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822: Integumentary > Dressing Selection and Bandaging > Flashcards

Dressing Selection and Bandaging Flashcards

1
Q

What are the 6 benefits of moist wound healing?

A
  • facilitates all 3 phases of healing
  • decreases the intensity and length of the inflammatory phase
  • traps endogenously produced enzymes within the wound bed, facilitating autolytic debridement
  • preserves endogenously produced growth factors within the wound fluid
  • reduces patient pain complaints
  • results in a more cosmetically appealing scar
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2
Q

What are 3 consequences if the wound is too moist?

A
  • Maceration
  • Additional skin damage/ulcer
  • Increased chance of infection
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3
Q

What are 2 consequences if the wound is too dry?

A
  • Crust formation

- Lack enzymes/ growth factors

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4
Q

What did Heather Hettrick compare a perfectly moist wound to?

A

al dente pasta

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5
Q

What are 5 functions of wound dressings?

A
  • Create moist environment
  • Provide thermal insulation
  • Hemostasis
  • Control edema
  • Eliminate dead space within wound bed
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6
Q

Wounds heal faster if the environment is maintained between __ and __ decrees Celsius.

A

37-38

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7
Q

Why is maintaining wound temperature between 37 and 38 degrees important?

A

It enhances tissue perfusion by causing vasodilation.

Increases oxygen saturation and decreases hemoglobin’s affinity for oxygen.

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8
Q

Wound temperature decreases with each dressing change and may remain decreased for up to __ minutes after a dressing change.

A

90

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9
Q

Why must dead space within a wound be eliminated?

A

to prevent premature wound closure and abscess formation

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10
Q

What are the 2 basic types of wound dressings?

A
  • primary

- secondary

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11
Q

Describe a primary wound dressing

A

It comes into direct contact with the wound and, therefore, is sometimes called the contact layer

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12
Q

Describe a secondary wound dressing

A

It is placed over the primary dressing to provide protection, cushioning, absorption, or occlusion

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13
Q

True or False

Alli Volkens spent countless hours making these notecards therefore should be the only one who uses them to study.

A

TRUE!

If you did not contribute please kindly remove yourself and make your own cards.

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14
Q

A moist wound heals - times faster than a dry wound

A

3-5

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15
Q

What is an example of a primary dressing that does not require a secondary dressing?

A

Band-Aid

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16
Q

What type of dressings are specialized synthetic or organic dressings that are typically more occlusive than gauze?

A

Moisture-Retentive Dressings

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17
Q

What does occlusion describe?

A

The ability of the dressing to transmit moisture vapor and gases from the wound bed to the atmosphere.

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18
Q

Describe truly occlusive and truly nonocclusive substances.

A

A truly occlusive substance, such as latex, is impermeable to water, vapor, or bacteria.

A truly nonocclusive substance, such as air, is completely permeable to water, vapor, and bacteria.

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19
Q

Moisture-retentive dressings have a ____ moisture vapor transmission rate than gauze. What does this mean?

A

lower

They are better able to trap wound fluid rich in enzymes, neutrophils, growth factors, and macrophages within the wound bed.

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20
Q

Lower moisture vapor transmission rates are associated with _____ wound healing and _____ pain complaints.

A

faster

lower

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21
Q

What are 2 common fears associated with the use of moisture-retentive dressings?

A
  • infection

- trauma to the wound bed and surrounding skin

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22
Q

What are the 4 reasons why occlusive dressings have lower infection rates compared to nonocclusive dressings?

A
  • they serve as a bacterial barrier
  • they require less frequent dressings changes
  • facilitate the neutralization of micoorganisms by retaining macrophages and neutrophils
  • facilitates the removal of necrotic tissue and debris microbes feed upon by preserving endogenous enzymes within the wound fluid
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23
Q

The risk of infection when using moisture-retentive dressings can be further reduced by following a few simple guidelines. What are they?

A
  • should be changes if the barrier properties become compromised
  • more frequent dressing checks should be performed in immunocompromised patients due to the risk of silent infections
  • discontinue if the signs of infection are detected
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24
Q

What are the 2 exceptions in which moisture-retentive dressings can be used on infected wounds?

A

Semipermeable foams and alginates

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25
Q

What prevents the moisture-retentive dressing from adhering to the wound bed?

