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FEATURES: CLINICAL MANAGEMENT EXTRA

Increased Bacterial Burden and Infection

The Story of NERDS and STONES

Sibbald, R. Gary BSc, MD, FRCPC (Med) (DERM), FAPWCA, MEd; Woo, Kevin RN, MSc, ACNP GNC(C); Ayello, Elizabeth A. PhD, RN, APRN,BC, CWOCN, FAPWCA, FAAN

Advances in Skin & Wound Care: October 2006 - Volume 19 - Issue 8 - p 462-463
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Abstract

1. In 2000, Sibbald et al encouraged the clinician to

a. use wet-to-dry saline dressings for faster healing.

b. look for a cause and address patient concerns before focusing on the wound.

c. monitor wound pain as an indicator of infection.

d. rely on the results of a wound culture for diagnosis and treatment.

2. In addition to debridement, the other 2 components of local wound care using moist healing principles are

a. bacterial balance and metabolic balance.

b. exudate balance and vascularization.

c. bacterial balance and moisture balance.

d. fluid retention and tissue nutritional balance.

3. A painful wound with delayed healing and deep tissue damage would be best described on the bacterial balance continuum as

a. having a balanced bacterial burden.

b. contaminated.

c. critically colonized.

d. infected.

4. Potential damage caused by invading wound bacteria is determined by an equation where infection is equal to the

a. number of organisms × wound size (cm).

b. wound size (cm) × degree of tissue damage on the continuum.

c. number of organisms × size of inflammation (cm).

d. number of organisms × organism virulence.

5. The most reliable test for osteomyelitis in a person with diabetes who has a pressure ulcer is

a. probing the wound.

b. an MRI.

c. exudate culture.

d. odor characteristics.

6. The first sign of critical colonization or local infection may be

a. a delay in the healing process.

b. pain.

c. odor.

d. necrosis.

7. The first 2 organisms likely to invade a wound with decreased host resistance are

a. anaerobic followed by Gram-positive.

b. Gram-negative followed by anaerobic.

c. Gram-positive followed by Gram-negative.

d. Gram-negative followed by aerobic.

8. Signs and symptoms in a wound with increased bacterial burden infection include nonhealing and

a. debris in the wound.

b. fever.

c. edema.

d. chills.

9. Which classification of wound infection most likely applies to a patient with fever, rigours, and hypotension?

a. superficial increased bacterial burden

b. critically colonized

c. deep wound infection

d. systemic infection

10. After 4 weeks of treatment, the size of a critically colonized wound should have decreased by

a. 10% to heal by week 8.

b. 20% to heal by week 10.

c. 20% to 40% to heal by week 12.

d. 50% to heal by week 14.

11. Tissue in a wound that is bright red and bleeds easily indicates

a. healthy granulation tissue.

b. a strong collagen matrix.

c. a deep compartment wound.

d. a suspected bacterial imbalance.

12. Which treatment is recommended for a nonhealable wound?

a. topical antimicrobial

b. moisture balance

c. active debridement

d. hypochlorite solution

13. Which agent is the best choice when treating aPseudomonaswound infection?

a. sodium hypochlorite

b. Cetrimide

c. acetic acid

d. Proflavine

14. Crepitus may present as a sign of infection in

a. arterial disease associated with tissue breakdown.

b. venous ulcers.

c. neuropathic/diabetic ulcers.

d. pressure ulcers.

15. Which statement about silver dressings used for superficial increased bacterial burden is true?

a. They have a high systemic toxicity and should be reserved for nonhealable wounds.

b. They must be continued as maintenance after the bacterial balance is achieved.

c. They are effective only when used together with systemic antibacterial agents.

d. They are a good choice with low toxicity to wounds.

16. A sign of a limb-threatening wound infection in a patient with diabetes is

a. a putrid odor and necrotic tissue in the wound.

b. cellulitis greater than 2 cm.

c. a red and bleeding 2-cm wound.

d. increasing exudate and bleeding.

17. STONES is an acronym developed to describe

a. a treatment protocol for severe wound infection.

b. signs associated with critically colonized wounds.

c. signs associated with a deep wound infection.

d. signs associated with systemic infection.

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© 2006 Lippincott Williams & Wilkins, Inc.