Dressing Selection and Bandaging Flashcards
What are the 6 benefits of moist wound healing?
- 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
What are 3 consequences if the wound is too moist?
- Maceration
- Additional skin damage/ulcer
- Increased chance of infection
What are 2 consequences if the wound is too dry?
- Crust formation
- Lack enzymes/ growth factors
What did Heather Hettrick compare a perfectly moist wound to?
al dente pasta
What are 5 functions of wound dressings?
- Create moist environment
- Provide thermal insulation
- Hemostasis
- Control edema
- Eliminate dead space within wound bed
Wounds heal faster if the environment is maintained between __ and __ decrees Celsius.
37-38
Why is maintaining wound temperature between 37 and 38 degrees important?
It enhances tissue perfusion by causing vasodilation.
Increases oxygen saturation and decreases hemoglobin’s affinity for oxygen.
Wound temperature decreases with each dressing change and may remain decreased for up to __ minutes after a dressing change.
90
Why must dead space within a wound be eliminated?
to prevent premature wound closure and abscess formation
What are the 2 basic types of wound dressings?
- primary
- secondary
Describe a primary wound dressing
It comes into direct contact with the wound and, therefore, is sometimes called the contact layer
Describe a secondary wound dressing
It is placed over the primary dressing to provide protection, cushioning, absorption, or occlusion
True or False
Alli Volkens spent countless hours making these notecards therefore should be the only one who uses them to study.
TRUE!
If you did not contribute please kindly remove yourself and make your own cards.
A moist wound heals - times faster than a dry wound
3-5
What is an example of a primary dressing that does not require a secondary dressing?
Band-Aid
What type of dressings are specialized synthetic or organic dressings that are typically more occlusive than gauze?
Moisture-Retentive Dressings
What does occlusion describe?
The ability of the dressing to transmit moisture vapor and gases from the wound bed to the atmosphere.
Describe truly occlusive and truly nonocclusive substances.
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.
Moisture-retentive dressings have a ____ moisture vapor transmission rate than gauze. What does this mean?
lower
They are better able to trap wound fluid rich in enzymes, neutrophils, growth factors, and macrophages within the wound bed.
Lower moisture vapor transmission rates are associated with _____ wound healing and _____ pain complaints.
faster
lower
What are 2 common fears associated with the use of moisture-retentive dressings?
- infection
- trauma to the wound bed and surrounding skin
What are the 4 reasons why occlusive dressings have lower infection rates compared to nonocclusive dressings?
- 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
The risk of infection when using moisture-retentive dressings can be further reduced by following a few simple guidelines. What are they?
- 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
What are the 2 exceptions in which moisture-retentive dressings can be used on infected wounds?
Semipermeable foams and alginates
What prevents the moisture-retentive dressing from adhering to the wound bed?
the interaction of the dressing with the wound fluid
How should moisture-retentive dressings be removed in order to reduce the risk of skin trauma?
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
On the wound dressing continuum of occlusion what is the least occlusive and what is the most occlusive?
Least: traditional gauze
Most: hydrocolloids
What are the 8 main categories of wound dressings on the market today?
- gauze dressings
- impregnated gauze dressings
- semipermeable films
- hydrogels
- semipermeable foams
- hydrocolloids
- alginates
- composite dressings
What are the 2 types of gauze dressings?
woven and nonwoven
What is woven gauze made from?
cotton yarn or thread
What is nonwoven gauze made from?
synthetic fibers pressed together
Do nonwoven or woven gauzes have greater absorbency?
nonwoven
What is loose weave gauze used for?
he mechanical debridement of wet-to-dry dressings by trapping foreign material, debris, and slough within the pores
Where does gauze fit on the permeable and occlusive continuum?
Highly permeable
Relatively nonocclusive
What does gauze promote in wounds with minimal exudate?
desiccation
Is gauze a primary or secondary dressing?
can be either
When is gauze the dressing of choice?
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.
Woven gauze may leave a residue or lint within the wound bed, the body may respond to this foreign material by forming what?
a granuloma
How should rolled gauze be applied?
Snugly but without tension and arranged on a slight angle rather than straight across
In what type of wound are Telfa dressings used?
superficial, nondraining wounds closed by primary or secondary intention
Impregnated gauzes are mesh gauze dressings into which materials such as what 4 things have been incorporated?
