{"id":114,"date":"2019-08-22T18:22:09","date_gmt":"2019-08-22T22:22:09","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/facultyancillaryresourceforclinicalproceduresforsaferpatient\/?post_type=chapter&#038;p=114"},"modified":"2020-03-23T17:52:05","modified_gmt":"2020-03-23T21:52:05","slug":"4-2-wound-healing-and-assessment","status":"publish","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/facultyancillaryresourceforclinicalproceduresforsaferpatient\/chapter\/4-2-wound-healing-and-assessment\/","title":{"raw":"4.2 Wound Healing and Assessment","rendered":"4.2 Wound Healing and Assessment"},"content":{"raw":"<h2 style=\"text-align: center\"><strong>Critical Thinking Exercises: Questions, Answers, and Sources \/ References<\/strong><\/h2>\r\nCritical thinking questions are in bold type, and the answers are italicized. Additional resources or references are provided below.\r\n<ol>\r\n \t<li><strong>A patient is 75 years old, smokes cigarettes, has renal disease, and is overweight. What additional factors should you consider prior to assessing the patient\u2019s wound? Provide your rationale.<\/strong><\/li>\r\n<\/ol>\r\n<ul>\r\n \t<li><em>Type of wound: This helps the nurse to anticipate findings.<\/em><\/li>\r\n \t<li><em>Medications: Corticosteroids delay wound healing. Chemo = potential bone marrow suppression = \u2193WBC = impaired immunity<\/em><\/li>\r\n \t<li><em>Other chronic disease: Diabetes is characterized by delayed wound healing due to circulatory changes associated with fat, and carbohydrate and protein metabolism. Anemia lowers oxygen availability to tissues. Impaired autoimmunie respnse = impaired healing<\/em><\/li>\r\n \t<li><em>Age: Associated with vascular changes = potential \u2193 oxygen to the tissues = \u2193 potential for healing<\/em><\/li>\r\n \t<li><em>Smoking: Results in vasoconstriction and arterial damage = potential \u2193 oxygen to the tissues = \u2193 potential for healing<\/em><\/li>\r\n \t<li><em>Obesity: Obese tissue is poorly vascularized = potential \u2193 oxygen to the tissues = \u2193 potential for healing<\/em><\/li>\r\n \t<li><em>Diet: does the patient have a well balance diet to provide the necessary fats, carbohydrates and protein needed for healing? What is the patient's hydration status?<\/em><\/li>\r\n<\/ul>\r\nSource:\r\n\r\nPotter, P., Perry, A., et al (2019). <em>Canadian fundamentals of nursing<\/em> (6th ed.). Elsevier; Mosby.\r\n\r\n&nbsp;\r\n\r\n2. <strong>What indications might lead the nurse to suspect that a patient is malnourished and, therefore, at risk for delayed wound healing?\u00a0<\/strong>\r\n<ul>\r\n \t<li><em>Recent unexplained weight loss, lethargy, loose skin, low prealbumin \/ albumin, poor dietary (food &amp; fluids) intake, poorly healing wounds<\/em><\/li>\r\n \t<li><em>Note: A diagnosis of malnutrition is based on a multitude of factors. Often through observations, the RN suspects malnutrition is present. The RN can implement dietary strategies \/ dietary consults as initial strategies to address this important health issue.<\/em><\/li>\r\n<\/ul>\r\nSource:\r\n\r\nPotter, P., Perry, A., et al (2019). <em>Canadian fundamentals of nursing<\/em> (6th ed.). Elsevier; Mosby.\r\n\r\n&nbsp;\r\n\r\n3. <strong>What phase of wound healing is indicated by the presence of epithelialization and wound contraction?<\/strong>\r\n<ul>\r\n \t<li><em>Proliferation phase<\/em><\/li>\r\n<\/ul>\r\n4. <strong>Name three extrinsic factors that can contribute to the risk of pressure injury.<\/strong>\r\n<ul>\r\n \t<li><em>Shear force: e.g., when being pulled up in the bed<\/em><\/li>\r\n \t<li><em>Friction: e.g., repetitive rubbing on the surface<\/em><\/li>\r\n \t<li><em>Immobility: If blood supply to areas of compression is diminished anoxia occurs, which can lead to tissue damage or death. This includes immobilization procedures such as restraints, or medication induced.