Progressive Care RN A Exam |
Questions and Answers | Latest
version 2024/2025
What is a wound - ANSWER -A wound can be defined as any disruption to the integrity of the skin,
mucous membrane or organ tissue. A wound can be caused by trauma, surgery, chemical or thermal
damage or disease. It can be acute or chronic
Repair stage of wound healing - ANSWER -inflammation, reconstruction and maturation
reconstruction phase of wound healing - ANSWER -Granulation: macrophages will continue to clean
up the wound and stimulate the fibroblasts to create connective tissue. A red collage type tissue
which eventually becomes scar tissue. This is healing and pink tissue
Contraction: the body is trying to make the wound smaller and the wound edges are being drawn
together
Epitheliasation: where the new skin is growing across the wound
Primary intention healing - ANSWER -Closure of surgical or traumatic wound where edges held in
close apposition by sutures, staples, tape or glue. Minimal tissue loss or scarring
Delayed primary intention healing - ANSWER -Wound kept open for intensive cleaning. Closed when
no signs of infection or foreign bodies.
Secondary intention healing - ANSWER -Too much tissue loss and you cannot pull the edges together.
The rapid phase will occur and will take longer and more scarring. Chronic and longer term wounds
Tissue loss. Wound healing delayed. Occurs by granulation, contraction and epitheliasation. Greater
scarring
Acute wound - ANSWER -a wound with an aetiology that occurs suddenly, either with or without
intention, but then heals in a timely manner. Usually within 4-12 weeks depending on the size, depth
and extent of damage to the epidermis and dermis layer of the skin
Chronic wound - ANSWER -a wound that has slow progression through the healing phases, or shows
delayed, interrupted or stalled healing due to instructing and extrinsic factors that impact on the
individual and their wound. Often complicated by underlying intrinsic factors.
Hypergrannulation - ANSWER -Granulation which has gone on too long. Typically granulation should
stop when the wound fills the cavity, hypergrannulation occurs when it goes beyond the wound bed.
Granulation tissue beyond the wound surface which interferes with epitheliasation
Contracture - ANSWER -Where there is excess hydroblast activity. Scar tissue over contracts, cosmetic
and functional deformity. Helped by splints, exercises, grafts, pressure garments and incision location
Hypertrophic scarring - ANSWER -Still within the original boundaries of the wound. Too much
collagen in the healed wound, leaving it red, raised, firm, itchy scar within the boundary of the
wound.
,Respond to compression and aid remodelling. The theory is it encouraged a more orderly maturation
of the collagen fibres, decreases oedema, decrease blood flow > hypoxia : fibroblast deformity
Keloid scarring - ANSWER -Hypertrophic scarring beyond the boundary of the original wound. Fibrous
growth from abnormal connective tissues response > tumours scars extending beyond boundary of
original wound, may become malignant.
Difficult to resolve. Surgical excision, corticosteroid infection, compression, radiation.
Can be more common in people with a darker complexion or genetic history
Wound infection - ANSWER -Wound infection can be defined as a
multiplication of pathogens that overwhelm
host defences, resulting in disruption of
healing and damage to tissues.
Wound infection can result in local and
systemic host responses
Biofilm - ANSWER -A biofilm can be described as microorganisms embedded in a thick, slimy barrier
of sugars and proteins. The biofilm barrier protects the microorganisms from external threats.
Role of antibiotics - ANSWER -All wounds are colonised with microbes
Not all are "infected"
Antibiotics are only indicated for wounds that are clinically infected
No evidence prophylaxis has a role in preventing infection
Local and systemic signs of infection may warrant the use of systemic antibiotics
Antimicrobial stewardship - ANSWER -Antimicrobial stewardship (AMS) is defined as an ongoing
effort by a health service organisation to optimise antimicrobial use among patients 'to improve
patient outcomes, ensure cost- effective therapy and reduce adverse sequelae of antimicrobial use
(including antimicrobial resistance).
A - wound assessment - ANSWER -Assess the patient, wellbeing and wound.
Patient, social situation, pmx, medications, allergies, the
wound/location/duration/acute/chronic/pain/measurements ect
B - wound assessment - ANSWER -Bring in the multi-disciplinary team
Dietician, nurse practitioner, wound care nurse, physiotherapist, occupational therapist, medical
staff, social worker, pharmacist, podiatrist ect.
C - wound assessment - ANSWER -control and treat barriers to healing
medications
comorbidities
pain
, the healing envrionment
D - wound assessment - ANSWER -Decide on most appropriate wound treatment
Short term goals: Time frame (up to approx 14 days) e.g. haemostasis, reduced pain, manage
infection, achieve moisture balance, commence granulation, commence debridement etc
Long term goals: Time frame (1 month? 3 months? - depends on wound) e.g. no infection, wound
25% / 50% / completely healed, function restored etc.
