Certified Wound Specialist Flashcards

A patient with controlled bilateral peripheral pitting edema and brownish staining of the skin near the ankles and anterior areas should be given the following advice to lessen the risk of ulcerations:

Answer: wear compression stockings

The described symptoms (pitting edema, brownish staining) are indicative of chronic venous insufficiency. Wearing compression stockings is the primary intervention to manage edema by improving venous return and reducing fluid accumulation. This helps prevent skin breakdown and ulcerations associated with chronic venous hypertension.

For a big open post-surgical abdominal incision that contains a fistula in the posterior aspect, which fistula care strategy is likely the best to prevent wound contamination from drainage?

Answer: Bridging

For a large open post-surgical abdominal incision with a posterior fistula, 'bridging' is the best fistula care strategy. This technique involves creating a pathway or 'bridge' over the fistula to direct drainage away from the main wound and into a collection device, effectively preventing contamination of the larger incision and protecting surrounding tissues.

What kind of preparation is required for a patient who will be receiving a chemical debridement with collagenase and who has a persistent leg ulcer covered in black eschar?

Answer: Cross-hatching the upper layers of the eschar

To enhance the effectiveness of chemical debridement with collagenase on a black eschar, cross-hatching the upper layers of the eschar is required. This mechanical preparation creates channels that allow the collagenase enzyme to penetrate deeper into the necrotic tissue, facilitating more efficient breakdown and removal of the eschar.

Which type of barrier protection is the best for intact skin to keep it safe from exudate and adhesive stripping?

Answer: Skin sealant

Skin sealants are the best barrier protection for intact skin against exudate and adhesive stripping. They form a thin, breathable, protective film that shields the skin from moisture, friction, and the trauma of adhesive removal, while allowing dressings to adhere effectively without causing irritation.

Which sort of insert relieves pressure when contemplating orthotics and shoe inserts for patients with a neuropathic foot?

Answer: Semi-rigid

For patients with a neuropathic foot, semi-rigid orthotics and shoe inserts are typically recommended. These provide a crucial balance of support, pressure redistribution, and shock absorption. They are firm enough to control foot mechanics and offload high-pressure areas, yet flexible enough to accommodate movement, reducing the risk of skin breakdown.

The best course of action for a patient who is dying and has begun to build pressure on the sacral area but who groans loudly and resists when the nurse assistant tries to turn him is to:

Answer: allow the patient to lie undisturbed as much as possible

In end-of-life care, patient comfort and dignity take precedence over aggressive pressure injury prevention measures that cause distress. If a dying patient resists turning due to pain, the most compassionate approach is to allow them to lie undisturbed as much as possible, prioritizing comfort and potentially utilizing an alternating pressure mattress for support.

What is the best dressing to use when a deep ulcerated area has a lot of exudate and the drainage is caused by tumor necrosis?

Answer: Alginate

Alginate dressings are highly absorbent and are ideal for deep, ulcerated wounds with a lot of exudate, such as those resulting from tumor necrosis. They form a gel upon contact with wound fluid, effectively managing moisture, promoting a moist wound healing environment, and can also aid in hemostasis.