- Study guides, Class notes & Summaries

Skin/wound care questions and answers What are priority assessments for clients with impaired skin integrity? - - Inspect bony prominences for any redness and moisture that could lead to skin breakdown/shearing - Ensure to check behind commonly missed places (ex. Behind the ear) Discuss safe transfers/repositioning techniques for clients with skin impairments - - Turn client q2h - Use trapeze bar when assisting with transfer - Elevate the HOB to reduce shearing - Limit chair time to 2 h...

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4 pages

Written in 2025/2026

Grade A+

Wisegrades

SKIN/WOUND CARE questions and answers Subjective Data previous skin disease, recent change in pigmentation, sunburn history, age, change in moles, excessive dryness/mosture, pruritic, bruising, rash/lesion, hair loss, change in nails Risk for skin breakdown related to chronic disease: DM- poor wound healing / PVD-poor circulation Subjective Data- Personal Behavior meds (do they have skin side effects), smoking, activity, skin care habits (sunscreen), nutrition and fluid intake, l...

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5 pages

Written in 2025/2026

Grade A+

Wisegrades

Skin Integrity and Wound Care Test Bank Questions And Correct Answers (Verified Answers) Plus Rationales 2025/2026 Q&A | Instant Download Pdf

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34 pages

Written in 2025/2026

Grade A+

lewizranking

Ch 48 Skin Integrity and Wound Care (P&P) Questions With Complete Solutions

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35 pages

Written in 2025/2026

Grade A+

Classroom

Chapter 48: Skin Integrity and Wound Care Questions With Complete Solutions

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9 pages

Written in 2025/2026

Grade A+

Classroom

Wound Care / Skin questions and answers

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6 items

Wisegrades

Skin/Wound Care questions and answers

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6 items

Wisegrades

Skin Integrity and Wound Care questions and answers

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5 items

Wisegrades

Skin Integrity and Wound Care questions and answers

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5 items

Wisegrades

Skin & Wound Care questions and answers assessment for pressure ulcers skin bony prominences & pressure injury sites predictive measurs mobility nutrition status body fluids pain who is at high risk for skin breakdown people with moisture from urine, stool, bile, wound drainage or gastric fluid what predictive measures to assess braden scale mobility nutrition body fluids comfort leels who is at the higher risk for pressure injuries

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14 pages

Written in 2025/2026

Grade A+

Wisegrades

Skin & Wound Care questions and answers After completing a scheduled every-2-hour turn by turning the client to the left side, the nurse notices a reddened area over the coccyx. The area blanches when the nurse compresses it with thumb pressure. One hour later, the nurse reassesses the area and finds the redness has disappeared. How should the nurse document this area? 1. Reactive hyperemia 2. Stage I pressure ulcer 3. Stage II pressure ulcer 4. Stage III pressure ulcer - Correct...

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7 pages

Written in 2025/2026

Grade A+

Wisegrades

Skin & Wound Care questions and answers Acute wounds - •trauma •surgical Chronic wounds - •diabetics are most at risk for arterial ulcers Pressure ulcers - •decubitus ulcer (bedsores) •impaired skin integrity •prolonged pressure in combo w/ shear or friction •Localized, over bony prominence Stage I Pressure Ulcer - •*NON*blanchable erythema •skin remains intact Stage II Pressure Ulcer - •partial-thickness skin loss

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7 pages

Written in 2025/2026

Grade A+

Wisegrades

Skin & Wound Care questions and answers Intrinsic (patient) risks - Factors such as ↓ Sensation/level of consciousness, ↓ Activity/Mobility, Poor nutrition/hydration, and Moisture that contribute to pressure-injury formation. Extrinsic (care/environment) risks - Factors such as Pressure + friction + shear, Prolonged chair time without micro-shifts, and Lack of pressure-redistributing surfaces/supportive devices that contribute to pressure-injury formation.

