CWCA (Other exams) cheat sheet

Phases in order: hemostasis (immediate), inflammation (days 0-4), proliferation (days 4-21), maturation/remodeling (day 21 up to 2 years).

Hemostasis = vasoconstriction + platelet aggregation + fibrin clot, which provides the provisional matrix that later cells migrate into.

Neutrophils peak at 24-48 hours for bacterial clearance; macrophages peak at 48-72 hours and release PDGF and TGF-beta to recruit fibroblasts.

Proliferation = fibroblast collagen synthesis, angiogenesis, granulation tissue formation, and epithelialization, with epithelial cells migrating roughly 1 mm per day from wound edges.

Maturation: type III collagen is remodeled into type I; tensile strength never exceeds about 80% of uninjured skin.

Healing intention: primary (edges approximated), secondary (heals by granulation and contraction with a larger scar), tertiary (delayed closure once contamination is controlled).

Chronic wound = fails the orderly repair sequence, commonly defined as more than 30 days without meaningful progress; usual drivers are ischemia, infection, moisture imbalance, and pressure.

Moist wound healing (Winter, 1962) accelerates epithelialization compared with dry, scab-covered wounds.

Repair inhibitors: corticosteroids, chemotherapy, radiation, diabetes, malnutrition (albumin below 3.5 g/dL), smoking, hypoxia, obesity, and advanced age.

Document location, etiology, stage, size (length x width x depth in cm), tissue types as percentages, exudate amount/type/odor, periwound skin, wound edges, tunneling/undermining by clock face, and pain.

Pressure injury staging: 1 = non-blanchable erythema; 2 = partial-thickness loss; 3 = full-thickness with fat visible; 4 = full-thickness with bone/tendon/muscle exposed; unstageable = base covered by slough/eschar; DTPI = deep maroon or purple area.

Braden Scale: 6 subscales, total 6-23; 18 or below = at risk, 9 or below = very high risk; a lower score means higher risk.

ABI: 0.9-1.3 normal; below 0.9 indicates arterial insufficiency; below 0.5 is severe; above 1.3 indicates non-compressible calcified vessels (diabetes, renal disease).

PUSH tool scores surface area (0-10), exudate amount (0-3), and tissue type (0-4); total range 0-17, and a falling score indicates healing.

Undermining and tunneling are measured in centimeters and localized with a clock face, with 12 o'clock pointing toward the patient's head.

Cultures should not be taken from surface exudate or without clinical signs of infection; tissue biopsy with quantitative culture is the gold standard.

Nutrition indicators: prealbumin (half-life about 2 days), albumin, weight trend, and intake history; poor intake delays healing.

Pain is a wound assessment parameter: use a validated scale and evaluate before, during, and after dressing changes.

Dressing selection matches exudate level, tissue type, wound depth, infection status, and periwound skin; keep the wound bed moist and the surrounding skin dry.

Debridement types: sharp/surgical (fastest), mechanical, enzymatic (collagenase), autolytic (hydrocolloid or film), and biologic (larvae); wet-to-dry is non-selective and discouraged.

Autolytic debridement requires adequate perfusion and immune function and is not appropriate for infected wounds.

Compression of roughly 30-40 mmHg at the ankle treats venous leg ulcers; contraindicated with ABI below 0.6-0.8; arterial ulcers never receive compression.

NPWT typically runs at -125 mmHg continuous; contraindicated over malignancy in the wound bed, untreated osteomyelitis, exposed vessels or nerves, and unexplored fistulas.

Offload diabetic foot ulcers: total contact cast is the gold standard; forefoot ulcers may use a cast walker or healing sandal; heel ulcers need pressure relief devices.

Reposition at-risk patients at least every 2 hours or per an individualized schedule; use 30-degree lateral tilt and keep the head of bed at or below 30 degrees when tolerated.

Goals should be measurable and time-bound (heal, maintain, or palliate); reassess and revise the plan if no progress is seen at about 2 weeks.

Silver, cadexomer iodine, PHMB, and honey dressings lower bioburden; use for a defined period and reassess, since some agents are cytotoxic and costly.

Local infection signs: erythema, warmth, edema, pain, purulent drainage, and delayed healing; fever, elevated WBC, and hypotension suggest systemic spread or sepsis.

Spectrum: contamination, colonization, critical colonization, then infection; only true infection warrants systemic antibiotics plus local wound care.

Biofilm requires mechanical disruption (debridement) plus an antimicrobial agent and is not eradicated by systemic antibiotics alone.

Levine swab technique: clean the wound, rotate the swab over 1 cm2 of viable wound bed for 5 seconds; tissue biopsy remains the gold standard.

Osteomyelitis workup: probe-to-bone test, elevated ESR/CRP, MRI, and bone biopsy with culture; it must be treated before definitive wound closure.

Hand hygiene: alcohol-based rub for most situations; soap and water when hands are visibly soiled and for C. difficile or norovirus because alcohol does not kill spores.

Standard precautions apply to every patient: gloves for contact with blood or body fluids, gown for splash risk, and eye protection as indicated.

Sterile technique for procedures entering sterile body areas; clean technique is acceptable for routine chronic wound dressing changes.

Sharps go into puncture-resistant containers at the point of use; bloodborne pathogen exposures are reported immediately for source testing and post-exposure prophylaxis evaluation.

Teach-back: the learner explains or demonstrates in their own words; it verifies comprehension better than asking whether the patient has questions.

Written materials should be at a 5th-6th grade reading level, with interpreters and translated materials used when needed.

Document education with topic, who was taught, method, learner response or teach-back, and the follow-up plan.

Pressure injury prevention teaching: daily skin checks, moisture and incontinence care, repositioning schedule, nutrition, heel offloading, and no massage over bony prominences.

Nutrition: 30-35 kcal/kg/day and 1.25-1.5 g/kg protein daily for adults with pressure injuries and adequate renal function; supplement vitamin C and zinc when deficient.

Diabetes teaching: glycemic control (HbA1c), daily foot inspection including soles with a mirror, no barefoot walking, properly fitting shoes, and prompt reporting of new lesions.

Smoking cessation improves tissue oxygenation and healing; offer referral to cessation resources rather than a one-time warning.

Staff education requires competency validation (skills check-off) plus periodic in-services, with attendance and competency documented.

Scope of practice is defined by the state Nurse Practice Act and facility policy; certification such as CWCA demonstrates knowledge but does not expand scope.

Negligence requires four elements: duty, breach of duty, causation, and damages.

Documentation standard: objective, measurable, timely, and accurate; if it was not documented, it is treated as not done.

HIPAA: protect PHI, share only on a need-to-know basis, and obtain consent per facility policy before photographing wounds.

Informed consent requires capacity, disclosure of risks/benefits/alternatives, voluntariness, and documentation.

Hospital-acquired Stage 3, Stage 4, and unstageable pressure injuries are CMS-reportable, non-reimbursable hospital-acquired conditions.

Medicare covers surgical dressings when the wound is documented and the dressing is prescribed with type, amount, and frequency; debridement has specific CPT codes.

Delegation to unlicensed assistive personnel follows the five rights of delegation and never transfers nursing assessment or clinical judgment.

Advocacy and chain of command: escalate unresolved patient safety concerns through the documented hierarchy in a timely manner.