Deck 9: Wound Healing, dressings, and Drains

Question 1

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 1

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

Question 2

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

Answer 2

A
Clean,full-thickness wound healing is an intricate biologic process that occurs in three overlapping phases.In cosmetic surgery,a clean incision with early suturing will produce a "hairline" scar,healing by first intention.An aseptically made wound with minimal tissue destruction and minimal tissue reaction begins to heal as the edges are approximated by close sutures or staples.No open areas or dead spaces are left to serve as potential sites of infection.In the inflammatory phase,an exudate containing blood,lymph,and fibrin begins to clot and loosely binds the cut edges together.Blood supply to the area increases,and the basic process of inflammation begins.Inflammation is a prerequisite to wound healing and is a vascular and cellular response to dispose of bacteria,foreign material,and dead tissue.

Question 3

Criteria for defining a deep incisional SSI include?

A) Presence of purulent drainage from the organ/space component of the surgical site
B) Presence of a spontaneous dehiscence
C) Purulent drainage from the skin or subcutaneous tissue
D) Presence of an abscess or other evidence of infection involving the fascial or muscle layers is found on examination
E) Purulent drainage from a drain that is placed through a stab wound into the organ space

Answer 3

B,D,E
Deep incisional infection involves deep soft tissues (e.g.,fascial and muscle layers)of the incision and at least one of the following: purulent drainage from the deep tissue,incision spontaneously dehisces or is deliberately opened by a surgeon,abscess or other evidence of infection involving the deep incision,or diagnosis of a deep incisional SSI by a surgeon or attending physician.If the area around a stab wound becomes infected,it is not an SSI.It is considered a skin or soft tissue infection,depending on its depth.

Question 4

A 48-year-old tetraplegic with a chronic sacral wound is scheduled for 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.
C) The debridement will remove dead tissue that could support infection.
D) Debridement creates a nidus that nourishes and supports healing.

Question 5

Before the patient leaves the OR for transport to the postanesthesia care unit (PACU)or intensive care unit (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 transition of care?

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) The instructions for reinfusing the autologous drainage collection

Question 6

What term represents a fibrous band between serous membranes that can cause obstructions and subsequent surgical emergencies?

A) Evisceration
B) Adhesion
C) Dehiscence
D) Keloid

Question 7

A 2011 systematic review found that approximately 55% of surgical site infections (SSIs)in the United States may be preventable by using evidence-based guidelines.The surgical team is 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 or depilatory.
B) The patient should bathe or shower the night before surgery with chlorhexidine gluconate (CHG).
C) The antimicrobial skin prep should be a slow-acting antibiotic.
D) Diabetic patients are recommended to have a short hospital stay to control glucose levels.

Question 8

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 9

Hydrotherapy for wound care was traditionally accomplished in an immersion bath whirlpool system.Because immersion in a tank is not practical from an intraoperative perspective,the hydrotherapy method most frequently used in the OR is:

A) hyperosmosis.
B) hydroirrigation.
C) pulsatile lavage.
D) water pik pressure-washout.

Question 10

Infection control and prevention surveillance was underway in the cardiac ICU because of an alarming prevalence of sternal wound infections.The infection preventionist and perioperative clinical nurse specialist reviewed the criteria 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 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 11

An experienced perioperative nurse was precepting a new perioperative nurse in the circulating role.She 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 of her actions contributing to an SSI.After the successful prep and the onset of the procedure,the experienced nurse and the new nurse had an opportunity to discuss SSIs in this patient population and preventive measures.What combinations of topic should they have discussed?

A) The role of the wound ostomy care nurse and postoperative care
B) Sterile technique during skin prep procedure and protection from cross-contamination
C) Wound classification and surgeon technique
D) The best antibiotics for bowel microbes and the most effective prepping solutions

Question 12

An evolving technology for the treatment of wounds is the use of an engineered skin substitute.The skin substitute stimulates wound epithelialization and is capable of producing growth factors.Descriptions of commercially available skin substitutes include:

A) fibroblasts seeded and cultured on bioabsorbable mesh.
B) topical application of micronized particulates.
C) gamma irradiated human cadaver skin.
D) fibroblasts mixed with bovine collagen gel.
E) cryopreserved human cadaver skin.

Question 13

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) Apply alcohol-based surgical hand rub to wet hands and arms.
B) Keep nails short and do not wear artificial nails or nail wraps.
C) Use a brush and CHG for the first 10-minute scrub of the day.
D) Apply an antibacterial moisturizing lotion to hands prior to beginning the hand scrub.

Question 14

A 76-year-old male patient 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.He will describe to him how hyperbaric oxygenation:

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.

Question 15

A 62-year-old man had surgery 6 days ago for a ruptured diverticulum.He is back in the OR for a debridement and washout.The patient's fever has subsided,and the drainage is clear.The surgeon will schedule the patient 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 16

A perioperative nurse 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 her artificial nail tips and cut her nails to 1/4 inch past her finger tips.
C) Complete nasal swab screening for Staphylococcus aureus.
D) Perform a 10-minute scrub.

Question 17

There are many factors that influence surgical wound healing.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) Antimicrobial prophylaxis.
D) The patient's nutritional status.

Question 18

A patient recently operated on for a ruptured appendix 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 19

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

A) Drains can prevent the development of deep wound infections.
B) Drains allow optimal observation of the incisional site.
C) Drains provide a portal for antibiotic irrigation.
D) Drains can provide opportunities for wound aeration.

Question 20

When providing discharge instructions to a 59-year-old woman who just underwent laparoscopic ACL repair,the RN informs the patient and responsible adult; "I am going to talk to you about when you need to call the surgeon.You should call your doctor if you have a fever greater than 101° F; if the surgical site has redness,swelling,or drainage; if your pain medication is not working; if you cannot eat or drink because of nausea or vomiting; if you have jaundice; or you are unable to urinate.I want to be sure that I did a good job of teaching you.Could you please tell me in your own words the reasons you should call the surgeon?" What health literacy strategy is the nurse using?

A) Aldrete Scoring System
B) Teach-Back method
C) QSEN teaching strategies
D) Ask Me 3TM method

Question 21

A 70-year-old male patient was fitted with a negative-pressure wound therapy system (NPWT),also called vacuum-assisted closure,after his most recent surgical wound debridement.This device works by:

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 macro-deformation and wound contraction.

Question 22

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 maintain a moist environment and prevent cell dehydration.
C) Surgical dressings maintain tension on the suture line to prevent dehiscence.
D) Surgical dressings promote patient comfort.
E) Surgical dressings may support, splint, or immobilize the incisional area.

Question 23

Also known as vacuum-assisted closure (VAC),negative-pressure wound therapy (NPWT)is used for difficult to manage wounds that do not respond to traditional wound care methods.What wounds are appropriate for this therapy?

A) Acute and traumatic wounds
B) Necrotic tissue with eschar present
C) Skin flaps
D) Meshed skin grafts
E) Malignant wounds