Dressing and moisture

Question 1

Primary dressing

Answer 1

• also called contact layer
• comes in direct contact with wound

Question 2

secondary dressings

Answer 2

• placed over the primary dressing to provide increased protection, absorption, compression or occulsion

Question 3

tertiary layer or support needs

Answer 3

similar to the secondary layer

Question 4

functional categories of dressing

Answer 4

• maintain existing moisture balance
• add moisture
• absorb excessive moisture

Question 5

Not enough moisture vs too much moisture

Answer 5

not enough:

• dry wound bed
• painful
• slower healing

too much moisture:

• macerated periound
• possible increase in wound size
• slower healing

Question 6

what are Skin protection/moisture barriers used for

Answer 6

• excess exudate on the wound edges can lead to maceration and destruction of critical wound edges
• protect with skin barriers
• consider dressings that absorb and decrease fluid at the wound edges

Question 7

Skin and periwound care: skin sealants/moisture barriers

Answer 7

• protect skin from maceration
• minimal protection from adhesives
• some products may interfere with wound care modalities
• ointments cannont be used with adhesive dressing

Question 8

Skin and periwound care

moiturizers

what too consider and what do they do

Answer 8

• maintain hydration
• provide protective layer to minimize fluid loss through skin
• dry skin can lead to inflammation, cracking, scaling, fissuring
• also consider dehydration

Question 9

transparent film dressings

Answer 9

• maitain exisiting moisture
• transparent sheets of polymers
• adhesive on oneside
• semi-permeable: allows oxygen and water vapor to cross
• encourage autolytic debridement
• allow visualization of wound bed
• waterproof
  can be primary or secondary

Question 10

transparent films

indications

Answer 10

• supports autolytic debridement
• maintains moist wound environment
• protection form shear, friction, bacteria
• allows visualiation
• can be primary or secondary dressing

Question 11

transparent films

disadvantages

Answer 11

• does not adhere well to moist skin
• difficulty to use with heavy exudate wounds
• contributes to periwound maceration
• contraindicated in infected wounds

Question 12

hydrocolloids

Answer 12

• maintain exisiting moisture
• occlusive waffer dressing composed of gel-forming polymers
• when applied to an exuding wound, exudate combines with the polymers to form a soft gel mass in the wound
  may be good with arterial wounds

Question 13

describe hydrocolloid dressings

Answer 13

• come in wide ranges of sizes, shapes, and types
• consists of 3 layers (inner slightly adhesive, middle absorbent layer with geltain/pectin base, outer semiocclusive)
• the resulting gel is acidic, not conducive to bacterial growth
• can help to slowly absorb excess moisture
• good to use when a wound is going from higher to lower exudate levels

Question 14

hydrocolloid dressings

indications/pros

Answer 14

• moisture retentive
• encourage autolytic debridement
• impermeable to urine, stool, bacteria
• provide thermal insulation
• waterproof
• moderate absorption

Question 15

hydrocolloid dressings

disadvantages

Answer 15

• may traumatize fragile periwound skin
• unable to visualize wound
• may leave residue in wound bed
• require a primary dressing to fill wound space, fissues or undermining
• may roll in areas of friction
• not for infected wounds

Question 16

hydrogels

Answer 16

• made of complex organic polymers with a higher water content
• moisture donating products that enable rapid rehydration of a wound
• may contain other ingredients: alginates for absorption, antimicrobials to decrease bioburden, collagen and growth factors for enhanced wound healing

Question 17

types of hydrogels

Answer 17

• amorphous gels
• sheets
• gel-impregnated gauze or mesh
• gels are useful for dry, desiccated wounds or if wound desiccation is anticipated
• conforms to the shape of the wound

Question 18

hydrogels

Pros

Answer 18

• hydrate dry wound beds (moisture retentive/add moisture)
• encourage autolytic debridement
• rinse easily from wound surface
• soothe wounds and reduce pain

Question 19

hydrogels

disadvantages

Answer 19

• not for exudating wounds
• macerate periwound tissue if wound becomes too wet
• requires secondary dressing
• usually require daily dressing changes
• not for infected wounds

Question 20

dressing to absorb moisture

Answer 20

• gauze
• foam
• calcium alginates

Question 21

gauze

indications

Answer 21

• superficial or cavity wounds
• moderate to heavy drainage
• filler for dead space
• form of mechanical debridement