- Petrolatum
- Bismuth
- Zinc
- Hydrogel
- Saline
Describe what impregnated gauze is used as?
It is used as a nonadherent contact layer which requires a secondary dressing, typically regular gauze
Gauze impregnated with ____ such as paste bandages, or Unna’s boot, are used primarily in the treatment of venous insufficiency ulcers
zinc
In what type of wound are petrolatum-impregnated gauzes common used for and why?
Burn wounds because they allow for pain-free removal
In what types of wounds can bismuth impregnated gauze NOT be used in and why?
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
Describe the structure of semipermeable film dressings
Thin, flexible sheets of transparent polyurethane with an adhesive backing
What are semipermeable films permeable to and what are the impermeable to?
Permeable to water vapor, O2, CO2
Impermeable to bacteria and water
Are semipermeable film dressings a good choice for deep wounds with excessive drainage?
No, because they have little absorptive/insulating capabilities
What are 2 benefits of semipermeable film dressings?
- Allow visualization of wound bed
- Highly elastic and conformable
How should semipermeable film dressings be applied?
Should be secured to a 1-2 cm border of intact skin, and should be applied without tension or wrinkles.
How long can semipermeable film dressings be left on?
5-7 days
In what type of wounds are semipermeable film dressings used?
Superficial wounds such as skin tears, lacerations, and abrasions.
Partial-thickness wounds, sutured wounds, and donor graft sites
In what other situations can semipermeable film dressings be used?
- To cover catheter sites or wounds to allow for bathing
- Areas of friction
- Within total contact casts and splints
In what situations should you not use semipermeable film dressings?
- Infected wounds
- Wounds with moderate to heavy drainage
- Patients with fragile skin
Hydrogels are __-__% water or glycerin based wound dressings that are available in sheets, amorphous gels, or impregnated gauzes
80-99
Hydrogels are able to absorb ______ amounts of fluid by swelling. They are also able to
_____ moisture to dry wounds.
minimal
donate
What are hydrogels permeable to? What does this result in?
gas and water, making them less effective bacterial barriers than semipermeable films or hydrocolloids
How may hydrogels decrease pain?
They feel cool when applied to the skin or wound
In what type of wounds are sheet hydrogels indicated for?
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
Why may hydrogels be chosen for use?
- to assist in autolytic debridement
- to moistens the wound bed for improved healing time
In what type of wounds should hydrogels not be used in?
- Heavily draining wounds
- Infected wounds
- Bleeding wounds
What should be used in combination with hydrogels to prevent maceration?
a skin sealant
What are semipermeable foam dressings made of?
Polyurethane foam with a hydrophilic wound side and a hydrophobic outside
What are semipermeable foam dressings permeable to? What are they impermeable to?
Permeable to gas but not to bacteria
What 4 advantages to semipermeable foam dressings?
- provide thermal insulation
- provide cushioning
- easy to apply and remove
Semipermeable foams are especially useful in managing what type of wounds?
Pressure ulcers, especially stage II and III
Semipermeable foams are not indicated in what types of wounds?
- dry or eschar-covered wounds
- arterial ulcers
- heel ulcers
In what type of wounds are semipermeable wounds used?
- wounds with minimal to heavy exudate
- granulating slough covered partial and full-thickness wounds
- donor sites
- ostomy sites
- minor burns
- skin grafts
What do hydrocolloids contain?
Hydrophilic colloidal particles such as gelatin, pectin, and carboxymethylcellulose with a very strong film or foam adhesive backing
Describe how hydrocolloids absorb fluid
They absorb fluid slowly byswelling into a gel-like mass
Upon a removal of a hydrocolloid a residue remains which often leads clinicians to believe what?
That the wound is infected due to the foul smell
What are hydrocolloids impermeable to?
water, O2, and bacteria
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?
DuoDerm
What are hydrocolloids used to treat?
- pressure ulcers (majority)
- minor burns
- venous insufficiency ulcers
How often should hydropcolloid wound dressings be changes?
every 3-8 days
In what type of wounds are hydrocolloids not recommended?
