Med surg exam 3
A nurse has been asked to obtain a client's signature on an operative consent form. When the nurse approaches the client, who is scheduled for a cholecystectomy later in the day, the client asks the nurse why the procedure is needed. Which response by the nurse is appropriate?
"I will ask the surgeon to come speak to you about the procedure."
Repair: primary intention (initial phase) how long whats occuring
-3-5 days SURGICAL INCISION -edges aligned and acute inflamation occurs
Monocytes -when do they arrive to site -what do they do
-3-7 day s -transform into macrophages
Neutrophils -when do they go to the site -what do they do -lifespan
-6-12 hr -phagocytize bacteria -24-48 hr
inflammatory bowel disease collaborative care goals of treatment
-Rest the bowel -Control inflammation -Combat infection -Correct malnutrition -Alleviate stress -Relieve symptoms -Improve quality of life
CM of GERD Complications
-burning, tight sensation, upper abdomen pain, regurgitation of hot bitter and sour liquid coming into throat or mouth, resp symptons, and lump in throat -dysphagia, esophagitis,dental erosion
Hepatitis D Virus -aka -can it survive on its own
-delta virus -cant survive on its own, needs HBV to replicate
CM of perforation in peptic ulcer Tx
-sudden dramatic onset of pain, tachycardia, weak pulse, bowel sounds absent , bacterial perionitis may occur 6-12 hr -stop spillage of gastric contents into peritoneal cavity and restore blood volume
hiatal hernia causes
-weakening of the diaphragm muscle -increased intra-abdominal pressure
Nutritional therapy IBD
1.Provide adequate nutrition without exacerbating symptoms 2.Correct and prevent malnutrition 3.Replace fluid and electrolyte losses 4.Prevent weight loss -Decreased oral intake -Blood loss -Malabsorption of nutrients
A client has 4000 mL removed via paracentesis. When the nurse weighs the client after the procedure, how many kilograms is an expected weight loss? Record you answer in whole numbers.
4
Repair: primary intention (Maturation phase)
7 days after injury scar forms
The nurse is developing a plan of care for a client with a stage 3 heel ulcer. Which intervention should the nurse include?
Apply a hydrocolloidal dressing.
A nurse is talking to a neighbor who asks about reoccurring symptoms of gnawing epigastric pain following meals and heartburn. Recognizing these symptoms, what suggestion could the nurse make?
Avoid alcohol and nonsteroidal anti-inflammatory medications.
The nurse is providing discharge instructions for a client who had an inguinal herniorrhaphy. What information should the nurse give the client?
Avoid lifting items weighing >5 lb (2.3 kg).
inflammatory bowel disease diagnostics
CBC, serum electrolytes, serum proteins, pus, blood, mucus, double contrast barium enema, CT, MRI, small bowel series
Gastritis diagnostics
CSC to identify anemia, serum antibody test, tissue biopsy
IBS (irritable bowel syndrome)
Characterized by intermittent abdominal pain or discomfort and stool pattern irregularities
A nurse is caring for a client with a postoperative wound evisceration. Which action should the nurse perform first?
Cover the protruding internal organs with sterile gauze, moistened with sterile saline solution.
A nurse is caring for an elderly bedridden adult in the long term care facility. To prevent pressure ulcers, which intervention should the nurse include in the care plan?
Develop a written, individual turning schedule
A client is brought to the emergency department with a painful swollen ankle. What is the nurse's most appropriate action?
Elevate the ankle.
A nurse asks a client who had abdominal surgery 3 days ago if they have moved their bowels since surgery. The client states, "I haven't moved my bowels, but I am passing gas." How should the nurse intervene?
Encourage the client to ambulate at least three times per day
Peptic Ulcer Disease (PUD)
Erosionof muscosa resulting from digestive action of HCl acid and pepsin
Repair: primary intention (Granulation phase)
Fibroblasts migrate to site and secrete collagen wound is pink and vascular
Goal of drug therapy of inflammatory bowel disease
Goals of drug treatment are to induce and maintain remission
Repair: secondary intention
Heal from inside out, edges cant be approximated.
Recovery of hepatitis
Homologous immunity to type A or B most pt recover completely with no complications
A nurse is teaching an elderly client about developing good bowel habits. Which statement by the client indicates to the nurse that additional teaching is required?