Question 22

gauze

disadvantages

Answer 22

• may shed, leaving lint in wound
• permeable to moisture and bacteria
• if becomes dry, removal can cause trauma

Question 23

foam

Pros/indications

Answer 23

• less frequent dressing changes
• moisture retentive/absorbs moderate amounts of drainage
• thermal insulation
• cushioning
• adherent and non-adherent forms
• no residue
• primary or secondary dressings

Question 24

foam

disadvantages

Answer 24

• foam memory may make it harder to conform to wound surface
• adhesive may traumatize skin
• may roll
• not on infected wounds
• may macerate if becomes saturated

Question 25

calcium alginate

indications/uses

Answer 25

• Autolytic debridement
• highly absorptive
• infected or uninfected wounds
• conform to wound or fill wound spaces/cavities
• non-adherent
• available with silver or honey for bioburden management

Question 26

calcium alginate

limitations

Answer 26

• requires secondary dressing, to secure in place
• adheres to the wound bed if exudate is inadequate to create gel effect
• not suitable for dry eschar or low exudating wounds

Question 27

Miscellaneous dressings

Hydrofiber dressings

Answer 27

• highly absorbent
• most of all dressings - similar to calcium alginates

Question 28

Miscellaneous dressings

charcoal

Answer 28

• controls odor

Question 29

topical antimicrobial dressing

silver

Answer 29

• proven antimicrobial activity
• silver sulfadiazine is used in treatment of burns
• other forms inorganic compounds (silver oxide and silver nitrate) can be embedded into dressings
• wide variety of dressings deliver systems can be combined with other treatments

• broad-spectrum and inactivates almost all bacteria
• may be used to reduce bacteria and colonized and infected wounds or use to reduce risk of infection

Question 30

Topical antimicrobial dressing

medical grade honey

Answer 30

• manuka honey - derived from tea plants
• antimicrobial
• can change the wound pH and jump start immune response
• can enhance debridement

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Question 31

cadexomer iodine

Answer 31

• paste or sheet dressings
• allow controlled release of 0.9% iodine
• reduces bioburden without being cytotoxic
• cannot be used with collagenase

Question 32

collagen dressings: advantages

Answer 32

• provide temporary scaffolding and attracts cells to wound
• creates moist wound environment
• easy to apply
• cost effective advanced wound care

Question 33

collagen dressings: when can it NOT be used

Answer 33

• not for 3rd degree burns
• not effective on necrotic tissue
• cultural restrictions as use bovine or porcine products

Question 34

advanced dressings: biologics

what is it/appligraft, allograft, osaasis, dermagraft

Answer 34

• specialized material derived from living organisms to harness healing properties
• appligraft: bovine type 1 collagen w/ living fibroblasts and keratinocytes
• allograft: cadaver skin to facilitate granulation while awaiting skin graftint
• oasis: porcine small intestine and collagen matrix
• dermagraft: living fibroblasts and ECM mesh scaffold

Question 35

advanced dressings: procellera

Answer 35

• embedded with silver and zinc that creates microbatteries when activated by moisture (microcurrent) to attract epithelial cells

Question 36

Growth factors: what do they do and how can they be used for dressings

regranex Gel

Answer 36

• small proteins that act as signals for intracellular communication
• stimulate mirgation/proliferation for formation of new tissue

regranex gel

• used for LE neuropathic ulcers
• need adequate blood supply
• applied in thin layer covered with moist dressing

Question 37

Pain during dressing changes

Answer 37

• minimize pain during dressing changes
• can have them do deep breathing, distraction, and rest breaks
• pain medication
• tape or adhesive dressing: take skin off the tape, pull in direction of hair growth, maybe moisten prior
• allow patient to assit with dressing removal (reduces anxiety)

Question 38

Timing for pain medication if using during dressing changes

Answer 38

• oral meds: 30 minutes prior to
• IM injection: 10 minutes prior
• IV injections: immediately prior to
• topical anestheics: 15-20 min
• topical injections: per MD
• TENS: place proximal to wound during debridement

Question 39

How to choose ideal wound healing

Answer 39

• provides moist wound environment
• manages exudate
• facilitate autolytic debridement
• minimizes pain
• prevents contamination by being impermeable to environmental bacteria (areas of incontinence)
• comparable with suppot needs (under contact cast or compression)
• Provides antimicrobial poperties if needed
• insulates and maintains optimal temperature
• prevents contamination
• easily applied and removed
• available and cost effective