1.25 Topical Agents/Modalities Flashcards
What are the common topical agents?
- hydrogen peroxide
- provodine/iodine
- acetic acid
- Daikin’s
- antibacterials
characteristics of hydrogen peroxide
- oxidizing agent
- cytotoxic
problem with hydrogen peroxide?
People put it on all the time and it kills cells
problem with idodine?
- same as peroxide, cytotoxic
- shouldn’t use it all the time
acetic acid as a topical agent
vinegar, not used often
What is Daikin’s?
.025% bleach (.05% at most) + saline
Use of Daikins
- generally soak a bandage in it
- must stop using after a few days of the treatment
- perianal area: may need longer to prevent fecal contamination in the wound
problem with Daikin’s
- kills bad AND good stuff
- stunts granulation tissue growth
Most antibacterials are ______
triple antibiotics
Why would it not be a good idea to use triple antibiotics like Neosporin?
creation of stronger superbugs due to adaptation
common antibacterials
- Neosporin
- Bacitracin
- Bactriban
- Genomycin
- Silvadene
bacitracin
single antibiotic
genomycin
topical
silvadene
aka silver surfer
- white cream used a lot with burns and ulcers
- impregnate gauze with it before applying
Why can’t you spread silvadene in a wound?
gauze would just slide around in the goop
Why is silver used in topical agents?
- antibacterial
- keeps it from getting infected
- keeps it moist
What are growth factors in wound care?
- put it on the wound, helps tissue grow
- all work differently, have different chem structures
- support different body function
two types of dressings
- primary
- secondary
primary dressing
- against the wound bed
- most often the dressing creating the desired effect
- keeps the wound dry
What happens if the primary dressing gets dried out?
need to apply moisture before taking it off
function of the secondary dressing
- holds primary dressing in in place and attaches to the outside skin
- can be an occlusive barrier if necessary
We always want the secondary dressing to be _____
dry
strikethrough
- fluid gets through the secondary dressing
- if both are wet, infection gets into the wound bed
What should be done if strikethrough happens?
- reinforce the bandage until it stops bleeding through
- re-evaluate the next dressing change
As the wound heals, what happens to moisture content?
different cycles of moisture content
categories of dressings
- gauze
- transparent film
- foam
- hydrogels
- hydrocolloids
- alginates
- skin substitutes
putting gauze in a wound
- should have some moisture
- don’t push in (create pressure and occlusion)
qualities of gauze
- good for filling space
- doesn’t absorb much
impregnated gauze
- usu with vaseline
- won’t stick to the wound
removal of gauze
NEVER remove dry bandage off a wound bed
transparent film
- one side sticky, the other completely sticky
- looks like saran wrap
- keeps bad stuff out but oxygen in
foam
- absorbs fluid
- may need to put thin film on the periwound to keep moisture off so the water that’s collected doesn’t macerate the tissue
hydrogels
- aqueous solution that adds water
- has its own structure
- can fill in the area and not put as much dressing on it
When should you not use hydrogels?
- somewhere there’s going to be some weight on it
- wouldn’t put it on someone’s butt
application of hydrogel
coat wound bed
fill with gauze
hydrocolloids
- absorbs moisture
- thin, low profile dressing
- doesn’t absorb as much as foam
- whole thing is sticky
benefit to hydrocolloids
because it absorbs moisture, won’t stick to the wound bed
alginates
- made of calcium alginate (seaweed)
- absorbs moisture and keeps it there
- comes in sheets, ribbons, etc
Where are alginates commonly used?
venous ulcers
What must you do with a wound that is undermined?
- fill in the undermined area
- make sure to document how many items you’ve put in
best way to approach a tunneled/undermined wound
- long piece of gauze with a tail outside the wound bed
- packing strips: cut, moisten, put in tunnel
What is the specialized dressing we talked about?
Unna boot
what is an unna boot?
- gauze impregnated with zinc
- long roll
- nonflexible
- great for venous ulcers
- wrap entire leg, toe up, no compression
- add self adherent bandage on top
purpose of zinc in the unna boot
- antibacterial
- protects skin
What is done after the unna boot is put on?
- walked for 10-30 mins
- if they can’t walk, have them do ankle pumps
Why do they need to exercise after unna boot is applied?
- muscles contract to walk
- compression pushes everything up
Who would you not use an unna boot on?
someone with CHF
modalities for wound care
- whirlpool
- ultrasound
- e-stim
- UV radiation
- hyperbaric oxygen threrapy (HBO)
- negative pressure wound therapy (wound vac)
- cold laser therapy
whirlpool guidelines for wound care
- usu body temp
- 15 mins
continuous ultrasound
- thermal
- increase circulation
pulsed ultrasound
- nonthermal
- could be used for venous ulcer that’s just starting to push stuff away from interstitial space
- can put the gel directly in the wound
When would you not use pulsed US on a wound?
huge one
e-stim in wound care
- depends on polarity
- negative: repels bugs and helps clear out a wound
UV radiation in wound care
- can kill bugs
- heal tissue in proper dosages
- just know it’s there, same as diathermy
HBO
hyperbaric oxygen therapy
How does HBO work?
- forces oxygen to distal blood supply
- get better blood flow to the area
- increase pressure/permeation to improve healing
problems with HBO?
- most insurance companies don’t cover (expensive, but works)
- time intensive (few hours a day)
wound vac: how it works
- white foam underneath as a barrier
- black foam cut to shape of wound, primary dressing
- film laid down and around, airtight
- tube fed through with a pump and vacuumed out
- foam collapses and pulls fluid to and away from the wound bed at the same time
How long will a wound vac be left on?
2-3 days at first then 3-5 days each time
What is so great about wound vacs?
- heals a wound very quickly
- occlusive (won’t get feces or urine in it)
- covered a lot more by insurance companies now
What can happen if a wound vac works too well?
can get hypergranulation outside the wound bed that would have to be cauterized by an MD
usu with shallow wounds