I need to use laxatives regularly to prevent constipation."
Which client statement indicates a need for further instruction about a duodenal ulcer?
I will need to take an antacid before every meal."
Nutritional therapy for N/V
IV fluids, NG tube, clear liquids, •Fluids between meals instead of with meals—to avoid overdistention
Wound measurement
In cm, oriented from head to toe, then side to side, then depth assess tunneling in clockwise direction ex: 7cm (htt) x 2 cm (sts) x 1 cm (depth) with 6 oclock 2cm tunneling
Chemotaxis -What is it
Migration of WBC along concentration gradient, accumulation of neutrophils and monocytes at site of injury
A nurse is caring for a client with active upper GI bleeding. What is the appropriate diet for this client during the first 24 hours after admission?
NPO
Gastritis causes
NSAIDS, alcohol, spicy foods, H. pylori
Education for GERD
Nutrition! decrease high fat, take fluid, avoid milk, avoid late night snacking , avoid chocolate, peppermint, caffeine, tomato, orange juice
When preparing a client for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis?
Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix.
s/s of local inflammation s/s of systemic inflammation
Redmess, heat, pain, swelling, loss of function increased WBC, malaise, Nausea, anorexia, increased pulse and RR, fever
Gastritis risk factors
Smokin, NG tube, autoimmune, can increase risl of gastric cancer, H.pylori
Which pressure ulcers are serious reportable events?
Stage 3 or 4 ulcer
Keloid scarring
The over production of scar tissue that sometimes occurs in the dermis and subcutaneous layer and results in a mass of scar tissue that is often tender or painful.
Ulcerative colitis vs crohns
UC: inflammation of colon and rectum CD: inflammation of any segment of GI mouth to anus
When caring for the client with hepatitis B, which situation would expose the nurse to the virus?
a blood splash into the nurse's eyes
how often does surface mucosa in stomach renew
about every 3 days
Esophageal Diverticula/Zenker's -most common site
above upper esophageal sphincter
Bright red emesis
active bleeding, esophageal varices or gastric/duodenal ulcer neoplasm
A client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note
anorexia, nausea, and vomiting.
Esophagaeal Diverticula nursing care
apply pressure at a pint on neck to empty pocket of food, diet limited to blenderized food
Dietary recommendations for PUD
bland diet, six small meals/day
Peforation of PUD tx
blood replacement with packed RBCS, indwelling catheter, broad spectrum antibiotics -stop all oral/NG feeds until HCP notified
Gastritis definition
breakdown and inflammation of gastric mucosal barrier, unprotected by Hcl and pepsin
malignant melanoma risks
cause unknown risks:red or blonde hair, light colored eyes, fair skin and freckles, chronic sun exposure, fam hx
Chronic Hep B goal of treatment
decrease viral load and rate of disease progression
Repair: teritary intention
delayed primary intention d/t delayed suturing of wound d/t contaminaiton Sutured once infection is healed
Esophageal Diverticula CM
dysphagia, regurgitation, chronic cough, aspiration, weightloss
Hiatal hernia diagnostics
esophagogram (barium swallow) or endoscopy
Convalescent phase of hepatitis
jaundice starting to disappear, hepatomegaly persists
Ulcerative colitis
large volume diarrhea loss, electrolyte loss, damage to colonic mucosa epithelium , protein loss, pseudopolyps
LAb work to identify early infection
left shift of neutrophils indicates early infection
Complications of vomitting
metabolic alkalosis, and dehydration
Stage one ulcer
nonblanchable intact spot over bony prominence
A client reports a firm, red nodule with a scaly crust on the back. What is the best nursing intervention?