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4 pages

Written in 2025/2026

Grade A+

Wisegrades

Skin & Wound Care questions and answers Pressure ulcers form primarily as a result of: - tissue ischemia Patient has been on that portion of the skin (bony prominence) for too long. Incontinent pts are at risk for pressure ulcers. - Too much pressure on that site - Decreased blood flow - Decreased oxygen - Leads to tissue ischemia The nurse notes a client's skin is reddened with a small abrasion and serous fluid present. The nurse should classify this stage of ulcer formation as: -...

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5 pages

Written in 2025/2026

Grade A+

Wisegrades

Skin & Wound Care Vocab questions and answers Abrasion Scrape, little bleeding, superficial, partial thickness Approximated Wound edges are closed & fit together Blanchable hyperemia pressing finger on affected area, blanches (turns white), erythema returns when you remove your finger. able to overcome ischemic episode Blanching Skin turns white when pressed & returns to normal color

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4 pages

Written in 2025/2026

Grade A+

Wisegrades

Skin/wound care questions and answers Integumentary System changes in the older adult -Maturation of epidermal cells is delayed leading to thin & easily damaged skin -Poor turgor -Circulation and collagen formation are impaired, decreased elasticity and increased risk for tissue damage from pressure -Drier skin (sweat glands decrease) -Skin may become unevenly pigmented Wound Classifications Intentional Unintentional Open Closed Acute Chronic Intentional Wound Planned disru...

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9 pages

Written in 2025/2026

Grade A+

Wisegrades

Skin/wound care questions and answers stage 1 wound - persistent red, blue, or purple hues, no skin break (firm or boggy) stage 1 wound drainage - no drainage stage 2 partial thickness - skin is broken, shallow, intact or ruptured blister stage 2 partial thickness drainage - small to heavy drainage stage 3, 4, and full thickness - skin is broken, deep crater w/ or w/o undermining stage 3, 4, and full thickness drainage - low exudate or moderate to heavy exudate stage 1 wound cleani...

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4 pages

Written in 2025/2026

Grade A+

Wisegrades

Skin/wound care questions and answers What is important with skin care ? - Pt must be repositioned at least Q2H to prevent pressure ulcers What are pressure ulcers - Injury to skin and underyling tissue d/t prolonged pressure What is shearing - Loss of skin integrity due to forces being applied that cause skin to move in opposite direction

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3 pages

Written in 2025/2026

Grade A+

Wisegrades

SKIN & WOUND CARE questions and answers how many skin assessments must you do per shift? at least 1 per day what is the pressure ulcer risk scale called? braden scale where to look for potential breakdown? - very thin tissue, bony prominences - nasal cannula areas - skin with adhesive tape or devices - blanchable or nonblanchable skin - moisture braden scale higher = better lower = more risk stages of wound healing - hemostasis = control of blood loss/clotting

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4 pages

Written in 2025/2026

Grade A+

Wisegrades

Skin + Wound Care questions and answers Structure of the skin - epidermis- protective waterproof layer of keratin, cells have no blood vessels of their own, regenerates easily + quickly dermis- elastic tissue made primarily of collagen; nerves, hair follicles, glands, immune cells, blood vessels subq- anchors the skin layers to underlying tissues Functions of the skin - protection- barrier against infection, prevent loss of mositur body temp- draws heat froom the skin as perspirati...

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13 pages

Written in 2025/2026

Grade A+

Wisegrades

Skin & Wound care questions and answers Pressure injury def localized damage to skin, unrelieved prolonged pressure National pressure ulcer advisory panel (NPUAP) improve outcomes, prevention & treatment 3 things affecting pressure injuries Pressure intensity pressure duration tissue tolerance What can affect tissue tolerance sheer, friction, moisture *poor nutrition, aging, hydration & low BP Pressure duration Low pressure- prolonged period & high pressure over short...

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6 pages

Written in 2025/2026

Grade A+

Wisegrades