Following a head injury, the client has thin drainage coming from ...

[nmorano1]

Following a head injury, the client has thin drainage coming from the left ear. The nurse describes this drainage as:
 
  1. Serous
  2. Purulent
  3. Cerebrospinal fluid
  4. Serosanguineous

Question 2

A client has a healing abdominal wound. The wound has minimal exudate and collagen for-mation. The wound is identified by the nurse as being in which phase of healing?
 
  1. Primary intention
  2. Inflammatory phase
  3. Proliferative phase
  4. Secondary intention

[stanleka1]

Answer to Question 1

ANS: 1
Serous drainage is clear, watery plasma. Purulent drainage is thick, yellow, green, tan, or brown. Drainage must be tested to determine if it is cerebrospinal fluid. The nurse should de-scribe the drainage by its appearance (i.e., serous). Serosanguineous drainage is pale, red, and watery, a mixture of clear and red fluid.

Answer to Question 2

ANS: 3
During the proliferative phase, the wound fills with granulation tissue (including collagen for-mation), the wound contracts, and the wound is resurfaced by epithelialization. Primary intention is not a phase of wound healing. Wounds that heal by primary intention have minimal tissue loss, such as a surgical wound. The edges are approximated and the risk for infection is low. During the inflammatory phase, platelets gather to stop bleeding, a fibrin matrix forms, and white blood cells reach the wound, clearing it of debris. Secondary intention is not a phase of wound healing. Wounds that heal by secondary intention have loss of tissue, such as a pressure ulcer. The wound is left open until it becomes filled by scar tissue.

[nmorano1]

TYSM

[Jossy]

Gracias!