APEA ASSESSMENT questions with correct answers

Wound Stages Answer Stage 1: - intact skin with non-blanchable redness of a localized area usually over a bony prominence. -Area may be painful, firm, soft, warmer or cooler as composed to adjacent tissue. Stage 2: -Partial-thickness loss of dermis presenting as a shallow open ulcer with a red-pink wound bed, without slough - may also be present as an intact or open/ ruptured serum filled blister Stage 3: - full-thickness loss and subcutaneous fat may be visible but bone, tendon or muscle are not exposed -Slough may be present but does not obscure the depth of tissue loss and the depth varies by anatomical location. Stage 4: -Full thickness tissue loss with exposed bone , tendon or muslce. -Slough or eschar may be present on some parts of the wound bed. -Depth varies. When assessing the Skin, it is noted to be very dry and cool to touch. Associated with : Hypothyrodism Answer - Dry, rough, cool to touch