<\/em><\/li>\r\n \t<li><em>Humidity: e.g., wet incontinence products<\/em><\/li>\r\n<\/ul>\r\nSource:\r\n\r\n<span style=\"color: #000000\">Magalh\u00e3es, M., Gragnani, A., Veiga, D., Blanes, L., \u00a0Galhardo, V., K\u00e1llas, H., Juliano, Y., Ferreira,<\/span> J. (2007). Risk factors for pressure ulcers in hospitalized elderly without significant cognitive impairment. <em>Wounds, 19<\/em>(1), 20-24. <a href=\"https:\/\/www.woundsresearch.com\/article\/6708\">https:\/\/www.woundsresearch.com\/article\/6708<\/a>\r\n<h2 style=\"text-align: center\"><strong>Sample Learning Activity<\/strong><\/h2>\r\n<ol>\r\n \t<li><strong>Find an assessment tool for pressure injury risk (e.g., Braden scale). For each of the risk categories in the table below, identify strategies that the nurse might choose to implement to help mitigate the risk<\/strong>.<\/li>\r\n<\/ol>\r\n<table>\r\n<tbody>\r\n<tr>\r\n<td style=\"width: 186.438px\">\r\n<h4><strong>Risk Category<\/strong><\/h4>\r\n<\/td>\r\n<td style=\"width: 804.438px\">\r\n<h4><strong>Potential Nursing Strategies<\/strong><\/h4>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 186.438px\"><strong>Friction &amp; shear<\/strong><\/td>\r\n<td style=\"width: 804.438px\">\r\n<ul>\r\n \t<li><em>Moisturize skin<\/em><\/li>\r\n \t<li><em>Use slider sheet \/ trapeze bar \/ mechanical lift<\/em><\/li>\r\n \t<li><em>Keep HOB \u226430 degrees<\/em><\/li>\r\n \t<li><em>Elevate <\/em><em>FOB<\/em><em> \/ knee gatch<\/em><\/li>\r\n \t<li><em>Use foot board<\/em><\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 186.438px\"><strong>Nutrition<\/strong><\/td>\r\n<td style=\"width: 804.438px\">\r\n<ul>\r\n \t<li><em>Consult dietician for consideration of high-protein, high-calorie diet<\/em><\/li>\r\n \t<li><em>Offer fluids q2h while awake<\/em><\/li>\r\n \t<li><em>Offer high-protein drinks<\/em><\/li>\r\n \t<li><em>Set-up and assist with meals<\/em><\/li>\r\n \t<li><em>Consult prescriber for multivitamin supplement<\/em><\/li>\r\n \t<li><em>Monitor weight for loss<\/em><\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 186.438px\"><strong>Mobility \/ activity<\/strong><\/td>\r\n<td style=\"width: 804.438px\">\r\n<ul>\r\n \t<li><em>Assist to change position q2h &amp; prn<\/em><\/li>\r\n \t<li><em>Consult physio for walking program<\/em><\/li>\r\n \t<li><em>Initiate scheduled walking<\/em><\/li>\r\n \t<li><em>If chair bound, use therapeutic cushions on seats<\/em><\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 186.438px\"><strong>Moisture<\/strong><\/td>\r\n<td style=\"width: 804.438px\">\r\n<ul>\r\n \t<li><em>Use of dry flow incontinence sheets<\/em><\/li>\r\n \t<li><em>Provide skin \/ continence care<\/em><\/li>\r\n \t<li><em>Use moisture barrier cream<\/em><\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 186.438px\"><strong>Sensory perception<\/strong><\/td>\r\n<td style=\"width: 804.438px\">\r\n<ul>\r\n \t<li><em>Awareness and attention to safety depending on patient\u2019s ability to respond to pressure related discomfort<\/em><\/li>\r\n \t<li><em>Elbow \/ heel protectors<\/em><\/li>\r\n \t<li><em>Assess need for therapeutic mattress<\/em><\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\nSource:\r\n\r\nInterior Health. (2016, September 20). <em>Braden Q scale<\/em> [Infographic]. <a href=\"https:\/\/www.clwk.ca\/buddydrive\/file\/cc-16-01-b-braden-q-scale\/\">https:\/\/www.clwk.ca\/buddydrive\/file\/cc-16-01-b-braden-q-scale\/<\/a>\r\n\r\nPotter, P., Perry, A., et al (2019). <em>Canadian fundamentals of nursing<\/em> (6th ed.). Elsevier; Mosby.