WOCN Wound Exam – Questions With Accurate
Solutions
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Terms in this set (444)
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 Impairs leukocyte function and negatively impacts
wound healing? collagen syntehesis, development of tensile strength,
epithelial resurfacing
What BG parameters should be BG <180 for leukocyte function; <140 for healing
maintained for wound healing? A1C <7 for most, <8 if hx of severe hypoglycemia,
advanced comorbidities, limited life expectancy
Why is nutrition relevant to wound Muscle or SubQ wasting increases risk of
healing? 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 compromise collagen synthesis/crosslinking
on wound healing?
What amino acids are essential for Glutamine and l-arginine
collagen synthesis? Not adequately produced during times of
What is the effect of stress on these physiologic stress
amino acids?
,What weight trend suggests nutritional Unplanned weight loss =>2.5% of usual weight in 30
deficiency? days or =>10% within 180 days
BMI <18.5
What serum albumin level indicates <3.5 g/dl
malnutrition?
What serum transferrin level indicates <100mg/dl
malnutrition?
What serum prealbumin level <19.5
indicates malnutrition?
What total lymphocyte count level <1500
indicates malnutrition?
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 capillary refill, pulses, presence/absence of edema,
perfusion/oxygenation? 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 Comorbidities/therapies such as HIV, steroid tehrapy
immunosuppression? in doses >30mg/day for >30 days, and/or chemo
resulting in neutropenia; high dose NSAIDs
What comorbidities compromise renal failure, liver failure, multisystem trauma,
wound healing? 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
Stratum lucidum - only in palms/soles, thick areas
Stratum granulosum - odland bodies secrete
ceramides, lipophilic
Stratum spinosum - desmosomes (cell to cell
junctions)
Stratum germinativum - dermal-epidermal junction
What is the Basement Membrane Dermal-epidermal junction
Zone?
What are the components of the Papillary dermis: papillae interlock with rete ridges,
dermis? capillary loops, sensitive to point pressure
Reticular dermis: mostly type 1 collagen, vasculars,
and lymphatics
What structures of the skin can Epidermis and parts of the dermis
regenerate?
What structures of the skin heal by Epidermal appendages, Subcutaneous
scar formation? tissue/fascia/muscle
How is newborn skin different? No scars up to 2nd trimester
30% thinner skin
Faster epidermal turnover
How is premature infant skin different? Very thin, increased fluid loss, functional stratum
corneum at 30-32 weeks
What problems may arise with infant increased permeability, increased MARSI risk,
skin? extravasation, diaper dermatitis
, How do you mitigate MARSI risk in avoid tape or use hydrocolloid base or silicone
infants/elderly? adhesive, no alcohol removers only mineral oil,
petroleum, silicone (preferred), and citrus)
How do you mitigate extravasation in Hyaluronidase
an infant? OR
phentolamine if vasoconstrictor
How do you mitigate diaper Higher pH
dermatitis? Use petroleum base for mild erythema and zinc
oxide for denuded skin
sever denudation -
carboxymethylcellulose/petrolatum/zinc oxide (Ilex)
What bathing considerations must you <30 weeks bathe with water only for 2 weeks
take for premature infants?
What are common issues with older Thinner, collagen shrinks and causes wrinkles
skin? Rete ridges and dermal papillae flatten - increased
risk for tears/stripping
Reduced sebaceous and sweat glands - dry skin
Erratic/decreased melanin production
Decreased sensation - increased trauma risk
Loss of SubQ tissue - increased shear and decreased
insulation
Increased malignant lesions - refer to derm
Reduced blood flow, increased epidermal turnover -
slow healing
Increased senescense
Maybe increased inflammatory mediators, decreased
inhibitors
Increased capillary fragility (bruises)
What strategies keep skin healthy? pH balanced cleaners - no alkaline soaps
Superfatted nonalkaline soaps for dry skin
CHG reduces pathogens and sepsis
Individualize bathing schedule
Apply lubricants, oils, creams to clean slightly damp
skin
Solutions
Save Groups
Terms in this set (444)
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 Impairs leukocyte function and negatively impacts
wound healing? collagen syntehesis, development of tensile strength,
epithelial resurfacing
What BG parameters should be BG <180 for leukocyte function; <140 for healing
maintained for wound healing? A1C <7 for most, <8 if hx of severe hypoglycemia,
advanced comorbidities, limited life expectancy
Why is nutrition relevant to wound Muscle or SubQ wasting increases risk of
healing? 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 compromise collagen synthesis/crosslinking
on wound healing?
