End Term Nursing Exam – Wound Care | High-Scoring
Questions & Solutions A+ Answers
Exudate: Purulent - ✔✔Pus, liquification of necrotic tissue (body is getting rid of debris)
Types of Wound Healing - ✔✔Primary Intention vs Seconday Intention vs Tertiary Intention
Primary Intention - ✔✔~Wound edges are approximated (closed) by sutures, staples
~NO blood, debris, exudate
~Healing occurs in approx 14 days
~↓ risk for infection
~Little tissue lost, ↓ scarring
Secondary Intention - ✔✔~ i.e. chronic wounds, DPUs
~edges CANNOT be approximated
~Wound bed will fill with granulating tissue
~↑ risk of infection, tissue loss, contractures
~longer healing times
Tertiary Intention - ✔✔~Occurs with contaminated wounds
~Keeping a wound open for 3 to 5 days to let healing begin
~After infection clears, wound is closed with sutures
Partial Thickness Wounds - ✔✔Involves the EPIDERMIS or PARTIAL thickness of the skin;
SHALLOW wound (Scrapes)
~Inflammatory Response: occurs in first 24 hours
~Epithelialization
~Restablishment of epidermal layers
, Epithelialization - ✔✔PARTIAL THICKNESS wounds healing in which EPITHELIAL cells
proliferate and migrate over the surface of the wound to re-establish the normal skin layers
Full Thickness Wound - ✔✔Wound that extends into the dermis; i.e. pressure ulcers
3 Phases of Healing
Phase I: Inflammatory - ✔✔Takes 3 days
~Hemostasis: CLOTS form a fibrin matrix
~Histamine release: results in VASODILATION
~Phagocytosis: LEUKOCYTES reach the wound (clean the wound bed)
~Formation of Collagen: fibroblasts synthesize COLLAGEN
Purpose of Inflammatory Phase - ✔✔To control bleeding and cleans the wound
Phase 2: Proliferative - ✔✔Takes 3-24 days
~Fills wound with granulation tissue
~Causes contraction of the wound
~Resurfaces the wound be epithelialization
Purpose of Proliferative Phase - ✔✔Fill wound with connective tissue of collagen; Collagen
provides structural integrity and strength
Phase 3: Remodeling or Maturation - ✔✔Takes more than 1 year
~Collagen continues to reorganize and gain strength, may not achieve maximal strength for 2
years
~Wound strength never exceeds 80% of its pre-injury strength
~Scar tissue has less pigmented cells (melanocytes)
Questions & Solutions A+ Answers
Exudate: Purulent - ✔✔Pus, liquification of necrotic tissue (body is getting rid of debris)
Types of Wound Healing - ✔✔Primary Intention vs Seconday Intention vs Tertiary Intention
Primary Intention - ✔✔~Wound edges are approximated (closed) by sutures, staples
~NO blood, debris, exudate
~Healing occurs in approx 14 days
~↓ risk for infection
~Little tissue lost, ↓ scarring
Secondary Intention - ✔✔~ i.e. chronic wounds, DPUs
~edges CANNOT be approximated
~Wound bed will fill with granulating tissue
~↑ risk of infection, tissue loss, contractures
~longer healing times
Tertiary Intention - ✔✔~Occurs with contaminated wounds
~Keeping a wound open for 3 to 5 days to let healing begin
~After infection clears, wound is closed with sutures
Partial Thickness Wounds - ✔✔Involves the EPIDERMIS or PARTIAL thickness of the skin;
SHALLOW wound (Scrapes)
~Inflammatory Response: occurs in first 24 hours
~Epithelialization
~Restablishment of epidermal layers
, Epithelialization - ✔✔PARTIAL THICKNESS wounds healing in which EPITHELIAL cells
proliferate and migrate over the surface of the wound to re-establish the normal skin layers
Full Thickness Wound - ✔✔Wound that extends into the dermis; i.e. pressure ulcers
3 Phases of Healing
Phase I: Inflammatory - ✔✔Takes 3 days
~Hemostasis: CLOTS form a fibrin matrix
~Histamine release: results in VASODILATION
~Phagocytosis: LEUKOCYTES reach the wound (clean the wound bed)
~Formation of Collagen: fibroblasts synthesize COLLAGEN
Purpose of Inflammatory Phase - ✔✔To control bleeding and cleans the wound
Phase 2: Proliferative - ✔✔Takes 3-24 days
~Fills wound with granulation tissue
~Causes contraction of the wound
~Resurfaces the wound be epithelialization
Purpose of Proliferative Phase - ✔✔Fill wound with connective tissue of collagen; Collagen
provides structural integrity and strength
Phase 3: Remodeling or Maturation - ✔✔Takes more than 1 year
~Collagen continues to reorganize and gain strength, may not achieve maximal strength for 2
years
~Wound strength never exceeds 80% of its pre-injury strength
~Scar tissue has less pigmented cells (melanocytes)
