WOUND EXAMINATION - CH. 4 EXAM 2025/2026
QUESTIONS WITH ANSWERS GRADED A+
Patient history should include: - demographics, lifestyle & functional status, current/past medical
& wound history
Systems review of: - cardiopulm, MS, neuromuscular, GI, integumentary systems
Test & Measures for: - wound & periwound characteristics
circulation
sensation
Exam the wound: - location, size, characteristics, edges, drainage, & odor
Wound size can be measured via: - direct measurement, wound tracing, photographs, or total
body surface area
Wound tracing - Transparent paper may be laid over the wound and the edges lightly traced; this
is effective for flat, irregular wounds
baggie or sheet with 1 cm block markings
to calculate area
Wound Tunneling - narrow passageway created by the separation of/destruction to fascial planes
How to measure tunneling? - insert a probe into passageway until resistance is felt. use clock
terms to ID tunnel's position within the wound bed
Undermining - tissue under wound edges becomes eroded, resulting in a large wound with a
small opening
Measuring undermining? - Insert a probe under wound edge directed almost parallel to the
wound surface until resistance is felt. have another probe parallel above wound to measure
distance
Use clock terms too.
What patients typically have undermining? - Patients with pressure or neuropathic ulcers
Necrotic tissue will feature: (2 things) - slough & eschar
Foreign bodies in a wound include: - staples, sutures, implants
QUESTIONS WITH ANSWERS GRADED A+
Patient history should include: - demographics, lifestyle & functional status, current/past medical
& wound history
Systems review of: - cardiopulm, MS, neuromuscular, GI, integumentary systems
Test & Measures for: - wound & periwound characteristics
circulation
sensation
Exam the wound: - location, size, characteristics, edges, drainage, & odor
Wound size can be measured via: - direct measurement, wound tracing, photographs, or total
body surface area
Wound tracing - Transparent paper may be laid over the wound and the edges lightly traced; this
is effective for flat, irregular wounds
baggie or sheet with 1 cm block markings
to calculate area
Wound Tunneling - narrow passageway created by the separation of/destruction to fascial planes
How to measure tunneling? - insert a probe into passageway until resistance is felt. use clock
terms to ID tunnel's position within the wound bed
Undermining - tissue under wound edges becomes eroded, resulting in a large wound with a
small opening
Measuring undermining? - Insert a probe under wound edge directed almost parallel to the
wound surface until resistance is felt. have another probe parallel above wound to measure
distance
Use clock terms too.
What patients typically have undermining? - Patients with pressure or neuropathic ulcers
Necrotic tissue will feature: (2 things) - slough & eschar
Foreign bodies in a wound include: - staples, sutures, implants
