WOCN WOUND EXAM WITH COMPLETE
QUESTIONS AND ANSWERS { GRADED
A+}
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 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
QUESTIONS AND ANSWERS { GRADED
A+}
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 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