Describe a suggested wound management plan (summarising information from TIME and dressing
plan)
E - wound assessment - ANSWER -Explain how you will assess the treatment plan and if it has worked
T - wound assessment - ANSWER -Tissue viability
- describe the wound bed and the surrounding skin, is it viable
I - wound assessment - ANSWER -Inflammation
- None
- Normal
- Abnormal, unexpected time period
- Abnormal, unexpected acute inflammation
- Abnormal chronic inflammatory disease
Infection
- Cellulitis
- Pus
- Abscess
- Subtle signs
- Delayed dealing
- Erythema
- Haemopurulent exudate
- Malodour
- Unexpected pain or tenderness
M - wound assessment - ANSWER -moisture
- Moisture balance of the wound and surrounding skin
- Dry? Macerated? Exudate - TACO
- Serous - clear fluid, no blood, no pus
- Haemoserous - slight blood stained serous fluid
Questions and Answers | Latest
version 2024/2025
What is a wound - ANSWER -A wound can be defined as any disruption to the integrity of the skin,
mucous membrane or organ tissue. A wound can be caused by trauma, surgery, chemical or thermal
damage or disease. It can be acute or chronic
Repair stage of wound healing - ANSWER -inflammation, reconstruction and maturation
reconstruction phase of wound healing - ANSWER -Granulation: macrophages will continue to clean
up the wound and stimulate the fibroblasts to create connective tissue. A red collage type tissue
which eventually becomes scar tissue. This is healing and pink tissue
Contraction: the body is trying to make the wound smaller and the wound edges are being drawn
together
Epitheliasation: where the new skin is growing across the wound
Primary intention healing - ANSWER -Closure of surgical or traumatic wound where edges held in
close apposition by sutures, staples, tape or glue. Minimal tissue loss or scarring
Delayed primary intention healing - ANSWER -Wound kept open for intensive cleaning. Closed when
no signs of infection or foreign bodies.
Secondary intention healing - ANSWER -Too much tissue loss and you cannot pull the edges together.
The rapid phase will occur and will take longer and more scarring. Chronic and longer term wounds
Tissue loss. Wound healing delayed. Occurs by granulation, contraction and epitheliasation. Greater
scarring
Acute wound - ANSWER -a wound with an aetiology that occurs suddenly, either with or without
intention, but then heals in a timely manner. Usually within 4-12 weeks depending on the size, depth
and extent of damage to the epidermis and dermis layer of the skin
Chronic wound - ANSWER -a wound that has slow progression through the healing phases, or shows
delayed, interrupted or stalled healing due to instructing and extrinsic factors that impact on the
individual and their wound. Often complicated by underlying intrinsic factors.
Hypergrannulation - ANSWER -Granulation which has gone on too long. Typically granulation should
stop when the wound fills the cavity, hypergrannulation occurs when it goes beyond the wound bed.
Granulation tissue beyond the wound surface which interferes with epitheliasation
Contracture - ANSWER -Where there is excess hydroblast activity. Scar tissue over contracts, cosmetic
and functional deformity. Helped by splints, exercises, grafts, pressure garments and incision location
Hypertrophic scarring - ANSWER -Still within the original boundaries of the wound. Too much
collagen in the healed wound, leaving it red, raised, firm, itchy scar within the boundary of the
wound.
,Respond to compression and aid remodelling. The theory is it encouraged a more orderly maturation
of the collagen fibres, decreases oedema, decrease blood flow > hypoxia : fibroblast deformity
Keloid scarring - ANSWER -Hypertrophic scarring beyond the boundary of the original wound. Fibrous
growth from abnormal connective tissues response > tumours scars extending beyond boundary of
original wound, may become malignant.
Difficult to resolve. Surgical excision, corticosteroid infection, compression, radiation.
Can be more common in people with a darker complexion or genetic history
Wound infection - ANSWER -Wound infection can be defined as a
multiplication of pathogens that overwhelm
host defences, resulting in disruption of
healing and damage to tissues.
Wound infection can result in local and
systemic host responses
Biofilm - ANSWER -A biofilm can be described as microorganisms embedded in a thick, slimy barrier
of sugars and proteins. The biofilm barrier protects the microorganisms from external threats.
Role of antibiotics - ANSWER -All wounds are colonised with microbes
Not all are "infected"
Antibiotics are only indicated for wounds that are clinically infected
No evidence prophylaxis has a role in preventing infection
Local and systemic signs of infection may warrant the use of systemic antibiotics
Antimicrobial stewardship - ANSWER -Antimicrobial stewardship (AMS) is defined as an ongoing
effort by a health service organisation to optimise antimicrobial use among patients 'to improve
patient outcomes, ensure cost- effective therapy and reduce adverse sequelae of antimicrobial use
(including antimicrobial resistance).
A - wound assessment - ANSWER -Assess the patient, wellbeing and wound.
Patient, social situation, pmx, medications, allergies, the
wound/location/duration/acute/chronic/pain/measurements ect
B - wound assessment - ANSWER -Bring in the multi-disciplinary team
Dietician, nurse practitioner, wound care nurse, physiotherapist, occupational therapist, medical
staff, social worker, pharmacist, podiatrist ect.
C - wound assessment - ANSWER -control and treat barriers to healing
medications
comorbidities
pain
, the healing envrionment
D - wound assessment - ANSWER -Decide on most appropriate wound treatment
Short term goals: Time frame (up to approx 14 days) e.g. haemostasis, reduced pain, manage
infection, achieve moisture balance, commence granulation, commence debridement etc
Long term goals: Time frame (1 month? 3 months? - depends on wound) e.g. no infection, wound
25% / 50% / completely healed, function restored etc.
Describe a suggested wound management plan (summarising information from TIME and dressing
plan)
E - wound assessment - ANSWER -Explain how you will assess the treatment plan and if it has worked
T - wound assessment - ANSWER -Tissue viability
- describe the wound bed and the surrounding skin, is it viable
I - wound assessment - ANSWER -Inflammation
- None
- Normal
- Abnormal, unexpected time period
- Abnormal, unexpected acute inflammation
- Abnormal chronic inflammatory disease
Infection
- Cellulitis
- Pus
- Abscess
- Subtle signs
- Delayed dealing
- Erythema
- Haemopurulent exudate
- Malodour
- Unexpected pain or tenderness
M - wound assessment - ANSWER -moisture
- Moisture balance of the wound and surrounding skin
- Dry? Macerated? Exudate - TACO
- Serous - clear fluid, no blood, no pus
- Haemoserous - slight blood stained serous fluid
