Nursing II End Term – Wound, Ostomy, and
Continence | Clinical Questions with Graded
Answers
CFCN nurses have elevated the quality of are for patients in? - ✔✔Hospitals
Long-term care facilities
Podiatry offices
Patient's own home
Who can join the WOCN society? - ✔✔Any full time student studying to become a RN with
either AS, BSN, or diploma.
Nursing students get 50% off membership fees
What causes skin damage? - ✔✔Pressure
How is pressure create? - ✔✔Pressure is created when the external surface against the skin
and the person's skeleton compresses soft tissue sufficiently to interrupt circulation to the
skin
If circulation is interrupted for a long period what happens? - ✔✔Tissue ischemia and tissue
death occur
What is Hypoxia? - ✔✔The amount of pressure necessary to compress capillaries. It is blocking
the nutrient supply/removal of waste products varies
What is Ischemia? - ✔✔Is the result of deprivation of nutrients and changes in PH due to
wastes products that will eventually lead to tissue damage.
What is vasopressors? - ✔✔Types of medication to keep BP up
, What type of patients are more of a risk for pressure? - ✔✔Patients with disease processes,
injury, those requiring vasopressor,or those with conditions resulting in impaired oxygenation
will require less pressure to create tissue ischemia.
Most common site for acute care? (pressure ulcers) - ✔✔Sacrum, coccyx, and heels can be
supine, lateral laying, and sitting = chair padding
What is a shear - ✔✔Is the interaction of gravity and friction causing twisting or kinking of
blood vessels
When does shear occur? - ✔✔When the skeleton moves, but the skin remains fixed to an
external surface. Occurs with greater levels of physical force and damages the deeper tissues.
Keep the HOB below 30 when boosting up
What does shear do to the blood flow? - ✔✔Rather than completely interrupting blood flow,
shear diminishes circulation to tissue and damages both tissue and blood vessels integrity.
What is friction? - ✔✔It contributed to pressure ulcer formation by damaging the skin at the
epidermal-dermal interface, the basement membrane
Can friction ulcers be reversed? - ✔✔Yes they can be easily reversed, unless the cause is not
removed and they are generally superficial
Examples of shear and friction? - ✔✔Pulling patient up in bed
Patient is fowler's position who slides down in bed
sliding patient from bed to stretcher
Heels and elbows which aid in movement for bedridden patients
Agitated patients or those experiencing seizures
superficial abrasion or blistering
What is moisture? - ✔✔Moisture is a chemical cause of skin ulcers through caustic fluids
(stool, urine, gastic effluent) or non-caustic fluids (perspiration)
Continence | Clinical Questions with Graded
Answers
CFCN nurses have elevated the quality of are for patients in? - ✔✔Hospitals
Long-term care facilities
Podiatry offices
Patient's own home
Who can join the WOCN society? - ✔✔Any full time student studying to become a RN with
either AS, BSN, or diploma.
Nursing students get 50% off membership fees
What causes skin damage? - ✔✔Pressure
How is pressure create? - ✔✔Pressure is created when the external surface against the skin
and the person's skeleton compresses soft tissue sufficiently to interrupt circulation to the
skin
If circulation is interrupted for a long period what happens? - ✔✔Tissue ischemia and tissue
death occur
What is Hypoxia? - ✔✔The amount of pressure necessary to compress capillaries. It is blocking
the nutrient supply/removal of waste products varies
What is Ischemia? - ✔✔Is the result of deprivation of nutrients and changes in PH due to
wastes products that will eventually lead to tissue damage.
What is vasopressors? - ✔✔Types of medication to keep BP up
, What type of patients are more of a risk for pressure? - ✔✔Patients with disease processes,
injury, those requiring vasopressor,or those with conditions resulting in impaired oxygenation
will require less pressure to create tissue ischemia.
Most common site for acute care? (pressure ulcers) - ✔✔Sacrum, coccyx, and heels can be
supine, lateral laying, and sitting = chair padding
What is a shear - ✔✔Is the interaction of gravity and friction causing twisting or kinking of
blood vessels
When does shear occur? - ✔✔When the skeleton moves, but the skin remains fixed to an
external surface. Occurs with greater levels of physical force and damages the deeper tissues.
Keep the HOB below 30 when boosting up
What does shear do to the blood flow? - ✔✔Rather than completely interrupting blood flow,
shear diminishes circulation to tissue and damages both tissue and blood vessels integrity.
What is friction? - ✔✔It contributed to pressure ulcer formation by damaging the skin at the
epidermal-dermal interface, the basement membrane
Can friction ulcers be reversed? - ✔✔Yes they can be easily reversed, unless the cause is not
removed and they are generally superficial
Examples of shear and friction? - ✔✔Pulling patient up in bed
Patient is fowler's position who slides down in bed
sliding patient from bed to stretcher
Heels and elbows which aid in movement for bedridden patients
Agitated patients or those experiencing seizures
superficial abrasion or blistering
What is moisture? - ✔✔Moisture is a chemical cause of skin ulcers through caustic fluids
(stool, urine, gastic effluent) or non-caustic fluids (perspiration)
