NURS 230 Lecture Notes - Lecture 7: From The Inside Out, Pressure Ulcer, Hyperaemia
Document Summary
Clear liquids- anything u can see thru besides alcohol. Full liquids- anything in liquid state (veg soup is not full liquid)(food must be. Mechanical soft- clear &full liquids plus diced or ground foods. Reactive hyperemia- blanched skin that turns back to pink at a reddened pressure ulcer site (tissue is trying to overcome decreased blood flow) Stage 1 pressure ulcer: non-blanch able (doesn"t turn white when u press it. Stage 2: goes into the subcutaneous layers of skin. Stage 3: goes into the soft tissue almost the bone (looks like a cave) Stage 4: goes all the way to bone level (big hole) Slough: dead tissue that must be removed so new tissue can grow. Eschar: dead tissues that sheds or falls off healthy skin. (crusty & black) (needs removed usually surgery) (eschar that is dry and without redness should not be removed) Granulation: healthy tissue that is growing to fill a wound (beefy red and granular)
