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RNSG 1430 Final (12/11) Already Graded A+.

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Function of skin correct answers •Protection •Temperature regulation •Psychosocial •Sensation •Vitamin D production •Immunologic •Absorption •Elimination Immunologic correct answers a breach in the surface of the skin triggers immunologic responses in the skin Risks for skin alterations correct answers Lifestyle variables, Age, Changes in health status, Reduced sensations, Illness, Therapeutic measures The Healing process steps correct answers 1.Hemostasis 2.Inflammatory phase 3.Proliferation phase 4.Maturation phase Hemostasis correct answers occurs immediately after the initial injury, blood vessels constrict and blood clotting begins through platelet activation and clustering Inflammatory phase correct answers follows hemostasis. Lasts 4-6 days. WBCs and macrophages move to the wound, Leukocytes arrive first to ingest bacteria and cellular debris. Proliferation phase correct answers Lasts for several weeks. New tissue is built to fill the wound space, primarily through the action of fibroblasts Maturation phase correct answers final stage. Remodeling begins about 3 weeks after the injury. Possibly continues for months or years Pressure Ulcers Stage 1 correct answers an area of intact skin with non-blanchable redness. The area may be painful, firm, soft, warmer, or cooler as compared with adjacent tissue. Pressure Ulcers Stage 2 correct answers involves partial thickness loss of dermis and presents as a shallow open ulcer Pressure Ulcers Stage 3 correct answers presents with full-thickness tissue loss. Sub Q fat may be visible, but bone, tendon, or muscle is not exposed. Slough that may be present does not obscure the depth of tissue loss. Ulcers at this stage may include undermining and tunneling. Pressure Ulcers Stage 4 correct answers involves full thickness tissue loss with exposed bone, tendon, or muscle. Slough or eschar may be present on some part of the wound bed and often include undermining and tunneling.


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