notify hcp
Crohn's complications
nutritional problems when terminal ileum involved, fat malabsorption
GAstritis tx
observe bleeding, lavage, drug therapy antacids, h2 blockers, PPis antibiotics for Hpylori
Hypertrophic scarring
overproduction of collagen that stays within the confines of the original wound
Goals of care for Cholecystitis
pain control, control infection, maintenance of F&E
CM gastric ulcers
pain in epigastrium, 1-2 hr after meals
risk for cholecystitis
pos fam hx, pregnancy
Assessment of pressure ulcer on dark skin
purple, brown, bluish, use natural light palpate for temp and texture
Gastritis CM
tissue edema, disruption of capillary walls, hemorrhage
Health promotion Hep A
vaccination, infection control measures
Nursing care for hepatitis
well balanced diet, vitamin supplements, rest, avoid alcohol and drugs, notify possible contacts
Things to rule out prior to IBS diagnosis
§Anemia §Fever §Persistent diarrhea §Rectal bleeding §Severe constipation §Weight loss
IBS gas causing foods
§Brown beans §Brussels sprouts, cabbage, cauliflower, raw onions §Grapes, plums, raisins
Overall goals of IBD
§Decreased number and severity of acute exacerbations §Normal fluid/electrolyte balance §Freedom from pain or discomfort §Compliance with medical regimen §Nutritional balance §Improved quality of life
ulceratice colitis pattern of inflammation
§Usually starts in the rectum and moves in a continual manner toward the cecum §Sometimes there is mild inflammation in the terminal ileum
Acute exacerbation of PUD
•Accompanied by bleeding, increased pain and discomfort, nausea, and vomiting
Drug therapy of cholecystitis
•Cholestyramine (Questran) may be given for pruritus
A client is diagnosed with contact dermatitis. Which medication should the nurse expect to be prescribed to treat this disorder?
topical corticosteroid
Vascular response inflammation
vasoconstriciton and release of chemicals by injured cells
A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note
yellow sclerae
A client newly diagnosed with ulcerative colitis who has been placed on steroids asks the nurse why steroids are prescribed. What should the nurse tell the client?
Steroids are used in severe flare-ups because they can decrease the incidence of bleeding."
A graduate nurse and the nurse's preceptor are establishing priorities for their morning assessments. Which client should they assess first?
The newly admitted client with acute abdominal pain
A client with a history of alcohol abuse was admitted with bleeding esophageal varices. After several days of treatment, the client is ready for discharge. The nurse enters the client's room to review discharge instructions with the client when the client tells the nurse that they want help to quit drinking. How should the nurse respond?
"I'll notify your physician and call the social worker so they can discuss treatment options with you.
IBS CM
-Abdominal pain -Diarrhea or constipation -Abdominal distention -Excessive flatulence -Bloating -Urgency -Sensation of incomplete evacuation -fatigue -sleep disturbances
Psychologic factors in IBS
-Anxiety, panic disorder -Depression -Posttraumatic stress disorder -Abuse history
Crohns disease pattern of inflammation
-Can occur anywhere in the GI tract -Occurs most commonly in the terminal ileum and colon -skip lesions -cobblestone appearance -abscesses can form -peritonitis can result -Fistulas can form between bowel and bladder, vagina and adjacent areas
eosinophilic esophagitis -characterized by -common in -food triggers
-Characterized by swelling of esophogus -hx of other allergic diseases -milk, egg, rye, beef, wheat
Destroyers of muscoal barrier
-H. pylori -Aspirin and NSAID -corticosteroids -alcohol, caffeine, smoking, stress
Correlation of IBS and intolerances
-Patients often report history of GI infections and food intolerances
A client who was transferred from a long-term care facility is admitted with dehydration and pneumonia. Which nursing interventions can help prevent pressure ulcer formation in this client? Select all that apply.
-Reposition the client every 2 hours. -Perform range-of-motion exercises. x Use commercial soaps to keep the skin dry. x Tuck bed covers tightly into the foot of the bed. -Encourage the client to eat a well-balanced diet.
