A new nurse reads a client has a wound "healing by second intention" and asks what that means.
Which description by the charge nurse is most accurate?
"The wound edges have been approximated and stitched together.”.
"The wound was stapled together after an infection was cleared up.”.
"The wound is an open cavity that will fill in with granulation tissue.”.
"The wound was contaminated by debris and cannot be closed at all.”.
The Correct Answer is C
Choice A rationale
Healing by primary intention, also known as primary union, occurs when a wound has clean edges that are approximated and sutured, stapled, or glued together. This process minimizes tissue loss and results in a fine scar. The wound's integrity is re-established with minimal granulation tissue formation.
Choice B rationale
This describes a form of delayed primary closure or tertiary intention healing. The wound is initially left open to allow for drainage and to clear infection. Once the wound is considered clean and free of infection, the edges are then approximated and closed, often with staples, to promote healing.
Choice C rationale
Healing by secondary intention, or secondary union, occurs in large, open wounds with significant tissue loss and non-approximated edges. The wound heals from the base up. This process involves the formation of new connective tissue and capillaries, called granulation tissue, to fill the defect before epithelialization can occur.
Choice D rationale
While contaminated wounds can heal by secondary intention, this description is not a complete definition. Secondary intention healing is a specific biological process involving granulation tissue, not just a description of a wound that is open due to contamination or debris. The defining characteristic is the formation of granulation tissue.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Wet-to-damp saline moistened gauze is a method of debridement and is not the most effective choice for a wound with copious exudate. This dressing type is less absorbent and would quickly become saturated, requiring frequent changes. Frequent changes and wetness can lead to periwound skin maceration and irritation, hindering the healing process.
Choice B rationale
Leaving a stage 3 pressure injury open to the air is contraindicated. A stage 3 pressure injury involves full-thickness skin loss and is susceptible to infection. Leaving the wound open would not manage the copious exudate, would expose the wound bed to pathogens, and would lead to dehydration of the wound bed, which impairs cellular migration and proliferation necessary for healing.
Choice C rationale
A transparent film is a moisture-retaining dressing that is inappropriate for a wound with copious exudate. This dressing is designed for superficial wounds with minimal exudate. Applying a transparent film to a heavily draining wound would lead to the accumulation of exudate underneath the dressing, causing maceration of the surrounding skin and potential for infection.
Choice D rationale
A multi-fiber superabsorbent dressing is the most appropriate choice for a stage 3 pressure injury with copious exudate. These dressings are designed to absorb large volumes of fluid, wicking it away from the wound bed and periwound skin. This action helps to manage moisture, protect the surrounding skin from maceration, and maintain a moist environment ideal for wound healing.
Correct Answer is B
Explanation
Choice A rationale
Applying topical medications in a circular motion can cause friction and irritate the compromised skin barrier in eczema. The goal of treatment is to protect the skin and reduce inflammation. Instead, a gentle, downward stroking motion in the direction of hair growth is recommended to avoid folliculitis and further skin damage.
Choice B rationale
Using a gloved hand during the application of topical treatments for a child with eczema prevents the transfer of microorganisms from the nurse's hands to the child's vulnerable skin, reducing the risk of secondary infection. It also protects the nurse from potential absorption of the medication, particularly if it's a steroid, through their own skin.
Choice C rationale
The frequent and liberal application of topical medications can lead to systemic absorption, especially with corticosteroids, due to the child's higher body surface area to weight ratio and thinner skin. This can cause adverse effects such as adrenal suppression and Cushing's syndrome. Medication application should strictly follow the prescribed dosage and frequency.
Choice D rationale
Lanolin is a common allergen and can exacerbate eczema symptoms in some individuals. It's an ingredient derived from sheep's wool and can trigger contact dermatitis in sensitive individuals. Therefore, lanolin-based ointments are not a universally recommended choice for eczema treatment and should be used with caution.
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