Integumentary System and Wounds Flashcards

A patient has a wound with 100% yellow slough covering the wound bed. Which debridement method is most appropriate when the patient has poor circulation and cannot tolerate sharp debridement?

Answer: Enzymatic debridement

Enzymatic debridement uses topical agents (e.g., collagenase) to selectively dissolve necrotic tissue and is appropriate when sharp debridement is contraindicated.

Which layer of the skin contains the Meissner's corpuscles and is responsible for most immune defense?

Answer: Dermis

The dermis houses mechanoreceptors such as Meissner's corpuscles, as well as immune cells, blood vessels, and collagen fibers.

A PT is treating a patient with a venous insufficiency ulcer. Which characteristic finding is most consistent with this diagnosis?

Answer: Shallow ulcer with irregular edges around the medial malleolus

Venous insufficiency ulcers classically appear as shallow, irregular wounds around the medial malleolus with surrounding hemosiderin staining and edema.

A patient presents with a stage 2 pressure injury. What is the correct description of this injury?

Answer: Partial-thickness skin loss with a shallow open wound

A stage 2 pressure injury involves partial-thickness loss of the dermis, presenting as a shallow open ulcer or an intact or ruptured seroma-filled blister.

Which dressing type provides a moist wound environment, is self-adhesive, and is most appropriate for a clean stage 2 pressure injury with minimal exudate?

Answer: Hydrocolloid dressing

Hydrocolloid dressings maintain a moist environment, are self-adhesive, and are ideal for low-exudate wounds such as stage 2 pressure injuries.

A patient with diabetes has neuropathy and presents with a plantar forefoot ulcer. The wound is surrounded by callus and has no signs of infection. What is the first priority in management?

Answer: Debridement of the surrounding callus and offloading

Offloading pressure and debriding the callus (which concentrates stress) are the primary interventions for neuropathic diabetic foot ulcers.

When assessing a wound using the RYB (Red-Yellow-Black) classification, which color indicates the presence of infection or fibrinous slough requiring cleaning?

Answer: Yellow

In the RYB system, yellow indicates the presence of fibrinous slough, purulent exudate, or infection that must be cleaned before healing can progress.

A PT assesses a wound and notes tunneling at the 3 o'clock position extending 2 cm. How should this finding be documented according to standard wound assessment convention?

Answer: Tunneling is present at 3 o'clock, 2 cm deep, measured with the patient supine, head = 12 o'clock

Standard wound documentation uses a clock-face orientation with the patient's head at 12 o'clock, and tunneling depth is recorded in centimeters.

Which skin change is an early sign of deep tissue pressure injury (DTI)?

Answer: Purple or maroon intact skin that may be painful or boggy

Deep tissue pressure injury presents as an area of persistent purple or maroon discoloration of intact skin, indicating underlying soft tissue damage.

A patient receiving radiation therapy develops radiodermatitis with moist desquamation. Which intervention is contraindicated?

Answer: Wet-to-dry gauze dressings

Wet-to-dry dressings are contraindicated in moist desquamation because removal causes trauma and further tissue damage to already fragile irradiated skin.

Which ABCDE criterion for melanoma assessment refers to a lesion having two or more distinct colors?

Answer: Color

The 'C' in the ABCDE melanoma screening criteria stands for Color variation, which includes multiple shades of brown, black, red, or white within a single lesion.

A wound swab culture returns positive for Pseudomonas aeruginosa. Which clinical sign is most associated with this organism?

Answer: Blue-green exudate with a fruity odor

Pseudomonas aeruginosa characteristically produces blue-green (pyocyanin) pigmented exudate with a fruity or grape-like odor.

Which phase of wound healing is characterized by formation of granulation tissue and angiogenesis?

Answer: Proliferation

The proliferative phase involves fibroblast migration, collagen synthesis, angiogenesis, and formation of granulation tissue to fill the wound defect.

A patient with a venous leg ulcer has a resting ABI of 0.55. Which treatment is contraindicated?

Answer: High-compression bandaging (40 mmHg)

An ABI below 0.8 indicates significant arterial insufficiency; high-compression bandaging is contraindicated because it further reduces arterial blood flow.

A PT is treating a patient with a full-thickness burn to the anterior trunk and both anterior lower extremities. Using the Rule of Nines, what percentage of total body surface area (TBSA) is burned?

Answer: 36%

The anterior trunk = 18% and each anterior lower extremity = 9% (×2 = 18%), totaling 36% TBSA using the Rule of Nines.

Which type of scar results from excessive collagen deposition that extends beyond the original wound boundaries?

Answer: Keloid scar

Keloid scars grow beyond the original wound margins into surrounding healthy tissue, unlike hypertrophic scars which remain within wound boundaries.

A patient presents with a wound that has edges that are raised, rolled under (epibole), and not advancing across the wound bed. This indicates:

Answer: Chronic wound with rolled edges requiring intervention

Epibole (rolled wound edges) indicates a stalled chronic wound where epithelial cells have rolled under the edge and must be disrupted to allow healing.

Which is the primary indication for negative pressure wound therapy (NPWT/VAC)?

Answer: Large, complex wound with significant exudate requiring granulation tissue formation

NPWT is indicated for complex, high-exudate wounds to promote granulation tissue formation, reduce edema, and manage wound fluid.

A second-degree partial-thickness burn is characterized by which finding?

Answer: Blistering, moist, and extremely painful wound

Partial-thickness (second-degree) burns involve the epidermis and superficial dermis, presenting as blistered, moist, and intensely painful wounds.

Which intervention is MOST appropriate to prevent pressure injury formation in a patient with complete spinal cord injury at T6?

Answer: Performing weight shifts every 15-30 minutes while in the wheelchair

Patients with SCI must perform frequent pressure relief (weight shifts) every 15-30 minutes to redistribute ischial pressure during prolonged sitting.