W-2 NURS 1027 Integumentary Conditions Exam With
Complete Solutions 100% Verified!!
Pressure Ulcers (Decubitus Ulcer):
Localized areas of prolonged ischemia of soft tissue that occur when pressure applied
to the skin over time greater than the normal capillary closure pressure
Acute Wounds( types of wounds)
disruptions in the integrity of the skin and underlying tissues that heal uneventfully with
time.
Chronic Wounds( types of wounds)
a wound that does not heal in an orderly set of stages and in a predictable amount of
time the way most wounds do; wounds that do not heal within three months are often
considered chronic.
Erythema
redness of the skin
Maceration
softening of tissue by soaking
Granulation
development of red, moist tissue made up of new blood vessels, indicating the
progression of wound healing
Exudate
,fluid, such as pus, that leaks out of an infected wound
Purulent
producing or containing pus
Slough
dead tissue that is shed from the skin; it is usually light colored, soft, and moist; may be
stringy at times
Necrotic
containing dead tissue
Eschar
dead matter that is sloughed off from the surface of the skin, especially after a burn
Risk Factors for Pressure Ulcer Development
impaired sensory perception, impaired mobility, altered level of consciousness, shear,
friction, moisture, nutrition, age etc.
pressure ulcer sites
-occiptal bone
-scapula
-spinous process
-elbow
-iliac crest
-sacrum
, -ischium
-achilles tendon
-heel
-sole
-ear
-shoulder
-anterior iliac spine
-trochanter
-thigh
-medial, lateral knee
-lower leg
-medial, lateral malleolus
-lateral edge of foot
-posterior knee
All clients should be assessed for skin integrity:
on admission , on a weekly basis and before transfer or discharge
Risk Assessment: Braden Scale:
areas assessed include: sensory perception, moisture, activity, mobility, nutrition,
friction and shear
Risk Assessment: Braden Scale:
Score indicates level of risk of skin breakdown:
Complete Solutions 100% Verified!!
Pressure Ulcers (Decubitus Ulcer):
Localized areas of prolonged ischemia of soft tissue that occur when pressure applied
to the skin over time greater than the normal capillary closure pressure
Acute Wounds( types of wounds)
disruptions in the integrity of the skin and underlying tissues that heal uneventfully with
time.
Chronic Wounds( types of wounds)
a wound that does not heal in an orderly set of stages and in a predictable amount of
time the way most wounds do; wounds that do not heal within three months are often
considered chronic.
Erythema
redness of the skin
Maceration
softening of tissue by soaking
Granulation
development of red, moist tissue made up of new blood vessels, indicating the
progression of wound healing
Exudate
,fluid, such as pus, that leaks out of an infected wound
Purulent
producing or containing pus
Slough
dead tissue that is shed from the skin; it is usually light colored, soft, and moist; may be
stringy at times
Necrotic
containing dead tissue
Eschar
dead matter that is sloughed off from the surface of the skin, especially after a burn
Risk Factors for Pressure Ulcer Development
impaired sensory perception, impaired mobility, altered level of consciousness, shear,
friction, moisture, nutrition, age etc.
pressure ulcer sites
-occiptal bone
-scapula
-spinous process
-elbow
-iliac crest
-sacrum
, -ischium
-achilles tendon
-heel
-sole
-ear
-shoulder
-anterior iliac spine
-trochanter
-thigh
-medial, lateral knee
-lower leg
-medial, lateral malleolus
-lateral edge of foot
-posterior knee
All clients should be assessed for skin integrity:
on admission , on a weekly basis and before transfer or discharge
Risk Assessment: Braden Scale:
areas assessed include: sensory perception, moisture, activity, mobility, nutrition,
friction and shear
Risk Assessment: Braden Scale:
Score indicates level of risk of skin breakdown:
