Exam 8: Wound Healing, Dressings, and Drains

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?

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?

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?

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:

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.

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?

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.

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?

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

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?

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:

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.

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):

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?

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.

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)?

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.

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.

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?

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):