\r\n<h2 style=\"text-align: center\">Sample Quiz Questions<\/h2>\r\n<p style=\"text-align: left\"><span style=\"background-color: #ffffff;color: #000000\"><strong>1.\u00a0<\/strong><\/span><strong>Name four different types of wounds<\/strong><\/p>\r\n<em>Wound dehiscence, surgical, arterial, venous, diabetic neuropathic, traumatic, pressure injury<\/em>\r\n\r\nSource:\r\n\r\nVancouver Coastal Health Authority. (2009). <em>Wound assessment<\/em> [online course]. <a href=\"http:\/\/ccrs.vch.ca\/onlinecourses\/wound_management\/woundassessment_v4\/index.html\" target=\"_blank\" rel=\"noopener noreferrer\">http:\/\/ccrs.vch.ca\/onlinecourses\/wound_management\/woundassessment_v4\/index.html<\/a>\r\n\r\n&nbsp;\r\n\r\n2. <strong>Order the phases of non-complicated wound healing in the correct sequence: hemostasis, maturation, inflammatory, proliferation.<\/strong>\r\n<ol>\r\n \t<li><em>Hemostasis\u00a0<\/em><\/li>\r\n \t<li><em>Inflammatory\u00a0<\/em><\/li>\r\n \t<li><em>Proliferation\u00a0<\/em><\/li>\r\n \t<li><em>Maturation <\/em><\/li>\r\n<\/ol>\r\nSource:\r\n\r\nBritish Columbia Provincial Nursing Skin and Wound Committee. (2011). <em>Guideline: Assessment and treatment of surgical wounds healing by primary and secondary intention in adults and children<\/em>. <a href=\"https:\/\/www.clwk.ca\/buddydrive\/file\/guideline-surgical-wounds-primary-secondary-intention\/\">https:\/\/www.clwk.ca\/buddydrive\/file\/guideline-surgical-wounds-primary-secondary-intention\/<\/a>\r\n\r\nPerry, A. G., Potter, P. A., &amp; Ostendorf, W. R. (2017). <em>Clinical\u00a0<\/em><em style=\"font-size: 1em\">nursing\u00a0<\/em><em style=\"text-align: initial;text-indent: 1em;font-size: 1em\">skills and techniques<\/em><span style=\"text-align: initial;text-indent: 1em;font-size: 1em\"> (9th ed.). Elsevier; Mosby.<\/span>\r\n\r\n<strong>3. True or false? Wet to dry dressings are effective in promoting wound healing.<\/strong>\r\n\r\n<em>False. Wet to dry dressings are not considered best practice. When removed they disrupt the wound bed including healing healthy cells. Moist wound environments are considered best practice and can be achieved through moist compresses and manufactured products such as hydrogel. <\/em>\r\n\r\nSource:\r\n\r\nHarris, C., Kuhnke, J., Haley, J., Cross, K., Somayaji, R., Dubois, J., Bishop, R., &amp; Lewis, K. (2018). Best practice recommendations for the prevention and management of surgical wound complications. Canadian Association of Wound Care.\u00a0<a href=\"https:\/\/www.woundscanada.ca\/docman\/public\/health-care-professional\/bpr-workshop\/555-bpr-prevention-and-management-of-surgical-wound-complications-v2\/file\">https:\/\/www.woundscanada.ca\/docman\/public\/health-care-professional\/bpr-workshop\/555-bpr-prevention-and-management-of-surgical-wound-complications-v2\/file<\/a>\r\n\r\n&nbsp;\r\n\r\n<strong>4. Which of the following do NOT promote wound healing? (Select all that apply)<\/strong>\r\n<ul>\r\n \t<li><strong>Soaking wounds in a warm bath<\/strong> <em>Incorrect: Warm baths\u2014unless sterile\u2014promote growth of microorganisms and can cause wound infection<\/em><\/li>\r\n \t<li><strong>Eating a balanced diet<\/strong> <em>Correct: fats, carbohydrates, protein, hydration<\/em><\/li>\r\n \t<li><strong>Exerting prolonged pressure on the site<\/strong>\u00a0<em>Incorrect: Exerting prolonged pressure can occlude capillary beds, thereby preventing delivery of oxygen and nutrients to the site.<\/em><\/li>\r\n \t<li><strong>Elevated blood glucose<\/strong>\u00a0<em>Incorrect: Hyperglycemia encourages bacterial growth and contributes to arterial changes, which lead to impaired circulation.<\/em><\/li>\r\n \t<li><strong>Smoking<\/strong>\u00a0<em>Incorrect: Smoking results in vasoconstriction and contributes to arterial changes, which lead to impaired circulation.<\/em><\/li>\r\n<\/ul>\r\nSource:\r\n\r\nPerry, A. G., Potter, P. A., &amp; Ostendorf, W. R. (2017). <em>Clinical\u00a0<\/em><em style=\"font-size: 1em\">nursing\u00a0<\/em><em style=\"text-align: initial;text-indent: 1em;font-size: 1em\">skills and techniques<\/em><span style=\"text-align: initial;text-indent: 1em;font-size: 1em\"> (9th ed.). Elsevier; Mosby.<\/span>\r\n\r\n&nbsp;\r\n\r\n<strong>5. Which elements are important to consider when assessing a closed (surgical) wound?<\/strong>\r\n<ul>\r\n \t<li><em>Location<\/em><\/li>\r\n \t<li><em>Peri skin condition (colour edema)<\/em><\/li>\r\n \t<li><em>Are the wound edges approximated or dehisced<\/em><\/li>\r\n \t<li><em>Presence of staples or sutures<\/em><\/li>\r\n \t<li><em>Pain<\/em><\/li>\r\n<\/ul>\r\nSource:\r\n\r\nBritish Columbia Provincial Nursing Skin and Wound Committee. (2011). <em>Guideline: Assessment and treatment of surgical wounds healing by primary and secondary intention in adults and children<\/em>.\u00a0<a href=\"https:\/\/www.clwk.ca\/buddydrive\/file\/guideline-surgical-wounds-primary-secondary-intention\/\">https:\/\/www.clwk.ca\/buddydrive\/file\/guideline-surgical-wounds-primary-secondary-intention\/<\/a>\r\n\r\nPerry, A. G., Potter, P. A., &amp; Ostendorf, W. R. (2017). <em>Clinical\u00a0<\/em><em style=\"font-size: 1em\">nursing\u00a0<\/em><em style=\"text-align: initial;text-indent: 1em;font-size: 1em\">skills and techniques<\/em><span style=\"text-align: initial;text-indent: 1em;font-size: 1em\"> (9th ed.). Elsevier; Mosby.<\/span>\r\n\r\n6. <strong>Which elements are important to consider when assessing an open wound (e.g., dehisced abdominal wound). Select all that apply.<\/strong>\r\n<ul>\r\n \t<li><strong>Location <\/strong><em>(Answer: yes)<\/em><\/li>\r\n \t<li><strong>Wound bed (slough, granulation, foreign bodies)<\/strong><em> (Answer: yes)<\/em><\/li>\r\n \t<li><strong>Periskin (intact, erythema, macerated, excoriated, callused, etc.)<\/strong><em> (Answer: yes)<\/em><\/li>\r\n \t<li><strong>Pain<\/strong> <em>(Answer: yes)<\/em><\/li>\r\n \t<li><strong>Size (length, width, depth) <\/strong><em>(Answer: yes)<\/em><\/li>\r\n \t<li><strong>Presence of undermining \/ tunnels (location, size)<\/strong><em> (Answer: yes)<\/em><\/li>\r\n \t<li><strong>Exudate (colour, amount, odour)<\/strong><em> (Answer: yes)<\/em><\/li>\r\n<\/ul>\r\nSource:\r\n\r\nBritish Columbia Provincial Nursing Skin and Wound Committee. (2011). <em>Guideline: Assessment and treatment of surgical wounds healing by primary and secondary intention in adults and children<\/em>. <a href=\"https:\/\/www.clwk.ca\/buddydrive\/file\/guideline-surgical-wounds-primary-secondary-intention\/\">https:\/\/www.clwk.ca\/buddydrive\/file\/guideline-surgical-wounds-primary-secondary-intention\/<\/a>\r\n\r\nPerry, A. G., Potter, P. A., &amp; Ostendorf, W. R. (2017). <em>Clinical nursing skills and techniques<\/em> (9th ed.). Elsevier; Mosby.\r\n\r\n&nbsp;","rendered":"<h2 style=\"text-align: center\"><strong>Critical Thinking Exercises: Questions, Answers, and Sources \/ References<\/strong><\/h2>\n<p>Critical thinking questions are in bold type, and the answers are italicized. Additional resources or references are provided below.<\/p>\n<ol>\n<li><strong>A patient is 75 years old, smokes cigarettes, has renal disease, and is overweight. What additional factors should you consider prior to assessing the patient\u2019s wound? Provide your rationale.<\/strong><\/li>\n<\/ol>\n<ul>\n<li><em>Type of wound: This helps the nurse to anticipate findings.<\/em><\/li>\n<li><em>Medications: Corticosteroids delay wound healing. Chemo = potential bone marrow suppression = \u2193WBC = impaired immunity<\/em><\/li>\n<li><em>Other chronic disease: Diabetes is characterized by delayed wound healing due to circulatory changes associated with fat, and carbohydrate and protein metabolism. Anemia lowers oxygen availability to tissues. Impaired autoimmunie respnse = impaired healing<\/em><\/li>\n<li><em>Age: Associated with vascular changes = potential \u2193 oxygen to the tissues = \u2193 potential for healing<\/em><\/li>\n<li><em>Smoking: Results in vasoconstriction and arterial damage = potential \u2193 oxygen to the tissues = \u2193 potential for healing<\/em><\/li>\n<li><em>Obesity: Obese tissue is poorly vascularized = potential \u2193 oxygen to the tissues = \u2193 potential for healing<\/em><\/li>\n<li><em>Diet: does the patient have a well balance diet to provide the necessary fats, carbohydrates and protein needed for healing? What is the patient&#8217;s hydration status?<\/em><\/li>\n<\/ul>\n<p>Source:<\/p>\n<p>Potter, P., Perry, A., et al (2019). <em>Canadian fundamentals of nursing<\/em> (6th ed.). Elsevier; Mosby.<\/p>\n<p>&nbsp;<\/p>\n<p>2. <strong>What indications might lead the nurse to suspect that a patient is malnourished and, therefore, at risk for delayed wound healing?\u00a0<\/strong><\/p>\n<ul>\n<li><em>Recent unexplained weight loss, lethargy, loose skin, low prealbumin \/ albumin, poor dietary (food &amp; fluids) intake, poorly healing wounds<\/em><\/li>\n<li><em>Note: A diagnosis of malnutrition is based on a multitude of factors. Often through observations, the RN suspects malnutrition is present. The RN can implement dietary strategies \/ dietary consults as initial strategies to address this important health issue.<\/em><\/li>\n<\/ul>\n<p>Source:<\/p>\n<p>Potter, P., Perry, A., et al (2019). <em>Canadian fundamentals of nursing<\/em> (6th ed.). Elsevier; Mosby.<\/p>\n<p>&nbsp;<\/p>\n<p>3. <strong>What phase of wound healing is indicated by the presence of epithelialization and wound contraction?<\/strong><\/p>\n<ul>\n<li><em>Proliferation phase<\/em><\/li>\n<\/ul>\n<p>4. <strong>Name three extrinsic factors that can contribute to the risk of pressure injury.<\/strong><\/p>\n<ul>\n<li><em>Shear force: e.g., when being pulled up in the bed<\/em><\/li>\n<li><em>Friction: e.g., repetitive rubbing on the surface<\/em><\/li>\n<li><em>Immobility: If blood supply to areas of compression is diminished anoxia occurs, which can lead to tissue damage or death. This includes immobilization procedures such as restraints, or medication induced.<\/em><\/li>\n<li><em>Humidity: e.g., wet incontinence products<\/em><\/li>\n<\/ul>\n<p>Source:<\/p>\n<p><span style=\"color: #000000\">Magalh\u00e3es, M., Gragnani, A., Veiga, D., Blanes, L., \u00a0Galhardo, V., K\u00e1llas, H., Juliano, Y., Ferreira,<\/span> J. (2007). Risk factors for pressure ulcers in hospitalized elderly without significant cognitive impairment. <em>Wounds, 19<\/em>(1), 20-24. <a href=\"https:\/\/www.woundsresearch.com\/article\/6708\">https:\/\/www.woundsresearch.com\/article\/6708<\/a><\/p>\n<h2 style=\"text-align: center\"><strong>Sample Learning Activity<\/strong><\/h2>\n<ol>\n<li><strong>Find an assessment tool for pressure injury risk (e.g., Braden scale). For each of the risk categories in the table below, identify strategies that the nurse might choose to implement to help mitigate the risk<\/strong>.<\/li>\n<\/ol>\n<table>\n<tbody>\n<tr>\n<td style=\"width: 186.438px\">\n<h4><strong>Risk Category<\/strong><\/h4>\n<\/td>\n<td style=\"width: 804.438px\">\n<h4><strong>Potential Nursing Strategies<\/strong><\/h4>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 186.438px\"><strong>Friction &amp; shear<\/strong><\/td>\n<td style=\"width: 804.438px\">\n<ul>\n<li><em>Moisturize skin<\/em><\/li>\n<li><em>Use slider sheet \/ trapeze bar \/ mechanical lift<\/em><\/li>\n<li><em>Keep HOB \u226430 degrees<\/em><\/li>\n<li><em>Elevate <\/em><em>FOB<\/em><em> \/ knee gatch<\/em><\/li>\n<li><em>Use foot board<\/em><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 186.438px\"><strong>Nutrition<\/strong><\/td>\n<td style=\"width: 804.438px\">\n<ul>\n<li><em>Consult dietician for consideration of high-protein, high-calorie diet<\/em><\/li>\n<li><em>Offer fluids q2h while awake<\/em><\/li>\n<li><em>Offer high-protein drinks<\/em><\/li>\n<li><em>Set-up and assist with meals<\/em><\/li>\n<li><em>Consult prescriber for multivitamin supplement<\/em><\/li>\n<li><em>Monitor weight for loss<\/em><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 186.438px\"><strong>Mobility \/ activity<\/strong><\/td>\n<td style=\"width: 804.438px\">\n<ul>\n<li><em>Assist to change position q2h &amp; prn<\/em><\/li>\n<li><em>Consult physio for walking program<\/em><\/li>\n<li><em>Initiate scheduled walking<\/em><\/li>\n<li><em>If chair bound, use therapeutic cushions on seats<\/em><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 186.438px\"><strong>Moisture<\/strong><\/td>\n<td style=\"width: 804.438px\">\n<ul>\n<li><em>Use of dry flow incontinence sheets<\/em><\/li>\n<li><em>Provide skin \/ continence care<\/em><\/li>\n<li><em>Use moisture barrier cream<\/em><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 186.438px\"><strong>Sensory perception<\/strong><\/td>\n<td style=\"width: 804.438px\">\n<ul>\n<li><em>Awareness and attention to safety depending on patient\u2019s ability to respond to pressure related discomfort<\/em><\/li>\n<li><em>Elbow \/ heel protectors<\/em><\/li>\n<li><em>Assess need for therapeutic mattress<\/em><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>Source:<\/p>\n<p>Interior Health. (2016, September 20). <em>Braden Q scale<\/em> [Infographic]. <a href=\"https:\/\/www.clwk.ca\/buddydrive\/file\/cc-16-01-b-braden-q-scale\/\">https:\/\/www.clwk.ca\/buddydrive\/file\/cc-16-01-b-braden-q-scale\/<\/a><\/p>\n<p>Potter, P., Perry, A., et al (2019). <em>Canadian fundamentals of nursing<\/em> (6th ed.). Elsevier; Mosby.<\/p>\n<h2 style=\"text-align: center\">Sample Quiz Questions<\/h2>\n<p style=\"text-align: left\"><span style=\"background-color: #ffffff;color: #000000\"><strong>1.\u00a0<\/strong><\/span><strong>Name four different types of wounds<\/strong><\/p>\n<p><em>Wound dehiscence, surgical, arterial, venous, diabetic neuropathic, traumatic, pressure injury<\/em><\/p>\n<p>Source:<\/p>\n<p>Vancouver Coastal Health Authority. (2009). <em>Wound assessment<\/em> [online course]. <a href=\"http:\/\/ccrs.vch.ca\/onlinecourses\/wound_management\/woundassessment_v4\/index.html\" target=\"_blank\" rel=\"noopener noreferrer\">http:\/\/ccrs.vch.ca\/onlinecourses\/wound_management\/woundassessment_v4\/index.html<\/a><\/p>\n<p>&nbsp;<\/p>\n<p>2. <strong>Order the phases of non-complicated wound healing in the correct sequence: hemostasis, maturation, inflammatory, proliferation.<\/strong><\/p>\n<ol>\n<li><em>Hemostasis\u00a0<\/em><\/li>\n<li><em>Inflammatory\u00a0<\/em><\/li>\n<li><em>Proliferation\u00a0<\/em><\/li>\n<li><em>Maturation <\/em><\/li>\n<\/ol>\n<p>Source:<\/p>\n<p>British Columbia Provincial Nursing Skin and Wound Committee. (2011). <em>Guideline: Assessment and treatment of surgical wounds healing by primary and secondary intention in adults and children<\/em>. <a href=\"https:\/\/www.clwk.ca\/buddydrive\/file\/guideline-surgical-wounds-primary-secondary-intention\/\">https:\/\/www.clwk.ca\/buddydrive\/file\/guideline-surgical-wounds-primary-secondary-intention\/<\/a><\/p>\n<p>Perry, A. G., Potter, P. A., &amp; Ostendorf, W. R. (2017). <em>Clinical\u00a0<\/em><em style=\"font-size: 1em\">nursing\u00a0<\/em><em style=\"text-align: initial;text-indent: 1em;font-size: 1em\">skills and techniques<\/em><span style=\"text-align: initial;text-indent: 1em;font-size: 1em\"> (9th ed.). Elsevier; Mosby.<\/span><\/p>\n<p><strong>3. True or false? Wet to dry dressings are effective in promoting wound healing.<\/strong><\/p>\n<p><em>False. Wet to dry dressings are not considered best practice. When removed they disrupt the wound bed including healing healthy cells. Moist wound environments are considered best practice and can be achieved through moist compresses and manufactured products such as hydrogel. <\/em><\/p>\n<p>Source:<\/p>\n<p>Harris, C., Kuhnke, J., Haley, J., Cross, K., Somayaji, R., Dubois, J., Bishop, R., &amp; Lewis, K. (2018). Best practice recommendations for the prevention and management of surgical wound complications. Canadian Association of Wound Care.\u00a0<a href=\"https:\/\/www.woundscanada.ca\/docman\/public\/health-care-professional\/bpr-workshop\/555-bpr-prevention-and-management-of-surgical-wound-complications-v2\/file\">https:\/\/www.woundscanada.ca\/docman\/public\/health-care-professional\/bpr-workshop\/555-bpr-prevention-and-management-of-surgical-wound-complications-v2\/file<\/a><\/p>\n<p>&nbsp;<\/p>\n<p><strong>4. Which of the following do NOT promote wound healing? (Select all that apply)<\/strong><\/p>\n<ul>\n<li><strong>Soaking wounds in a warm bath<\/strong> <em>Incorrect: Warm baths\u2014unless sterile\u2014promote growth of microorganisms and can cause wound infection<\/em><\/li>\n<li><strong>Eating a balanced diet<\/strong> <em>Correct: fats, carbohydrates, protein, hydration<\/em><\/li>\n<li><strong>Exerting prolonged pressure on the site<\/strong>\u00a0<em>Incorrect: Exerting prolonged pressure can occlude capillary beds, thereby preventing delivery of oxygen and nutrients to the site.<\/em><\/li>\n<li><strong>Elevated blood glucose<\/strong>\u00a0<em>Incorrect: Hyperglycemia encourages bacterial growth and contributes to arterial changes, which lead to impaired circulation.<\/em><\/li>\n<li><strong>Smoking<\/strong>\u00a0<em>Incorrect: Smoking results in vasoconstriction and contributes to arterial changes, which lead to impaired circulation.<\/em><\/li>\n<\/ul>\n<p>Source:<\/p>\n<p>Perry, A. G., Potter, P. A., &amp; Ostendorf, W. R. (2017). <em>Clinical\u00a0<\/em><em style=\"font-size: 1em\">nursing\u00a0<\/em><em style=\"text-align: initial;text-indent: 1em;font-size: 1em\">skills and techniques<\/em><span style=\"text-align: initial;text-indent: 1em;font-size: 1em\"> (9th ed.). Elsevier; Mosby.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><strong>5. Which elements are important to consider when assessing a closed (surgical) wound?<\/strong><\/p>\n<ul>\n<li><em>Location<\/em><\/li>\n<li><em>Peri skin condition (colour edema)<\/em><\/li>\n<li><em>Are the wound edges approximated or dehisced<\/em><\/li>\n<li><em>Presence of staples or sutures<\/em><\/li>\n<li><em>Pain<\/em><\/li>\n<\/ul>\n<p>Source:<\/p>\n<p>British Columbia Provincial Nursing Skin and Wound Committee. (2011). <em>Guideline: Assessment and treatment of surgical wounds healing by primary and secondary intention in adults and children<\/em>.\u00a0<a href=\"https:\/\/www.clwk.ca\/buddydrive\/file\/guideline-surgical-wounds-primary-secondary-intention\/\">https:\/\/www.clwk.ca\/buddydrive\/file\/guideline-surgical-wounds-primary-secondary-intention\/<\/a><\/p>\n<p>Perry, A. G., Potter, P. A., &amp; Ostendorf, W. R. (2017). <em>Clinical\u00a0<\/em><em style=\"font-size: 1em\">nursing\u00a0<\/em><em style=\"text-align: initial;text-indent: 1em;font-size: 1em\">skills and techniques<\/em><span style=\"text-align: initial;text-indent: 1em;font-size: 1em\"> (9th ed.). Elsevier; Mosby.