NPTE: Integumentary (scorebuilder 2008)
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| Exudate classification: presents as clear, light color with a thin, watery consistency | serous
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| Exudate classification: presents as red with a thin, watery consistency | sanguineous
• appears to be red due to presence of blood, or may be brown if allowed to dehydrate
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| Exudate classification: presents as light red or pink with a thin, watery consistency | serosanguineous
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| Exudate classification: presents as opaque, yellow or tan color with thin, watery consistency | seropurulent
• may be an early warning sign of impending infection.
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| Exudate classification: presents as yellow or green with a thick viscous consistency | purulent
• indicative of infection
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| pressure ulcer staging • Stage I | observable pressure-related alteration of intact skin.
• may include: change in skin color, temperature, stiffness, or sensation
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| pressure ulcer staging • Stage II | partial-thickness skin loss. involves epidermis and/or dermis.
• ulcer is superficial and presents as abrasion, blister or a shallow crater.
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| pressure ulcer staging • Stage III | full-thickness skin loss that involves damage or necrosis of subcutaneous tissues. May extend to but not through underlying fascia.
• presents as a deep crater with or without undermining adjacent tissue.
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| pressure ulcer staging • Stage IV | full-thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures.
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| Wagner Grade 0 | no open lesion but may possess pre-ulcerative lesions; healed ulcers; presence of bony deformity.
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| Wagner Grade 1 | superficial ulcer not involving subcutaneous tissue
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| Wagner Grade 2 | deep ulcer with penetration through the subcutaneous tissue; potentially exposing bone, tendon, ligament, or joint capsule
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| Wagner Grade 3 | deep ulcer with osteitis, abscess or osteomyelitis.
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| Wagner Grade 4 | gangrene of digit
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| Wagner Grade 5 | gangrene of foot requiring disarticulation
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| Superficial burn | involves only outer epidermis. area may be red with slight edema. no scarring.
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| Superficial partial-thickness burn | involves epidermis and upper portion of the dermis. may be extremely painful and exhibit blisters. minimal to no scarring.
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| Deep partial-thickness burn | involves complete destruction of the epidermis and majority of dermis. may appear discolored with broken blisters and edema. damages to nerve endings may result in only moderate pain. hypertrophic scars and keloids.
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| Full thickness burn | involves complete destruction of epidermis and dermis along with partial damage of subcutaneous fat layer. eschar formation and minimal pain. requires grafts and may be susceptible to infection.
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| Subdermal burn | involves complete destruction of epidermis, dermis, and subcutaneous tissues. may involve muscle and bone. often requires surgical intervention.
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| Definition: zone of coagulation | the area of the burn that received the most severe injury along with irreversible cell damage.
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| Definition: zone of stasis | the area of less severe injury that possesses reversible damage and surrounds the zone of coagulation.
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| Definition: zone of hyperemia | the area surrounding the zone of stasis that presents with inflammation, but will fully recover without any intervention or permanent damage.
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| Rule of nines: • Head and neck | 9%
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| Rule of nines: • Anterior trunk | 18%
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| Rule of nines: • Posterior trunk | 18%
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| Rule of nines: • Bilateral anterior arm, forearm, hand | 9%
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| Rule of nines: • Bilateral posterior arm, forearm, hand | 9%
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| Rule of nines: • Genital region | 1%
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| Rule of nines: • Bilateral anterior LE | 18%
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| Rule of nines: • Bilateral posterior LE | 18%
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| Rule of nines: • How do children differ? | Child under 1 has 9% taken from the LEs and added to head region. Each year of life, 1% is added back to the LEs.
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| Topical agents used in burn care: • Can be used with or without dressing | • silver sulfadiazine
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| Topical agents used in burn care: • Is painless | • Silver sulfadiazine
• Silver nitrate
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| Topical agents used in burn care: • can be applied to wound directly | • silver sulfadiazine
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| Topical agents used in burn care: • broad-spectrum | • silver sulfadiazine
• silver nitrate
• povidone-iodine
mafenide acetate
gentamicin
nitrofurazone
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| Topical agents used in burn care: • non-allergenic | • silver nitrate
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| Topical agents used in burn care: • effective against yeast | • silver sulfadiazine
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| Topical agents used in burn care: • antifungal | • povidone-iodine
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| Topical agents used in burn care: • easily removed with water | • povidone-iodine
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| Topical agents used in burn care: • penetrates burn eschar | • mafenide acetate
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| Topical agents used in burn care: • may be used with or without occlusive dressing | • mafenide acetate
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| Topical agents used in burn care: • may be covered or left open to air | • gentamicin
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| Topical agents used in burn care: • bacteriocidal | • nitrofurazone
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| Topical agents used in burn care: • does not penetrate into eschar | • silver sulfadiazine
• silver nitrate
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| Topical agents used in burn care: • discolors, making assessment difficult | • silver nitrate
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| Topical agents used in burn care: • can cause severe electrolyte imbalance | • silver nitrate
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| Topical agents used in burn care: • removal of dressing is painful | • silver nitrate
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| Topical agents used in burn care: • not effective against pseudomonas | • povidone-iodine
• nitrofurazone
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| Topical agents used in burn care: • may impair thyroid function | • povidone-iodine
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| Topical agents used in burn care: • painful application | • povidone-iodine
• mafenide acetate
• nitrofurazone
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| Topical agents used in burn care: • may cause metabolic acidosis | • mafenide acetate
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| Topical agents used in burn care: • may compromise respiratory function | • mafenide acetate
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| Topical agents used in burn care: • may inhibit epithelialization | • mafenide acetate
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| Topical agents used in burn care: • causes resistant strains | • gentamicin
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| Topical agents used in burn care: • ototoxic | • gentamicin
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| Topical agents used in burn care: • nephrotoxic | • gentamicin
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| Topical agents used in burn care: • may lead to overgrowth of fungus and pseudomonas | • nitrofurazone
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| definition: allograft | temporary skin graft taken from another human, usually cadaver
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| definition: autograft | permanent skin graft taken from a donor site on the pt.'s body
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| definition: heterograft | temporary skin graft taken from another species.
