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