
of wound
Honey (medical-grade)
Comes in paste, colloid, alginate, gel
Has antimicrobial properties and is effective as it changes wound pH creating negative environment
for bacteria proliferation and produces hydrogen peroxide
Also decrease wound odor - may be used in pilonidal cyst
Cause increase in drainage requiring more frequent dressing changes
Gentian violet/methylene blue
Provides bacteriostatic coverage to help manage wound bioburden and protect against infection -
MRSA, VRE and Candida
Effectiveness is indicated by change in color and moisture in dressing will become white
Negative pressure wound therapy
Machine applies localized negative pressure to surface and margins of wound pulling up base of
wound and enhancing healing rates
Good for wounds that need rapid healing
Woven gauze dressing
Provides minimal absorption of exudate
Supports debridement if applied and kept moist and can be used as filler dressing in sinus tracts -
clean and pack a wound
When packing dry wound saturate it in hydrogel to hydrate dry wound
Gauze island dressing can be used to over clean wound with little or no drainage
Island dressing is Gauze pad + adhesive fabric
Acute wound packed with saline-moistened nonwoven gauze
Transparent film dressing
Semipermeable membrane that permits gaseous exchange between the bed and environment
Minimally absorbent so that environment is kept moist in presence of exudate - trap wounds
moisture of the wound
Bacteria does not penetrate membrane
Used for dry, noninfected wound, wound with minimal drainage or stage 1 pressure ulcer to prevent
friction and shear
Useful to secure IV lines and other tubing b/c provide occlusive barrier
Difficult to remove require lateral pull (press one hand down on it and pull)
Can be used to affix gauze, secondary dressing, provide autolysis for small wounds
Non-adherent dressing
Woven or nonwoven dressing may be impregnated with petrolatum or antimicrobial medications,
minimally absorbent.
Provide protection to fragile granulating tissue while allowing interstitial fluid and moisture from
wound to evaporate - provide moist healing
Used on minor wounds or skin tears
Soft silicone dressing
Composed of silicone that functions as an atraumatic wound contact layer
