1 minute read

Chapter 51: Wound Management Buttaro: Primary Care: A Collaborative Practice, 6th Edition

Multiple Choice

1. A patient has a pressure ulcer that has been treated with topical medications. During a follow-up visit, the provider notes an area of red bumps in the lesion. What does this indicate?

a. Healing tissue b. Poor perfusion c. Secondary infection d. Tunneling lesions

ANS: A a. Compression therapy b. Hyperbaric oxygen therapy c. Revascularization procedures d. Skin grafting

Wounds that are healing or have the potential to heel will demonstrate pink or red tissue and the absence of exudate, infection, or debris and will have bumpy granulation tissue. Perfusion is assessed by pulse assessment and localized capillary refill. Secondary infection is characterized by exudate and cellular debris. Tunneling is a secondary wound.

2. A patient has an ulcer on one lower leg just above the medial malleolus. The provider notes irregular wound edges with granulation tissue and moderate exudate, with ankle edema in that leg. What is the initial treatment to help treat this wound?

ANS: A

NURSINGTB.COM a. Autolytic debridement b. Biologic debridement c. Chemical debridement d. Mechanical debridement

This patient has symptoms consistent with venous ulcers, which are characterized by irregular borders and granulation tissue. Compression therapy is the initial treatment of choice to reduce edema and promote venous return. Hyperbaric oxygen therapy, revascularization procedures, and skin grafting are generally used to treat arterial ulcers.

3. A patient with a wound containing necrotic tissue requires debridement. The practitioner notes an area of erythema and exudate in the wound. Which type of debridement will most likely be used?

ANS: D

Mechanical debridement may be performed using a syringe with an 18-gauge needle to remove hyperkeratotic or necrotic tissue. Autolytic and chemical debridement methods require dressings that retain moisture and are contraindicated in the presence of infection. Biologic debridement uses maggots and is not widely used in the United States.

This article is from: