Deck 8: Wound Healing, Dressings, and Drains

Question 1

The perioperative nurse practitioner received a call from Maureen Haas 2 days after she was discharged to home.Maureen related that her drains were not working or drawing in fluid,and she had red,hot-to-touch skin and swelling around the left drain exit site.Maureen also noted some yellowish fluid seeping around the drainage tube that smelled bad.What indications convinced the nurse practitioner that Maureen followed her postoperative teaching?

A) Maureen called the right person,the nurse practitioner.
B) Maureen communicated the appropriate descriptive information about her incision.
C) Maureen was on her way to the emergency department for pain medication.
D) Maureen stated that she took better care of her incision by coating the 4 ´ 4 gauze pads with antibacterial spray.

Answer 1

B
Discuss how to clean around drain sites if applicable.Provide instruction on how to reapply the dressing.Instruct the patient to keep the suture line clean;do not rub vigorously;pat dry after bathing or showering.Provide education about the appearance of the wound at this stage.Remind the patient that the wound edges still may be red and slightly raised.Recommend that the patient report any swelling,redness,tenderness,or excessive scar thickening that persists beyond 8 weeks.Instruct the patient on the contact person and number to call with signs and symptoms of infection and what important information should be described.

Question 2

Jacob Sutzkever,a 62-year-old man,had surgery 6 days ago for a ruptured diverticulum.What was the wound classification at the time of his emergency surgery?

A) Clean wound,classification I
B) Clean/contaminated wound,classification II
C) Contaminated wound,classification III
D) Infected wound,classification IV

Answer 2

C
The diverticulum rupture exposes,or contaminates,the peritoneal cavity with bowel contents and bowel organisms that can cause infection.

Question 3

Which statement best reflects the appropriate purpose of a surgical drain?

A) Drains can prevent the development of deep wound infections.
B) Drains provide pockets through which air and fluids can collect in the surgical site.
C) Drains provide a portal for antibiotic irrigation.
D) Drains can provide opportunities for wound aeration.

Answer 3

A
Drains control ecchymosis and provide exits through which air and fluids,such as serum,blood,lymph,intestinal secretions,bile,and pus,can be evacuated from the operative site.Drains also may be used to prevent the development of deep wound infections.

Question 4

Which of the criteria below are appropriate when determining whether an incisional surgical site infection (SSI)is superficial or deep? Select all that apply.

A) Where the purulent drainage comes from,superficial or deep
B) Where the positive wound culture comes from,superficial or deep
C) Whether the wound dehisces and/or is deliberately opened by a surgeon
D) The diagnosis by the surgeon or attending physician

Question 5

Pilar Slayton has just seen her surgeon for her first postoperative visit after a modified radical mastectomy 6 days ago.Her incision is healing well and the closed drain was removed.There are no signs of infection or impaired healing.The surgeon reviewed the operative report and noted that Pilar's wound classification was documented in the perioperative record as classification II.After Pilar left,the surgeon called the perioperative nurse to investigate the reason wound classification II was assigned during the surgery.What is the most probable explanation for this notation?

A) A break in aseptic technique
B) An error of transmission in the perioperative record
C) The nurse thought that the closed drain warranted classification II.
D) Any of these events could have occurred and were not communicated to the team.

Question 6

Nancy Gallo returns back to work in a busy OR tomorrow after a 3-week vacation.She is certain she will be assigned to scrub in cardiac surgery in the morning.Select the infection prevention measures she must accomplish before she returns to the OR.

A) Home launder her hats and scrubs.
B) Remove nail polish and jewelry and cut her nails to 1/4 inch past her finger tips.
C) Take a shower with antimicrobial shower gel.
D) Examine her hands and arms for evidence of impaired skin integrity.

Question 7

Infection control and prevention surveillance was underway in the cardiac intensive care unit because of an alarming prevalence of sternal wound infections.The infection preventionist and perioperative resource nurse reviewed the criteria in order to define the SSI and develop strategies for further investigation and prevention.The infectious signs and symptoms arose on postoperative day 2 with edema,redness,and purulent exudates that appeared to be isolated to the subcutaneous plane above the sternum.What two important criteria must be met to conclusively define this surgical site infection (SSI)?

A) Physician examination for wound separation with cultures of superficial and deep tissues
B) Positive wound cultures from deep tissues,but not the organ space,with cultures of drainage
C) Positive wound cultures obtained from the deepest accessible source of wound drainage
D) Positive diagnosis of the SSI by the surgeon or attending physician

Question 8

Which statement about surgical dressings is true?

A) Surgical dressings cushion and protect the wound from trauma and gross contamination,and absorb drainage.
B) Surgical dressings cover the wound to maintain moisture to promote granulation.
C) Surgical dressings maintain tension on the suture line to prevent dehiscence.
D) Surgical dressings protect surrounding drapes,linen,and clothing from contamination.

Question 9

Surgical site infections (SSIs)account for 14% to 16% of all hospital-acquired infections.Perioperative nurses and surgical technologists are responsible for understanding the factors that contribute to SSIs and preventive measures.Which of the following is a true statement about preparation of the patient?

A) Hair removal should be accomplished in the OR with a sterile razor.
B) The patient should be required to bathe or shower the night before surgery.
C) The antimicrobial skin prep should proceed in concentric circles toward the incision.
D) Diabetic patients are recommended to have a short hospital stay to control glucose levels.

Question 10

There are many factors that influence surgical wound healing.Some are helpful and some are beyond the scope of the surgical team.Select the response below that reflects a factor with high influence over wound healing and is within the control of the surgical team.

A) Use of a local anesthetic with epinephrine at the incision site
B) Antibiotic sensitivity studies conducted on wound culture results
C) Selection of wound closure materials,dressings,and drains
D) Positive cultures from a chronic wound beyond the patient's incision site

Question 11

Jacob Sutzkever is a 62-year-old man who had surgery 6 days ago for a ruptured diverticulum.He is back in the OR for a debridement and washout.Jacob's fever has subsided and the drainage is clear.The surgeon will continue with wet to dry dressings and schedules Jacob to return to the OR in 3 days for:

A) one more final debridement and washout.
B) packing with antibiotic-impregnated gauze before final closure.
C) sutured closure of the peritoneum and muscle fascia layer and secondary closure with granulation of the subcutaneous and skin layers.
D) delayed primary sutured closure.

Question 12

Samantha Green sought the consult of a plastic surgeon to repair a large 2-year-old surgical scar on her right leg that was healed but remained darkly pigmented,uneven,and raised.The plastic surgeon reviewed the operative report from Samantha's prior surgery,which revealed an uneventful procedure,wound classification I,closure with uninterrupted 4-0 nylon,and no drain.The underlying cause of the uneven healing was probably due to:

A) failed remodeling phase resulting from inadequate skin care after initial healing.
B) unknown interruption in the normal healing process during proliferative and remodeling phases.
C) failed proliferative phase caused by improper postoperative dressings.
D) the possibility that Samantha is prone to keloid and adhesion formation.

Question 13

Before the patient leaves the OR for transport to the PACU or ICU,the circulating nurse empties the closed drain reservoir.What important information must the circulating nurse document and communicate about the drain to the PACU or ICU nurse during hand-off report?

A) The name and manufacturer of the drain
B) The location and type of drain,description and amount of drainage
C) The amount of negative pressure in the collection bulb
D) How to reinfuse an autologous drain collection

Question 14

Cosmetic elective plastic surgery,on healthy patients,is based on the expectations that healthy healing and ideal cosmesis will be achieved.On which phase or phases of healing is considerable emphasis placed during the procedure?

A) Inflammatory phase
B) Proliferative phase
C) Remodeling phase
D) Proliferative phase and remodeling phase

Question 15

Jacob Sutzkever had a temperature of 103° F and returned to the OR for a debridement and washout of purulent drainage from his wound on postoperative day 3.What was the wound classification at the time of his debridement and washout surgery?

A) Clean wound,classification I
B) Clean/contaminated wound,classification II
C) Contaminated wound,classification III
D) Infected wound,classification IV

Question 16

Samuel Garcia,a 48-year-old tetraplegic with a chronic sacral wound,is scheduled for another wound debridement.What is the purpose of doing a wound debridement on a chronic wound?

A) The debridement will stimulate circulation and promote healing.
B) The debridement will prevent the growth of parasitic maggots and leeches.
C) The debridement will remove dead tissue that could support infection.
D) Debridement creates a nidus that nourishes and supports healing.

Question 17

The bariatric unit was experiencing an alarming rate of postoperative wound dehiscence and evisceration on postoperative day 1,as the patients began to ambulate independently.The perioperative nurse practitioner and clinical nurse specialist met with two of the surgical technologists who were the scrubbed persons for these procedures.They collaborated with the patient safety,risk management,and infection preventionist representatives to conduct a failure mode effects analysis (FMEA)on surgical routine,wound closure,and postoperative care.They decided to audit three factors that fall under the influence of the surgical team.Select the response below that reflects significant surgical team influence on wound healing.

A) Patient nutrition,blood albumin level,sterile technique
B) Sterile technique,wound closure materials,hemostasis methods
C) Patient smoking history,suture diameter and use of nonabsorbables,steroid therapy
D) Patient body mass index,use of retention sutures,and abdominal binder

Question 18

Surgical team members have control of many of the factors that have been shown to contribute to SSIs.Which statement below reflects a best practice for surgical scrub/surgical hand asepsis?

A) Do not wear hand or arm jewelry;pin rings and watches to scrub pocket instead.
B) Keep nails short and do not wear artificial nails or nail wraps.
C) Wear home-laundered scrubs only when working in the preop or PACU areas.
D) Wear a surgical mask at all times when colonized with S.aureus or group A streptococcus.

Question 19

Identify the primary substance that composes a layer of the epidermis,is responsible for hardening nails and hair,and protects the body from fluid loss and invasion by pathogens.

A) Lipids
B) Keratin
C) Dermis
D) Collagen

Question 20

Melanie Schendell,an experienced perioperative nurse,was precepting a new perioperative nurse in the circulating role.Melanie watched and coached as the new nurse prepared to perform the skin prep on a patient for closure of a colostomy.The new nurse had never had the opportunity to prep a patient with an existing colostomy and was concerned about the potential for her actions contributing to a surgical site infection (SSI).After the successful prep and the onset of the procedure,Melanie and the new nurse had an opportunity to discuss SSIs in this patient population and preventive measures.What combinations of topics should they have discussed?

A) Preoperative antibiotics,ostomy care before surgery,and bowel prep
B) Documentation of preoperative shower,hair removal at the incision site,prep solutions
C) Order of prep scrub at the incision site (e.g.,ostomy or incision first),wound classification
D) Documentation of preoperative shower,hair removal at the incision site,prep solutions and order of prep scrub at the incision site (e.g.,ostomy or incision first),wound classification

Question 21

Maureen Haas,a 62-year-old,2-day postoperative patient with bilateral radical mastectomy surgery,was discharged to home with compression dressings,two closed drainage systems,and two pain pumps with soaker hoses within her incision.Her sister was her primary caregiver and was educated,along with Maureen,on dressing and drain care.Important information that Maureen and her sister must have,and demonstrate understanding of,before they leave for home includes what concepts? Select all that apply.

A) Written and verbal instructions to the patient and the caregiver
B) Assurance of patient compliance
C) The signs and symptoms that should be reported
D) If bathing or showering is permitted
E) Dressing change and wound care products,how to clean the wound,and how to reapply the dressing
F)How to manage the drains and pain pumps

Question 22

Samuel Garcia was fitted with a negative-pressure wound therapy system,also called vacuum-assisted closure,after his most recent surgical wound debridement.This device works by (select all that apply):

A) Suctioning lymphatic drainage from the wound and decreasing inflammation
B) Promoting microscopic bleeding and releasing cellular cytoplasm to cleanse the wound
C) Creating mechanical tension on the tissues and pulling wound edges together
D) Causing development of new blood vessels

Question 23

What critical information would you include in an educational module presented to nurses and residents that covered postoperative incision care to prevent SSIs in the cardiac ICU? Select all that apply.

A) Review of basic handwashing and sterile technique
B) Review of infection control measures during cardiac surgery
C) Instruction on appropriate dressing change procedure and timing of first dressing change
D) Discussion of recent ICU infection surveillance reports and who cared for those patients
E) Signs and symptoms of SSIs

Question 24

In the care of the postoperative patient,which statement reflects a best practice over which surgical team members have considerable influence? Select all that apply.

A) Maintain an intact sterile dressing over the closed wound for 24 to 48 hours.
B) Change dressings using sterile technique.
C) Employ basic hand hygiene before and after changing the postoperative dressing.
D) Teach the patient and family about incision care.

Question 25

Samuel Garcia has been approved as a candidate for hyperbaric oxygenation as a management therapy for his chronic sacral wound.He responded well to his surgical debridement and the nurse is planning to explain the next course of therapy.She will describe to him how hyperbaric oxygenation (select all that apply):

A) Increases the ability of the blood to carry oxygen to the tissues
B) Restores cells and kills bacteria that thrive without oxygen
C) Decreases white blood cell migration,which lowers inflammation
D) Slows but strengthens the healing process