<\/span><\/p>\n<p>6. <strong>Which elements are important to consider when assessing an open wound (e.g., dehisced abdominal wound). Select all that apply.<\/strong><\/p>\n<ul>\n<li><strong>Location <\/strong><em>(Answer: yes)<\/em><\/li>\n<li><strong>Wound bed (slough, granulation, foreign bodies)<\/strong><em> (Answer: yes)<\/em><\/li>\n<li><strong>Periskin (intact, erythema, macerated, excoriated, callused, etc.)<\/strong><em> (Answer: yes)<\/em><\/li>\n<li><strong>Pain<\/strong> <em>(Answer: yes)<\/em><\/li>\n<li><strong>Size (length, width, depth) <\/strong><em>(Answer: yes)<\/em><\/li>\n<li><strong>Presence of undermining \/ tunnels (location, size)<\/strong><em> (Answer: yes)<\/em><\/li>\n<li><strong>Exudate (colour, amount, odour)<\/strong><em> (Answer: yes)<\/em><\/li>\n<\/ul>\n<p>Source:<\/p>\n<p>British Columbia Provincial Nursing Skin and Wound Committee. (2011). <em>Guideline: Assessment and treatment of surgical wounds healing by primary and secondary intention in adults and children<\/em>. <a href=\"https:\/\/www.clwk.ca\/buddydrive\/file\/guideline-surgical-wounds-primary-secondary-intention\/\">https:\/\/www.clwk.ca\/buddydrive\/file\/guideline-surgical-wounds-primary-secondary-intention\/<\/a><\/p>\n<p>Perry, A. G., Potter, P. A., &amp; Ostendorf, W. R. (2017). <em>Clinical nursing skills and techniques<\/em> (9th ed.). Elsevier; Mosby.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"author":397,"menu_order":1,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-114","chapter","type-chapter","status-publish","hentry"],"part":112,"_links":{"self":[{"href":"https:\/\/pressbooks.bccampus.ca\/facultyancillaryresourceforclinicalproceduresforsaferpatient\/wp-json\/pressbooks\/v2\/chapters\/114","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.bccampus.ca\/facultyancillaryresourceforclinicalproceduresforsaferpatient\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.bccampus.ca\/facultyancillaryresourceforclinicalproceduresforsaferpatient\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/facultyancillaryresourceforclinicalproceduresforsaferpatient\/wp-json\/wp\/v2\/users\/397"}],"version-history":[{"count":15,"href":"https:\/\/pressbooks.bccampus.ca\/facultyancillaryresourceforclinicalproceduresforsaferpatient\/wp-json\/pressbooks\/v2\/chapters\/114\/revisions"}],"predecessor-version":[{"id":785,"href":"https:\/\/pressbooks.bccampus.ca\/facultyancillaryresourceforclinicalproceduresforsaferpatient\/wp-json\/pressbooks\/v2\/chapters\/114\/revisions\/785"}],"part":[{"href":"https:\/\/pressbooks.bccampus.ca\/facultyancillaryresourceforclinicalproceduresforsaferpatient\/wp-json\/pressbooks\/v2\/parts\/112"}],"metadata":[{"href":"https:\/\/pressbooks.bccampus.ca\/facultyancillaryresourceforclinicalproceduresforsaferpatient\/wp-json\/pressbooks\/v2\/chapters\/114\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.bccampus.ca\/facultyancillaryresourceforclinicalproceduresforsaferpatient\/wp-json\/wp\/v2\/media?parent=114"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/facultyancillaryresourceforclinicalproceduresforsaferpatient\/wp-json\/pressbooks\/v2\/chapter-type?post=114"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/facultyancillaryresourceforclinicalproceduresforsaferpatient\/wp-json\/wp\/v2\/contributor?post=114"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/facultyancillaryresourceforclinicalproceduresforsaferpatient\/wp-json\/wp\/v2\/license?post=114"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}