Drug tx for IBS -Loperamide (Imodium) -Lotronex -•Lubiprostone (Amitiza) -Linaclotide (Linzess) -Antidepressants
-Used to treat incidences of diarrhea, Synthetic opioid, Decreases intestinal transit -Serotonergic antagonist, Used to treat severe pain and diarrhea -Approved for the treatment of women with IBS-related constipation -Approved for the treatment of men and women with IBS-related constipation -decrease periph nerve sensitivity
Hepatitis C Virus -acute -chronic -transmitted by
-acute asymptomatic -chronic liver damage -IV drug use, sexual, dialysis, blood transfusion prior to 1992, occupational exposure
Complications of hepatitis
-acute liver failure, cirrhosis, hepatocellular carcinoma
NURSING MANAGEMENT OF GERD
-elevate HOB 30 degrees -Dont lay down 2-3 hr after eating -evaluate med effectiveness and side effects - avoid factos causing reflux (smoking and acidic foods) -stress and weight reduction -small frequent meals
Hepatitis E Virus -how is it transmitted -where does it primarily occur
-fecal oral route in contaminated water -developing countries, rare in United states
Esophageal Strictures -most common cause -tx
-gerd -dilations
Eosiniophilic Esophagitis CM Treatment
-heartburn, difficulty swallowing, food impaction -acid supression, corticosteroids, endoscopic dilation
MOst common complication of peptic ulcer disease Most lethal complication of peptic ulcer
-hemorrhage most common -Perforation most lethal
duodenal ulcer -Who does it occur in -what is it associated with
-in any age and anyone, but more common in ages 35-45 w family tx -alcohol, cigarettes, H.pylori
Acute hepatitis infection Chronic hepatitis infection
-liver damage, lysis of infected cells, liver cells can regenerate -Progress to cirrhosis
Hepatitis A -what is it -chronic? -how is it transmitted
-mild to acute liver failure -not chronic -Via fecal-oral route, contaminated food or drinking water **GOLDEN CORRAL
Health promotion Hep C
-no vaccination, screen people born 1945-1965
CM duodenal ulcers
-pain beneath xiphoid process, back pain, 2-5 hr after meals
gastric outlet obstruction -CM
-pain worsens at end of day when stomach fills, belching and vomitting, palpable, loud peristalsis
Hepatitis B Virus -Vaccine? -How is it transmitted -Those at risk -How long does it live on surface
-yes, decreased incidence with vaccine -via blood or mucosal exposure -health care and public safety workers -live on dry surface for 7 days can be chronic or acute
nonmelanoma skin cancer
Actinic Keratosis (premalignant) Basal Cell Carcinoma (BCC)(least deadly) Squamous Cell Carcinoma (SCC) (smoking)
A client is evaluated for severe pain in the right upper abdominal quadrant, which is accompanied by nausea and vomiting. The physician diagnoses acute cholecystitis and cholelithiasis. For this client, which nursing diagnosis takes top priority?
Acute pain related to biliary spasms
A client with inflammatory bowel disease undergoes an ileostomy. On the first day after surgery, the nurse notes that the client's stoma appears dusky. How should the nurse interpret this finding?
Blood supply to the stoma has been interrupted.
Dehiscence
Bursting open of a wound, especially a surgical abdominal wound
Inflammatory Bowel Disease CM
Diarrhea, bloody stools, weight loss. abdominal pain, fever, fatigue
Drug and nutritional therapy for wound healing
Regranex and diet high in protein, carb, vitamins and moderate fat\
A school nurse is examining a student at an elementary school and notes vesicular lesions that ooze, forming crusts on the face and extremities. Which actions by the nurse are most appropriate?
Sending the child home and encourage evaluation by physician. Correct response:
Which statement would be appropriate for a nurse documenting a stage 1 pressure ulcer found on a client who is immobilized?
The client's skin is intact with non-blanchable redness of a localized area over a bony prominence
A client with a recent history of rectal bleeding is being prepared for a colonoscopy. The nurse knows that positioning the client lying on the left side with the knees bent is an appropriate intervention. The nurse recognizes that this position will
allow proper visualization of the large intestine.
acute gastritis CM
anorexia, vomiting, nausea, tenderness, feeling full, hemorhhage
Which task may a nurse delegate to a nursing assistant?
assisting a client who had surgery to ambulate in the hallway
ABCDE rule for skin cancer
asymmetry, border irregularity, color change , diameter above 6mm, evolving in appearance
A nurse is performing a skin assessment on a younger adult who reports frequent sunbathing. Which skin changes should the nurse observe for in this client?