A

the interaction of the dressing with the wound fluid

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26
Q

How should moisture-retentive dressings be removed in order to reduce the risk of skin trauma?

A

The edge of the dressing should be lifted up near the corner and then stretched longitudinally to decrease the dressing’s adhesion to the skin’s surface

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27
Q

On the wound dressing continuum of occlusion what is the least occlusive and what is the most occlusive?

A

Least: traditional gauze

Most: hydrocolloids

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28
Q

What are the 8 main categories of wound dressings on the market today?

A
  • gauze dressings
  • impregnated gauze dressings
  • semipermeable films
  • hydrogels
  • semipermeable foams
  • hydrocolloids
  • alginates
  • composite dressings
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29
Q

What are the 2 types of gauze dressings?

A

woven and nonwoven

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30
Q

What is woven gauze made from?

A

cotton yarn or thread

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31
Q

What is nonwoven gauze made from?

A

synthetic fibers pressed together

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32
Q

Do nonwoven or woven gauzes have greater absorbency?

A

nonwoven

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33
Q

What is loose weave gauze used for?

A

he mechanical debridement of wet-to-dry dressings by trapping foreign material, debris, and slough within the pores

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34
Q

Where does gauze fit on the permeable and occlusive continuum?

A

Highly permeable

Relatively nonocclusive

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35
Q

What does gauze promote in wounds with minimal exudate?

A

desiccation

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36
Q

Is gauze a primary or secondary dressing?

A

can be either

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37
Q

When is gauze the dressing of choice?

A

When a wound requires daily or more frequent dressing changes. Therefore, gauze is commonly used on infected wounds or wounds being treated with enzymatic debriding agents.

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38
Q

Woven gauze may leave a residue or lint within the wound bed, the body may respond to this foreign material by forming what?

A

a granuloma

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39
Q

How should rolled gauze be applied?

A

Snugly but without tension and arranged on a slight angle rather than straight across

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40
Q

In what type of wound are Telfa dressings used?

A

superficial, nondraining wounds closed by primary or secondary intention

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41
Q

Impregnated gauzes are mesh gauze dressings into which materials such as what 4 things have been incorporated?

A
  • Petrolatum
  • Bismuth
  • Zinc
  • Hydrogel
  • Saline
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42
Q

Describe what impregnated gauze is used as?

A

It is used as a nonadherent contact layer which requires a secondary dressing, typically regular gauze

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43
Q

Gauze impregnated with ____ such as paste bandages, or Unna’s boot, are used primarily in the treatment of venous insufficiency ulcers

A

zinc

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44
Q

In what type of wound are petrolatum-impregnated gauzes common used for and why?

A

Burn wounds because they allow for pain-free removal

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45
Q

In what types of wounds can bismuth impregnated gauze NOT be used in and why?

A

Venous insufficiency ulcers, because bismuth is cytotoxic to inflammatory cells and may be a sensitizing agent, that is, it may cause irritation, dermatitis, or an increased inflammatory response

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46
Q

Describe the structure of semipermeable film dressings

A

Thin, flexible sheets of transparent polyurethane with an adhesive backing

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47
Q

What are semipermeable films permeable to and what are the impermeable to?

A

Permeable to water vapor, O2, CO2

Impermeable to bacteria and water

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48
Q

Are semipermeable film dressings a good choice for deep wounds with excessive drainage?

A

No, because they have little absorptive/insulating capabilities

49
Q

What are 2 benefits of semipermeable film dressings?

A
  • Allow visualization of wound bed

- Highly elastic and conformable

50
Q

How should semipermeable film dressings be applied?

A

Should be secured to a 1-2 cm border of intact skin, and should be applied without tension or wrinkles.

51
Q

How long can semipermeable film dressings be left on?

A

5-7 days

52
Q

In what type of wounds are semipermeable film dressings used?

A

Superficial wounds such as skin tears, lacerations, and abrasions.

Partial-thickness wounds, sutured wounds, and donor graft sites

53
Q

In what other situations can semipermeable film dressings be used?

A
  • To cover catheter sites or wounds to allow for bathing
  • Areas of friction
  • Within total contact casts and splints
54
Q

In what situations should you not use semipermeable film dressings?