- Arterial ulcers
- 3rd degree burns
- Wounds with minimal drainage
- wounds with exposed fascia (stage IV PU)
Hydrocolloids are contraindicated in what type of wounds?
infected wounds
The use of hydrocolloids has been associated with ____granulation (hyper or hypo)
hypergranulation
What are alginates made of?
Salts of alginic acid from brown seaweed and converted into calcium/sodium salts
What do alginates react with when placed within the wound?
serum and wound exudate to form a hydrophilic gel to provide a moist wound environment
Where do alginates fit on the permeability and occlusive continuum?
Highly permeable and nonocclusive
Do alginates require a secondary dressing?
Yes
What are the 3 forms alginates are available in and what are each used to treat?
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
An alginate can absorb __ times its weight
20
In what type of wounds are alginates used in?
- VI ulcers
- pressure ulcers
- neuropathic ulcers
- burns
- infected wounds
When alginates are used on infected wounds how often should the dressing be changed?
at least daily
In what types of wounds are the use of alginates not recommended?
- full thickness (3rd degree) burns
- wounds with exposed tendon, joint capsule, or bone
How many layers do most composite dressings have?
3
Describe the inner layer of composite dressings
It is nonadherent, preventing trauma to the wound bed during dressing changes
Describe the middle layer of composite dressings
It absorbs moisture and wicks it away from the wound bed to prevent maceration while maintaining a moist wound environment
What does the middle layer consist of?
Hydrogel, semipermeable foam, hydrocolloid, or alginate
Describe the outer layer of composite dressings
It serves as the bacterial barrier and is commonly composed of a semipermeable film
What are 2 types of antimicrobial wound dressings?
- Silver
- cadexomer iodine
What do silver dressings do to the wound bed?
They turn the wound bed a blue-black color which must not be mistaken for eschar
True or False
Silver dressings cannot be used in conjunction with electrical stimulation
True
Cadexomer iodine must be used cautiously in patients with what type of disease?
thyroid
What is the key function of charcoal dressings?
control odor by absorbing odor-producing gases released by bacteria
What type of honey can be impregnated in a dressing?
Leptospermum, also known as Manuka honey
What are the 2 proposed benefits of honey-impregnated dressings?
- control wound bioburden
- control wound odor
What are the 5 purported ways honey-impregnated dressings improve healing?
- Antimicrobial
- Stimulates angioblasts, fibroblasts, monocytes
- Reduces inflammation and edema
- Osmotic action controls drainage
- May stimulate growth factors
Collagen dressings should be considered in what stage of pressure ulcer?
III or IV
What are the 5 purported ways collagen dressings improve healing?
- 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
What do skin sealants do?
Make the skin tacky to provide a better edge seal
Skin sealants must be used on _____ skin
intact
What do moisture barriers do?
Prevent perineal rashes/skin breakdown
What 3 things do moisturizers do?
- help restore the barrier function of the epidermis
- provide a soothing protective film over intact skin
- increase the water content of the epidermis
_____-based moisturizers are particularly effective in the management of calluses, dry skin in individuals with diabetes, and burn scars.
Petroleum
Are ointments or creams/lotions more occlusive? Explain why…
Ointments, because they are mixtures of water and oil. Whereas lotions are primarily water
When staples or sutures are not used to close a primary wound, what is used?
tissue adhesive/skin glue
Growth factors include what 3 things?
- cytokines
- interleukins
- colony-stimulating factors
In what type of wounds are growth factors used?
chronic wounds that are recalcitrant to traditional interventions
What is a disadvantage to using growth factors?
Extremely costly
What is the name of the growth factor approved for use on diabetic foot ulcers?
Becaplermin
What is the name of the growth factor approved for use on PT chronic ulcers?
Porcine/Oasis
Biosynthetic dressings encourage what type of debridement?
autolytic
What are the 3 types of skin grafts?
- allograft (tissue taken from a cadaver)
- xenografts (tissue taken from an animal)
- autografts (tissue taken from unaffected area of the patient)
If the wound is infected what are 3 dressing options?
- gauze
- alginate
- semipermeable foam
*avoid occlusive dressings
What type of dressing should be used if the intent is to leave it on for 3 or more days?
Adhesive, moisture-retentive dressings