asymmetry, border irregularity, color variation, and diameter
ulcerative colitis CM
bloody diarrhea, several to 20x/day, abdominal pain,Fever, Rapid weight loss of more than 10% of total body weight - Malabsorption, Anemia, Tachycardia, Dehydration
IBD gerontologic considerations
can be confused with C diff, colitis associated with diverticulosis or NSAID ingestion §Corticosteroids §Surgical morbidity §Colitis §Volume depletion and electrolyte imbalance from diarrhea
When to clean a wound, and with what
clean when wound is granulating, keep slightly moist and protected, dryness is enemy of wound, use topical microbials with caution
Crohn's CM
diarrhea, crampy abdominal pain. weight loss, rectal bleeding, fever
Treatment of pressure ulcer
document size, stage, location, infection, pain, exudate, appearance (measure depth and width) Relieve pressure, debride, cleanse with nontoxic solutions, keep ulcer bed moist, cover with appropriate dressing, assess stage 2-4 for infection (contaminated) Nutrition, increased protein 1.25-1.5
Cholecystits (Gall Bladder) characteristics
edematous, distended with bile pus, cystic duct may be occluded
A nurse is teaching parents how to reduce the spread of impetigo. The nurse should encourage parents to:
educate kids on handwashing
treatment of peptic ulcers
eliminate smoking and alcohol, dietary modificaiton, stress management, reduce gastric acidity, healing may take weeks, stop nsaids and aspirin for 4-6 wks, pain disappears after 3-6 days
Stage 4 pressure ulcer
full thickness loss extending to bone and supporting structures. tunneling may occur
unstagable pressure ulcer
full thickness loss in which depth of ulcer is obscured by slough or eschar, must remove to determine stage
Stage 3 pressure ulcer
full thickness loss, subq tissue may be visible. bone/tendon/muscle not
Cholecystits (Gall Bladder) complications
gall bladder rupture causing peritonitis
Hiatal hernia CM
heartburn after meals or when laying supine, dysphagia
What dressing for contaminated wound
hydrocolloid dressing
Inflammatory bowel disease
immune reaction to owns intestinal tract, widespread inflammation and tissue destruction
Lymphocyte
immunity
Health promotion Hep B
immunization
fecal odor and bile in emesis
indicated lower intesinal obstruction
Fluid in tissue spaces d/t inflammation what is it composed of?
initially serous fluid, then proteins (albumin)
How common are gastric ulcers? peak incidence?
less comon than duodenal ulcers peak incidence above 50 yrs age
Hiatal hernia lifestyle tx and surgical tx
lifestyle: stop alcohol, elevated head of bed, stop smoking, avoid lifting, reduce weight, use antacids Surgery: reduction of herniated stomach, herniotomu, antireflux procedure, laparoscopically
Definition of pressure ulcers and most common sites
localized injury to underlying tissue under bony prominences sacral and heel
What if platelets are low in inflammation
longer time creating clots and can cause bleeding risks
Prevention of pressure ulcers
mobilize, remove moisture, avoid massage over bony promninces, use lift sheets, elbow and foot protectors, clean if incontinent
ileostomy
monitor stoma color, output can be up to 2000 ml in 24 hr, observe for hemorrhage, dehydration, small bowel obstruction, initial drain will be liquid
Stage 2 pressure ulcer
partial thickness loss of dermis, shallow open ulcer w red or pink wound bed, presents as intact or ruptured serum filled blister
Inflammatory Bowel disease
periods of remission and periods of exacerbation, cause is unknown, no cure
RICE
rest, ice, compression, elevation
Cholecystits (Gall Bladder) CM
steady, excruciating pain, referred shoulder pain, RUQ pain, occur 3-6 hr after high fat meal, dark amber urine
Step down compared to step up approach
step down: start higher and go down step up: less toxic therapies first, work up
Cholelothiasis
stones in the gallbladder
inflammatory bowel disease (IBD) complications
§Hemorrhage §Strictures §Perforation §Fistulas §Colonic dilation -colorectal cancer -systemuc complications
Foods that can trigger IBD
§Lactose intolerance §High-fat foods §Cold foods §High-fiber foods
Nutritional therapy during acute exacerbation of IBD
§Regular diet may not be tolerated §Liquid enteral feedings are preferred §Regular foods are reintroduced gradually
Crohns Surgical therapy Short bowel syndrome
§Strictures §Obstructions §Bleeding §Fistula -from repeated removal of sections of small intestine -Widening of strictures obstructing the bowel