A
  • Infected wounds
  • Wounds with moderate to heavy drainage
  • Patients with fragile skin
55
Q

Hydrogels are __-__% water or glycerin based wound dressings that are available in sheets, amorphous gels, or impregnated gauzes

A

80-99

56
Q

Hydrogels are able to absorb ______ amounts of fluid by swelling. They are also able to
_____ moisture to dry wounds.

A

minimal

donate

57
Q

What are hydrogels permeable to? What does this result in?

A

gas and water, making them less effective bacterial barriers than semipermeable films or hydrocolloids

58
Q

How may hydrogels decrease pain?

A

They feel cool when applied to the skin or wound

59
Q

In what type of wounds are sheet hydrogels indicated for?

A

Superficial and partial thickness wounds such as abrasions, skin tears, blisters, donor sites, radiation burns, thermal burns, pressure ulcers, diabetic ulcers, mastitis, and surgery sites

60
Q

Why may hydrogels be chosen for use?

A
  • to assist in autolytic debridement

- to moistens the wound bed for improved healing time

61
Q

In what type of wounds should hydrogels not be used in?

A
  • Heavily draining wounds
  • Infected wounds
  • Bleeding wounds
62
Q

What should be used in combination with hydrogels to prevent maceration?

A

a skin sealant

63
Q

What are semipermeable foam dressings made of?

A

Polyurethane foam with a hydrophilic wound side and a hydrophobic outside

64
Q

What are semipermeable foam dressings permeable to? What are they impermeable to?

A

Permeable to gas but not to bacteria

65
Q

What 4 advantages to semipermeable foam dressings?

A
  • provide thermal insulation
  • provide cushioning
  • easy to apply and remove
66
Q

Semipermeable foams are especially useful in managing what type of wounds?

A

Pressure ulcers, especially stage II and III

67
Q

Semipermeable foams are not indicated in what types of wounds?

A
  • dry or eschar-covered wounds
  • arterial ulcers
  • heel ulcers
68
Q

In what type of wounds are semipermeable wounds used?

A
  • wounds with minimal to heavy exudate
  • granulating slough covered partial and full-thickness wounds
  • donor sites
  • ostomy sites
  • minor burns
  • skin grafts
69
Q

What do hydrocolloids contain?

A

Hydrophilic colloidal particles such as gelatin, pectin, and carboxymethylcellulose with a very strong film or foam adhesive backing

70
Q

Describe how hydrocolloids absorb fluid

A

They absorb fluid slowly byswelling into a gel-like mass

71
Q

Upon a removal of a hydrocolloid a residue remains which often leads clinicians to believe what?

A

That the wound is infected due to the foul smell

72
Q

What are hydrocolloids impermeable to?

A

water, O2, and bacteria

73
Q

What is the name of the most highly studied hydrocolloid due to the fact that it is an effective barrier against urine, stool, MRSA, hepatitis B, HIV-1, and Pseudomonas?

A

DuoDerm

74
Q

What are hydrocolloids used to treat?

A
  • pressure ulcers (majority)
  • minor burns
  • venous insufficiency ulcers
75
Q

How often should hydropcolloid wound dressings be changes?

A

every 3-8 days

76
Q

In what type of wounds are hydrocolloids not recommended?

A
  • Arterial ulcers
  • 3rd degree burns
  • Wounds with minimal drainage
  • wounds with exposed fascia (stage IV PU)
77
Q

Hydrocolloids are contraindicated in what type of wounds?

A

infected wounds

78
Q

The use of hydrocolloids has been associated with ____granulation (hyper or hypo)

A

hypergranulation

79
Q

What are alginates made of?

A

Salts of alginic acid from brown seaweed and converted into calcium/sodium salts

80
Q

What do alginates react with when placed within the wound?

A

serum and wound exudate to form a hydrophilic gel to provide a moist wound environment

81
Q

Where do alginates fit on the permeability and occlusive continuum?

A

Highly permeable and nonocclusive

82
Q

Do alginates require a secondary dressing?

A

Yes

83
Q

What are the 3 forms alginates are available in and what are each used to treat?

A

1) alginate sheets are placed on wound beds to absorb drainage
2) alginate ropes are used to lightly fill wound tunnels or areas of undermining
3) alginate-tipped applicators are used to fill wound cavities and tunnels, perform culture swabs, and measure wound depth

84
Q

An alginate can absorb __ times its weight

A

20

85
Q

In what type of wounds are alginates used in?

