WOCN WOUND EXAM QUESTIONS WITH CORRECT ANSWERS GRADED TO PASS

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 wound healing? - Impairs leukocyte function and negatively impacts collagen syntehesis, development of tensile strength, epithelial resurfacing What BG parameters should be maintained for wound healing? - BG <180 for leukocyte function; <140 for healing A1C <7 for most, <8 if hx of severe hypoglycemia, advanced comorbidities, limited life expectancy Why is nutrition relevant to wound healing? - Muscle or SubQ wasting increases risk of 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 on wound healing? - compromise collagen synthesis/crosslinking What amino acids are essential for collagen synthesis? What is the effect of stress on these amino acids? - Glutamine and l-arginine Not adequately produced during times of physiologic stress What weight trend suggests nutritional deficiency? - Unplanned weight loss =>2.5% of usual weight in 30 days or =>10% within 180 days BMI <18.5 What serum albumin level indicates malnutrition? - <3.5 g/dl What serum transferrin level indicates malnutrition? - <100mg/dl What serum prealbumin level indicates malnutrition? - <19.5 What total lymphocyte count level indicates malnutrition? - <1500 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 perfusion/oxygenation? - capillary refill, pulses, presence/absence of edema, 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 immunosuppression? - Comorbidities/therapies such as HIV, steroid tehrapy in doses >30mg/day for >30 days, and/or chemo resulting in neutropenia; high dose NSAIDs What comorbidities compromise wound healing? - renal failure, liver failure, multisystem trauma, 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 Zone? - Dermal-epidermal junction What are the components of the dermis? - Papillary dermis: papillae interlock with rete ridges, capillary loops, sensitive to point pressure Reticular dermis: mostly type 1 collagen, vasculars, and lymphatics What structures of the skin can regenerate? - Epidermis and parts of the dermis What structures of the skin heal by scar formation? - Epidermal appendages, Subcutaneous 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 skin? - increased permeability, increased MARSI risk, extravasation, diaper dermatitis How do you mitigate MARSI risk in infants/elderly? - avoid tape or use hydrocolloid base or silicone adhesive, no alcohol removers only mineral oil, petroleum, silicone (preferred), and citrus) How do you mitigate extravasation in an infant? - Hyaluronidase OR phentolamine if vasoconstrictor How do you mitigate diaper dermatitis? - Higher pH Use petroleum base for mild erythema and zinc oxide for denuded skin sever denudation - carboxymethylcellulose/petrolatum/zinc oxide (Ilex) What bathing considerations must you take for premature infants? - <30 weeks bathe with water only for 2 weeks