IBS and fiber
•Aim for a minimum of 20 g/day •Use a stool bulking agent •Monitor tolerance to increased fiber •Suggest gradual changes to avoid bloating and abdominal discomfort due to gas
•Extracorporeal shock-wave lithotripsy (ESWL)
•High-energy shock waves disintegrate stones
Surgical therapy of Cholecystitis
•Laparoscopic cholecystectomy •Treatment of choice -Open (incisional) cholecystectomy
Chronic gastritis CM
•Loss of intrinsic factor can occur when acid-secreting cells are lost or nonfunctioning •Essential for absorption of cobalamin (vitamin B12)
CM during incubation of hepatitis
•Malaise •Anorexia •Weight loss •Fatigue •Nausea/vomiting •Abdominal discomfort •Distaste for cigarettes ↓ Sense of smell -Headache -Low-grade fever -Arthralgias -Skin rashes
Cholecystits (Gall Bladder)
•Most commonly associated with obstruction from stones or sludge
Systemic manifestations of hepatitis
•Rash •Angioedema •Arthritis •Fever •Malaise •Cryoglobulinemia •Glomerulonephritis -Vasculitis •Dark urine •Light or clay-colored stools •Pruritus
•Chemoreceptor trigger zone (CTZ)
•Responds to chemical stimuli of drugs and toxins •Located in the brainstem
Nutritional therapy cholecystitis
•Small, frequent meals with some fat •Diet low in saturated fat •High in fiber and calcium •Reduced-calorie diet if patient is obese •Avoidance of rapid weight loss •May need to restrict fats for 4-6 weeks -fat soluble vitamins
Hepatitis diagnostic studies
•Specific antigen and/or antibody for each type of viral hepatitis
Cholecystits (Gall Bladder) Diagnostic studies
•Ultrasonography •ERCP •Percutaneous transhepatic cholangiography •HIDA scan -X-Ray •↑ Liver enzyme levels •↑ Serum amylase level - increased serum liver enzymes -abnormal gallbladder ultrasound findings
Gatorade with nausea and vomiting
•Use Gatorade, broth with caution because of high salt intake
What can pass through mucosal barrier
•Water, electrolytes, and water-soluble substances can pass through barrier
Two factors contributing to pressure ulcers
shear force and moisture
Treatment of malignant melanoma based on
site of original tumor, stage of cancer, pt age and health
Hiatal Hernia -definition -mostcommon type
-portion of stomach into esophagus through openning or hiatus in diaphragm - sliding in which stomach slides into hiatus when pt is supine and goes back to normal when pt stands up
Risk factors for GERD
-pregnancy, obesity, smoking, hiatal hernia
GERD -caused by -manifestation of
-reflux of gastric contents, incompetent LES -mucosal damage
A client has a newly created colostomy. After participating in a teaching session with the nurse and receiving support from the spouse, the client decides to change the colostomy pouch unaided. Which behavior suggests that the client is beginning to accept the change in body image? You Selected:
The client touches the altered body part
Hiatal hernial gerontologic considerations
increase with age, meds to decrease LES spincter, first indication can be bleeding or resp complications
A client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, the nurse should stress the importance of
increasing fluid intake to prevent dehydration.
What would be the priority treatment of a client who has reported severe lower right quadrant pain that has now resolved?
preparation for emergency surgery
Baretts esophagus, complication of GERD
replacement of normal squamous epithelium with columnar epithelium (precancerous) must be monitored every 2-3 yr w endoscopy
Which statement indicates that a client with esophageal reflux disorder understands the dietary teaching?
"I won't drink any carbonated drinks."
Vasodilation chemical mediators (edema)
-movement of fluid from capillaries into tissue spaces causes edema
Achalasia -what is it? -CM
-peristalsis is absent in lower 2/3 of esophagus -CM dysphagia, halitosis, substernal chest pain,
Diagnosis of Malignant Melanoma
shave biopsy, melafind, breslow and clark
An adolescent, age 14, is hospitalized for nutritional management and drug therapy after experiencing an acute episode of ulcerative colitis. Which nursing intervention is appropriate?
providing small, frequent meals
Regeneration wound healing v repair wound healing
regeneration- replavement of cells of same type repair- replaced with connective tissue
What does the inflammatory process do
removes necrotic materials and establishes an environment suitable for healing and repair
Complications of pressure ulcers
reoccurance, chronic infection, osteomyletis, death