A
  • VI ulcers
  • pressure ulcers
  • neuropathic ulcers
  • burns
  • infected wounds
86
Q

When alginates are used on infected wounds how often should the dressing be changed?

A

at least daily

87
Q

In what types of wounds are the use of alginates not recommended?

A
  • full thickness (3rd degree) burns

- wounds with exposed tendon, joint capsule, or bone

88
Q

How many layers do most composite dressings have?

A

3

89
Q

Describe the inner layer of composite dressings

A

It is nonadherent, preventing trauma to the wound bed during dressing changes

90
Q

Describe the middle layer of composite dressings

A

It absorbs moisture and wicks it away from the wound bed to prevent maceration while maintaining a moist wound environment

91
Q

What does the middle layer consist of?

A

Hydrogel, semipermeable foam, hydrocolloid, or alginate

92
Q

Describe the outer layer of composite dressings

A

It serves as the bacterial barrier and is commonly composed of a semipermeable film

93
Q

What are 2 types of antimicrobial wound dressings?

A
  • Silver

- cadexomer iodine

94
Q

What do silver dressings do to the wound bed?

A

They turn the wound bed a blue-black color which must not be mistaken for eschar

95
Q

True or False

Silver dressings cannot be used in conjunction with electrical stimulation

A

True

96
Q

Cadexomer iodine must be used cautiously in patients with what type of disease?

A

thyroid

97
Q

What is the key function of charcoal dressings?

A

control odor by absorbing odor-producing gases released by bacteria

98
Q

What type of honey can be impregnated in a dressing?

A

Leptospermum, also known as Manuka honey

99
Q

What are the 2 proposed benefits of honey-impregnated dressings?

A
  • control wound bioburden

- control wound odor

100
Q

What are the 5 purported ways honey-impregnated dressings improve healing?

A
  • Antimicrobial
  • Stimulates angioblasts, fibroblasts, monocytes
  • Reduces inflammation and edema
  • Osmotic action controls drainage
  • May stimulate growth factors
101
Q

Collagen dressings should be considered in what stage of pressure ulcer?

A

III or IV

102
Q

What are the 5 purported ways collagen dressings improve healing?

A
  • Stimulates macrophages, angioblasts, keratinocytes, platelets
  • Protects growth factors
  • Provides scaffolding for cell proliferation/migration
  • Maintain moist wound environment
  • May encourage balance between MMPs and TIMPs
103
Q

What do skin sealants do?

A

Make the skin tacky to provide a better edge seal

104
Q

Skin sealants must be used on _____ skin

A

intact

105
Q

What do moisture barriers do?

A

Prevent perineal rashes/skin breakdown

106
Q

What 3 things do moisturizers do?

A
  • help restore the barrier function of the epidermis
  • provide a soothing protective film over intact skin
  • increase the water content of the epidermis
107
Q

_____-based moisturizers are particularly effective in the management of calluses, dry skin in individuals with diabetes, and burn scars.

A

Petroleum

108
Q

Are ointments or creams/lotions more occlusive? Explain why…

A

Ointments, because they are mixtures of water and oil. Whereas lotions are primarily water

109
Q

When staples or sutures are not used to close a primary wound, what is used?

A

tissue adhesive/skin glue

110
Q

Growth factors include what 3 things?

A
  • cytokines
  • interleukins
  • colony-stimulating factors
111
Q

In what type of wounds are growth factors used?

A

chronic wounds that are recalcitrant to traditional interventions

112
Q

What is a disadvantage to using growth factors?

A

Extremely costly

113
Q

What is the name of the growth factor approved for use on diabetic foot ulcers?

A

Becaplermin

114
Q

What is the name of the growth factor approved for use on PT chronic ulcers?

A

Porcine/Oasis

115
Q

Biosynthetic dressings encourage what type of debridement?

A

autolytic

116
Q

What are the 3 types of skin grafts?

A
  • allograft (tissue taken from a cadaver)
  • xenografts (tissue taken from an animal)
  • autografts (tissue taken from unaffected area of the patient)
117
Q

If the wound is infected what are 3 dressing options?

A
  • gauze
  • alginate
  • semipermeable foam

*avoid occlusive dressings

118
Q

What type of dressing should be used if the intent is to leave it on for 3 or more days?

A

Adhesive, moisture-retentive dressings

822: Integumentary (16 decks)

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