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Nursing In a Flash 
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Question Answer
A dressing is sticking to a surgical incision, what should you do?
Show Answer
Lightly moisten with saline
What should you do prior to applying elastic bandages to a client's lower extremities?
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Elevate dependent extremities to enhance venous return, apply before client sits or stands
When is cold therapy contraindicated?
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Edematous tissue, decreased circulation (arteriosclerosis), neuropathy, shivering
What conditions can be contraindications for heat therapy?
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Bleeding, inflammation (such as appendicitis), cardiac problems
Irrigation solution should be the same temperature as _____.
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Body Temperature
Irrigation of an open wound requires ____ technique.
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Sterile
What is the difference between black (PU) foam and white (PVA) foam (for V.A.C.)?
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Black foam stimulates granulation and wound contraction. White foam restricts granulation.
You notice purulent drainage when changing a dressing. No culture is ordered for this change, so you?.
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Obtain a wound culture anyway.
When changing a NPWT unit dressing, the system should be in de vac mode for ____ minutes.
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30-45
____ dressings are for infected wounds. They shouldn't be used in dry wounds.
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Calcium alginate
____ dressings provide a moist environment, are soothing, and decrease pain in a wound.
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Hydrogel
____ is most useful on shallow, or moderately deep dermal ulcers.
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Hydrocolloid
____ dressings can be used on clean, granulating wounds.
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Hydrocolloid
This type of dressing is self adhesives and traps the wound's moisture over the wound. It is ideal for small, superficial wounds or to protect high risk skin?
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Film Dressing
4X4s are used in wounds that?
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Have exudate or red wound drainage (blood or seronsanguinous drainage)
A Tefla is used on wounds?
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That are clean and with little or no drainage
When removing tape from a wound, it should be pulled _____ (toward or away from) the wound.
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Toward
What type of clients are at an increased risk of developing pressure ulcers?
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Neurologically impaired, chronically ill in LTC, decreased mental status, ICU, oncology, hospice, orthopedic patients
A surgical wound heals by ____.
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Primary intention.
A wound involving loss of tissue like a burn, pressure ulcer, or severe laceration heals by ____.
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Secondary intention.
What are three components of partial-thickness wound healing?
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Inflammatory response, epithelial proliferation and migration, re-establishment of the epidermal layers
What are the three phases involved in the healing process of a full-thickness wound?
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Inflammatory, proliferative, remodeling
____ occurring after hemostasis indicates a slipped surgical suture, a dislodged clot, infection or erosion of a blood vessel by a foreign object.
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Hemorrhage
How can internal hemorrhage be detected?
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Look for distention or swelling, change in type/amount of drainage, signs and symptoms of hypovolemic shock.
When is the risk of hemorrhage after surgery the greatest?
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24-48 hours after
What three risk factors increase the risk of wound infection, related to the wound itself?
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Wound contains dead/necrotic tissue, foreign bodies in or near the wound, decreased blood supply/local defenses
What are the signs and symptoms of an infected wound?
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Fever, tenderness, pain, increased WBC, inflamed wound edges
Infection can appear as early as ____ days. Surgical infections usually appear ____ days postoperatively.
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2-3 days. 4-5 days.
Dehiscence most commonly occurs ____ days after injury.
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3-11.
Who is at high risk for dehiscence?
Show Answer
Obese, poor nutrition, present infection.


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