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| definition: mesh graft | skin graft that is altered to create a mesh-like appearance in order to cover a larger surface area.
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| definition: sheet graft | skin graft is transferred directly from the donor site to the recipient site.
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| definition: split-thickness skin graft | a skin graft that contains only a superficial layer of the dermis in addition to the epidermis
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| definition: full-thickness skin graft | a skin graft that contains the dermis and the epidermis
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| burn location: anticipated deformity: • anterior neck | flexion with possible lateral flexion
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| burn location: splinting type: • anterior neck | soft collar, molded collar, philadelphia collar
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| burn location: splinting type: • anterior chest and axilla | axillary or airplane splint, shoulder abduction brace
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| burn location: anticipated deformity: • anterior chest and axilla | shoulder adduction, extension, and medial rotation
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| burn location: anticipated deformity: • elbow | flexion and pronation
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| burn location: splinting type: • elbow | gutter splint, conforming splint, three-point splint, air splint
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| burn location: anticipated deformity: • hand | extension or hyperextension of the MCP joints, flexion of the IP jts, adduction and flexion of the thumb, flexion of the wrist
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| burn location: splinting type: • hand | wrist splint, thumb spica splint, palmar or dorsal extension splint
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| burn location: anticipated deformity: • hip | flexion and adduction
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| burn location: splinting type: • hip | anterior hip spica, abduction splint
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| burn location: anticipated deformity: • knee | flexion
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| burn location: splinting type: • knee | conforming splint, three point splint, air splint
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| burn location: anticipated deformity: • ankle | plantarflexion
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| burn location: splinting type: • ankle | posterior foot drop splint, posterior ankle conforming splint, anterior ankle conforming splint
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| selective or non-selective debridement? • sharp | selective
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| selective or non-selective debridement? • enzymatic | selective
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| selective or non-selective debridement? • autolytic | selective
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| selective or non-selective debridement? • wet-to-dry | non-selective
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| selective or non-selective debridement? • wound irrigation | non-selective
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| selective or non-selective debridement? • hydrotherapy | non-selective
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| arterial or venous insufficiency ulcer? • location: lower one-third of leg | arterial
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| arterial or venous insufficiency ulcer? • location: toes, web spaces | arterial
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| arterial or venous insufficiency ulcer? • location: dorsal foot | arterial
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| arterial or venous insufficiency ulcer? • location: lateral malleolus | arterial
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| arterial or venous insufficiency ulcer? • location: proximal to medial malleoulus | venous insufficiency
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| arterial or venous insufficiency ulcer? • appearance: smooth edges, well defined | arterial
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| arterial or venous insufficiency ulcer? • appearance: lack granulation tissue | arterial
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| arterial or venous insufficiency ulcer? • appearance: tend to be deep | arterial
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| arterial or venous insufficiency ulcer? • appearance: irregular shape | venous insufficiency
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| arterial or venous insufficiency ulcer? • appearance: shallow | venous insufficiency
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| arterial or venous insufficiency ulcer? • pain: severe | arterial
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| arterial or venous insufficiency ulcer? • pain mild to moderate | venous insufficiency
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| arterial or venous insufficiency ulcer? • pedal pulse: diminished or absent | arterial
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| arterial or venous insufficiency ulcer? • pedal pulse: normal | venous insufficiency
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| arterial or venous insufficiency ulcer? • no edema | arterial
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| arterial or venous insufficiency ulcer? • increased edema | venous insufficiency
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| arterial or venous insufficiency ulcer? • skin temperature: decreased | arterial
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| arterial or venous insufficiency ulcer? • skin temperature: normal | venous insufficiency
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| arterial or venous insufficiency ulcer? • tissue changes: thin and shiny | arterial
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| arterial or venous insufficiency ulcer? • tissue changes: hair loss | arterial
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| arterial or venous insufficiency ulcer? • tissue changes: yellow nails | arterial
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| arterial or venous insufficiency ulcer? • tissue changes: flaking | venous insufficiency
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| arterial or venous insufficiency ulcer? • tissue changes: dry skin | venous insufficiency
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| arterial or venous insufficiency ulcer? • tissue changes: brownish discoloration | venous insufficiency
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| arterial or venous insufficiency ulcer? • leg elevation decreases pain | venous insufficiency
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| arterial or venous insufficiency ulcer? • leg elevation increases pain | arterial
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| Dressing: used for partial and full-thickness wounds | • Hydrocolloids
• Foam Dressings
• Alginates
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| Dressing: used for granular or necrotic wounds | • Hydrocolloids
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| Dressing: provides a moist environment for wound healing | • Hydrocolloids
• Hydrogels
• Foam Dressings
• Transparent film
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| Dressing: Enables autolytic debridement | • Hydrocolloids
• Hydrogels
• Foam Dressings
• Transparent Films
• Alginates
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| Dressing: Offers protection from microbial contamination | • Hydrocolloids
• Alginates
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| Dressing: Provides moderate absorption | • Hydrocolloids
• Foam Dressing
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| Dressing: Does not require a second layer | • Hydrocolloids
• Adhesive version of Foam Dressing
• Gauze
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| Dressing: Provides a waterproof surface | • Hydrocolloids
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| Dressing: May traumatize surrounding intact skin upon removal | • Hydrocolloids
• Adhesive form of Foam Dressing
• Adhesive form of Transparent film
• Gauze
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| Dressing: May tend to roll in areas of excessive friction | • Hydrocolloids
• Foam Dressings
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| Dressing: Cannot be used on infected wounds | • Hydrocolloids
• Transparent films
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| Dressing: Used for superficial and partial-thickness wounds | • Hydrogels
• Transparent films
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| Dressing: Used for minimal drainage | • Hydrogels
• Transparent films
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| Dressing: May reduce pain/pressure | • Hydrogels
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| Dressing: Can be used as coupling agent for ultrasound | • Hydrogels
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| Dressing: Minimally adheres to wound | • Hydrogels
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| Dressing: Potential for dressing to dehydrate | • Hydrogels
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| Dressing: Cannot be used on wound with significant drainage | • Hydrogels
• Transparent Films
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| Dressing: Typically requires second dressing | • Hydrogels
• Non-adhesive form of Transparent films
• Alginates
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| Dressing: Used for varying levels of exudate | • Foam dressings (up to moderate level of absorption)
• Gauze
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| Dressing: Provides protection and cushioning | • Foam dressings
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| Dressing: Lack of transparency makes inspection of wound difficult | • Foam dressing
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| Dressing: Allows visualization of wound | • Transparent films
• Some Hydrocolloids
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| Dressing: resistant to shearing forces | • Transparent films
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| Dressing: cost-effective | • Transparent films (over time)
• Gauze
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| Dressing: Excessive accumulation of exudate can result in maceration | • Transparent films
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| Dressing: Can be used for wet-to-wet, wet-to moist, or wet-to-dry debridement | • Gauze
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| Dressing: Can be used on infected or non-infected wounds | • Gauze
• Alginates
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| Dressing: Can be used alone or in combination with other dressings or topical agents | • Gauze
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| Dressing: Can modify number of layers to accomodate for changing wound status | • Gauze
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| Dressing: Adheres to wound | • Gauze
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| Dressing: Requires frequent dressing change | • Gauze
• Alginates
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| Dressing: non-occlusive --> increased infection rate | • Gauze
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| Dressing: Used for pressure wounds or venous insufficiency ulcers | • Alginates
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| Dressing: moisture-retentive | • Hydrogels
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| Dressing: High absorptive capacity | • Alginates
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| Dressing: non-adhering to wound or skin | • Alginates
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| Dressing: cannot be used on wounds with exposed tendon, joint capsule or bone | • Alginates
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| Which dressing would you use? minimal drainage pressure ulcer stage II, keep under frequent observation | • Transparent Film
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| Which dressing would you use? moderate drainage pressure ulcer stage IV, want to observe it. | • Hydrocolloids (a transparent one)
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| Dressing: Order from most to least occlusive: | • Hydrocolloids • Hydrogels •Semi-permeable foam • Semi-permeable film • Impregnated gauze • Alginates • Normal (traditional) gauze
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| Which dressing would you use? pt. with diabetes, pressure ulcer on 1st met. head, Stage III, infected | • Alginates
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| Which dressing would you use? pt. with diabetes, pressure ulcer on 1st met. head, Stage IV, necrotic | • Hydrocolloids
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| Which dressing would you use? pt. with diabetes, pressure ulcer on 1st met. head, stage IV, infected | • Gauze
• since it's infected, can't used hydrocolloids. since it's stage IV can't use alginates - exposed tissue.
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| Dressing: Most moisture retentive to least: | • Alginates • Semi-permeable foam • Hydrocolloids • Hydrogels • Semi-permeable films
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