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OR Nurse:
doi: 10.1097/01.ORN.0000369299.09901.ea
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Maintaining skin integrity in the OR

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INSTRUCTIONS Maintaining skin integrity in the OR

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Maintaining skin integrity in the OR

GENERAL PURPOSE: To provide the professional registered nurse with an overview of pressure ulcers in the perioperative setting. LEARNING OBJECTIVES: After reading the preceding article and taking the following test, you should be able to: 1. Explain the pathophysiology, presentation, and staging of pressure ulcers. 2. Identify the risk factors for developing pressure ulcers. 3. Discuss perioperative strategies for preventing pressure ulcers.

1. Which statement is not accurate about a pressure ulcer?

a. It's a localized injury to the skin and/or underlying tissue.

b. It usually occurs over a bony prominence.

c. It's difficult to predict pressure ulcer risk preoperatively.

d. It's typically due to pressure, sometimes in combination with shear and/or friction.

2. Which statement is true?

a. Cellular death occurs at pressures above 23 mm Hg.

b. Tissue damage stops once pressure is relieved.

c. Waste product buildup contributes to discoloration of tissues.

d. Excessive pressure prevents oxygen and nutrients from reaching cells.

3. Which is a preoperative risk factor for pressure ulcers?

a. decreased lymphocyte count

b. elevated serum cholesterol

c. increased serum albumin

d. BMI of 22.9 kg/m2

4. Intraoperative pressure ulcer risk factors include all of the following except

a. the type of surgery.

b. warm room temperature.

c. impaired sensorium.

d. prolonged hypothermia.

5. Which procedure specialty has the highest incidence of pressure ulcers?

a. spinal and abdominal

b. neurologic

c. elder orthopedic

d. vascular

6. Folding of underlying tissue when the skeletal structure moves but the skin remains stationary is known as

a. friction.

b. shear.

c. compression.

d. pressure.

7. The prevalence rate for the development of a pressure ulcer during a 6-hour surgery is

a. 5.8%.

b. 8.9%.

c. 9.9%.

d. 13.2%.

8. A full-thickness ulcer with exposed subcutaneous tissue, necrotic tissue, or undermining is staged as

a. Stage II.

b. Stage III.

c. Stage IV.

d. Unstageable.

9. Which stage is a full-thickness ulcer with necrotic tissue covering the wound bed?

a. Stage II

b. Stage III

c. Stage IV

d. Unstageable

10. A deep tissue injury will present as

a. a discolored area of intact skin.

b. an intact or ruptured serum-filled blister.

c. redness on intact skin that doesn't blanch.

d. a shallow, partial-thickness ulcer.

11. Which statement about presentation of pressure ulcers is accurate?

a. They progress inward from the epidermis to subcutaneous tissue.

b. They first appear as pink discoloration on intact skin.

c. A blood-filled blister can occur as a result of damage to underlying soft tissue.

d. An ulcer first noted several days post-op couldn't have been triggered by surgery.

12. The Braden Scale

a. consists of six subscales to assess the risk for pressure ulcers.

b. is a tool to stage pressure ulcers.

c. has subscale scores that total between 1 and 6.

d. indicates low risk for pressure ulcers when the subscale total is low.

13. Which area is most at risk for developing a pressure ulcer from supine surgical positioning?

a. iliac crests

b. lumbar area

c. dorsum of the foot

d. dependent side of the face

14. Which area is typically not a pressure concern for a patient in the lithotomy position?

a. sacrum/coccyx

b. heels

c. scapulae

d. thoracic spine

15. Intraoperative strategies to reduce pressure ulcer risk include

a. keeping the skin moist at all times.

b. using blankets and sheets for padding.

c. using transparent dressings to reduce friction in high-risk areas.

d. placing foam positioning devices under the OR bed mattress.

16. Criteria for using a pressure-relieving device postoperatively include all except

a. the patient is female.

b. the patient is over 40 years old.

c. surgery lasting over 2.5 hours.

d. the patient has vascular disease.

17. Which postoperative strategy is recommended for preventing pressure ulcers?

a. Avoid positioning devices as they create pressure.

b. Keep the head of the bed in a high position to avoid pressure on the back.

c. Cleanse skin with mild agents and hot water.

d. Remove adhesive and gel interfaces from the skin immediately postoperatively.

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