Chapter 08: Wound Healing, Dressings, and Drains

Chapter 08: Wound Healing, Dressings, and Drains

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. 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

 

 

ANS:  B

The epidermis is the outermost layer of the skin, lines the ear canals, and is contiguous with the mucous membranes. The epidermis is composed of several layers consisting of keratin and lipids. Keratin is the primary substance that hardens nails and hair and protects the body from fluid loss and invasion by pathogens.

 

REF:   Page 250

 

2. 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

 

 

ANS:  C

The causes of wounds can be described as follows: surgical—caused by an incision or excision; traumatic—caused by mechanical, thermal, or chemical destruction; chronic—caused by an underlying pathophysiologic condition (e.g., pressure ulcers or venous leg ulcers) over time. The amount of tissue loss, the existence of contamination or infection, and the degree of damage to tissue are some factors that determine the type of wound closure selected by the surgeon. The healing process is inherently related to whether the wound is closed or left open.

 

REF:   Pages 250-253

 

3. 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

 

 

ANS:  B

Patients should be assessed for factors that may impair wound healing. Adherence to strict and thorough antimicrobial preparation of the patient and operative site is essential to minimize the risk of postoperative SSI. Wound healing also can be impaired by poor surgical technique. Rough handling of tissue may cause trauma that can lead to bleeding and other conditions conducive to infection. Examples of surgical technique promoting wound healing include adequate hemostasis, precise cutting and suturing techniques, efficient use of time to minimize wound exposure to air, elimination of dead spaces, and minimal pressure from retractors and other instruments.

 

REF:   Pages 250-253

 

4. 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

 

 

ANS:  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.

 

REF:   Pages 252-253

 

5. 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.

 

 

ANS:  B

Unknown factors can interrupt or impact the normal healing process; these factors are not influenced by the surgical team or the patient. The proliferative phase allows new epithelium to cover the wound, beginning the process within hours of the injury. The remodeling phase begins after approximately 2 to 4 weeks, depending on the size and nature of the wound. It may last 1 year or longer. Contraction begins approximately 5 days after the wound onset and peaks at 2 weeks, gradually shrinking the entire wound.