What amino acids are essential for Glutamine and l-arginine
collagen synthesis? Not adequately produced during times of
What is the effect of stress on these physiologic stress
amino acids?
,What weight trend suggests nutritional Unplanned weight loss =>2.5% of usual weight in 30
deficiency? days or =>10% within 180 days
BMI <18.5
What serum albumin level indicates <3.5 g/dl
malnutrition?
What serum transferrin level indicates <100mg/dl
malnutrition?
What serum prealbumin level <19.5
indicates malnutrition?
What total lymphocyte count level <1500
indicates malnutrition?
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 capillary refill, pulses, presence/absence of edema,
perfusion/oxygenation? 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 Comorbidities/therapies such as HIV, steroid tehrapy
immunosuppression? in doses >30mg/day for >30 days, and/or chemo
resulting in neutropenia; high dose NSAIDs
What comorbidities compromise renal failure, liver failure, multisystem trauma,
wound healing? 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
Stratum lucidum - only in palms/soles, thick areas
Stratum granulosum - odland bodies secrete
ceramides, lipophilic
Stratum spinosum - desmosomes (cell to cell
junctions)
Stratum germinativum - dermal-epidermal junction
What is the Basement Membrane Dermal-epidermal junction
Zone?
What are the components of the Papillary dermis: papillae interlock with rete ridges,
dermis? capillary loops, sensitive to point pressure
Reticular dermis: mostly type 1 collagen, vasculars,
and lymphatics
What structures of the skin can Epidermis and parts of the dermis
regenerate?
What structures of the skin heal by Epidermal appendages, Subcutaneous
scar formation? tissue/fascia/muscle
How is newborn skin different? No scars up to 2nd trimester
30% thinner skin
Faster epidermal turnover
How is premature infant skin different? Very thin, increased fluid loss, functional stratum
corneum at 30-32 weeks
What problems may arise with infant increased permeability, increased MARSI risk,
skin? extravasation, diaper dermatitis
, How do you mitigate MARSI risk in avoid tape or use hydrocolloid base or silicone
infants/elderly? adhesive, no alcohol removers only mineral oil,
petroleum, silicone (preferred), and citrus)
How do you mitigate extravasation in Hyaluronidase
an infant? OR
phentolamine if vasoconstrictor
How do you mitigate diaper Higher pH
dermatitis? Use petroleum base for mild erythema and zinc
oxide for denuded skin
sever denudation -
carboxymethylcellulose/petrolatum/zinc oxide (Ilex)
What bathing considerations must you <30 weeks bathe with water only for 2 weeks
take for premature infants?
What are common issues with older Thinner, collagen shrinks and causes wrinkles
skin? Rete ridges and dermal papillae flatten - increased
risk for tears/stripping
Reduced sebaceous and sweat glands - dry skin
Erratic/decreased melanin production
Decreased sensation - increased trauma risk
Loss of SubQ tissue - increased shear and decreased
insulation
Increased malignant lesions - refer to derm
Reduced blood flow, increased epidermal turnover -
slow healing
Increased senescense
Maybe increased inflammatory mediators, decreased
inhibitors
Increased capillary fragility (bruises)
What strategies keep skin healthy? pH balanced cleaners - no alkaline soaps
Superfatted nonalkaline soaps for dry skin
CHG reduces pathogens and sepsis
Individualize bathing schedule
Apply lubricants, oils, creams to clean slightly damp
skin
