A postoperative abdominal surgery patient has been admitted to the surgical floor. The nurse is aware that wound healing is delayed due to complications.
Which conditions would prevent normal wound healing at the surgical site?
(Select all that apply.)
Hypovolemia
Poorly controlled blood glucose levels
Protein deficiency
Adequate hydration
Routine ambulation
Steroid therapy
Obesity
Vitamin C supplementation
Correct Answer : A,B,C,F,G
Rationale for each choice:
Choice A: Hypovolemia
Impaired perfusion: Hypovolemia, or a decrease in circulating blood volume, leads to reduced blood flow to the wound site. This means that less oxygen and nutrients are delivered to the tissues, which are essential for healing processes like cell growth and collagen synthesis.
Impaired oxygen delivery: Oxygen is crucial for white blood cells to fight infection and for fibroblasts to create new tissue. Hypovolemia can significantly hinder wound healing by reducing oxygen availability at the wound site.
Delayed inflammatory response: The inflammatory phase of wound healing relies on adequate blood flow to deliver immune cells and initiate tissue repair. Hypovolemia can delay this response, leading to prolonged inflammation and delayed healing.
Decreased fibroblast activity: Fibroblasts, the cells responsible for collagen production, require oxygen and nutrients to function effectively. Hypovolemia can impair fibroblast activity, leading to reduced collagen synthesis and delayed wound closure.
Choice B: Poorly controlled blood glucose levels
Impaired immune function: High blood glucose levels impair the function of white blood cells, making the body more susceptible to infections. Infections at the wound site can significantly delay healing.
Impaired collagen synthesis: Hyperglycemia can also impair collagen synthesis, which is essential for wound strength and closure.
Vascular damage: Chronically high blood glucose levels can damage blood vessels, leading to impaired blood flow and oxygen delivery to the wound site, further hindering healing.
Choice C: Protein deficiency
Impaired collagen synthesis: Protein is a crucial building block for collagen, the main structural protein in connective tissue. A lack of protein can lead to reduced collagen production, resulting in delayed wound healing and weaker scar tissue.
Impaired immune function: Protein is also essential for immune cell function. A deficiency can impair the body's ability to fight infections, increasing the risk of wound complications.
Choice D: Adequate hydration
Incorrect: Staying well-hydrated supports the body’s healing process by ensuring proper blood flow and nutrient transport, thus it does not impede wound healing.
Choice E: Routine ambulation
Incorrect: Early ambulation after surgery promotes healing by improving circulation and reducing the risk of complications like blood clots, making it beneficial rather than harmful.
Choice F: Steroid therapy
Immunosuppressive effects: Steroids suppress the immune system, making the body less able to fight infections and hindering the inflammatory phase of wound healing.
Decreased collagen synthesis: Steroids can also decrease collagen synthesis, leading to weaker wound tissue and delayed closure.
Choice G: Obesity
Impaired blood flow: Excess adipose tissue can compress blood vessels, reducing blood flow to the wound site and impairing oxygen and nutrient delivery.
Increased inflammation: Adipose tissue produces inflammatory cytokines, which can prolong the inflammatory phase of wound healing and delay tissue repair.
Higher risk of infection: The folds of skin in obese individuals can create moist environments that are more prone to bacterial growth and infection.
Choice H: Vitamin C supplementation
Incorrect: Vitamin C plays a key role in collagen formation and tissue repair, so it supports rather than hinders wound healing.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Rationale for Choice A:
While maintaining normal body temperature is important for overall health, it's not the most immediate priority in a patient with fluid volume deficit due to ongoing bleeding. Fluid volume status takes precedence over temperature regulation in this context.
Hypovolemia can lead to hypothermia, but addressing the fluid deficit directly will also help stabilize temperature.
Focusing solely on temperature could delay crucial interventions to address the fluid loss and potentially worsen the patient's condition.
Rationale for Choice B:
An intact surgical incision is essential for proper wound healing and prevention of infection. However, in the context of active bleeding, it's not the priority outcome.
Maintaining adequate fluid volume is crucial to ensure perfusion of tissues, delivery of oxygen and nutrients, and proper organ function—all of which take precedence over incision integrity in this acute situation.
Addressing the fluid deficit will indirectly support wound healing by promoting tissue perfusion and reducing the risk of complications.
Rationale for Choice C:
Patient education is important, but it's not the most immediate priority in a patient with active bleeding and fluid volume deficit.
The patient's ability to comprehend and implement measures to reduce fluid loss may be compromised due to the hypovolemic state and potential cognitive effects.
Focusing on patient education at this stage could delay essential interventions to address the fluid loss and potentially worsen the patient's condition.
Rationale for Choice D:
Urine output is a sensitive and reliable indicator of renal perfusion and overall fluid status. In a patient with fluid volume deficit, maintaining a urine output of at least 30 mL/hour is a key indicator that the kidneys are receiving adequate blood flow and that fluid volume is being restored.
This outcome directly addresses the fluid deficit and serves as a measurable goal for fluid replacement therapy.
It takes priority over other choices because it directly reflects the patient's fluid status and the effectiveness of interventions to address the bleeding and fluid loss.
Correct Answer is A
Explanation
Choice A rationale:
Generic drugs are chemically identical to their brand-name counterparts, meaning they have the same active ingredients, dosage form, strength, route of administration, quality, performance characteristics, and intended use. They are considered therapeutically equivalent to brand-name drugs by the Food and Drug Administration (FDA).
Here are the key reasons why a patient would likely receive a generic version if the insurance company declines to cover the brand-name drug:
Cost: Generic drugs are significantly less expensive than brand-name drugs. This is because generic drug manufacturers do not have to repeat the extensive research and development costs associated with the original brand-name drug. They can enter the market after the brand-name drug's patent expires, leading to substantial cost savings.
Insurance Coverage: Insurance companies often have preferred drug lists (formularies) that prioritize generic drugs due to their cost-effectiveness. If a brand-name drug is not on the formulary or requires a high co-pay, the insurance company may encourage or even require the use of a generic alternative to manage costs.
Availability: Generic drugs are often widely available in pharmacies, making them readily accessible to patients. This availability further contributes to their cost-effectiveness and convenience.
I'm unable to provide lengthy rationales for the other choices as they are not relevant to the correct answer.
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