Dressings Flashcards
Define Occlusion
Ability of a dressing to transmit moisture vapor and gases from the wound bed to the atmosphere
Dressing that is most occlusive
latex
Dressing that is most nonocclusive
Loose-weave gauze
Moisture-retentive dressings facilitate autolytic debridement withing __–____hours
72-96 hours
Occlusive dressings lower infection rates, how? - 4 ways
- Serve as bacterial barrier
- Require less frequent changes
- Retaining macrophages and neutrophils –> neutralization of microorganisms
- Preserves endogenous enzymes –> removal of necrotic tissue
Moisture-retentive dressings are contraindicate for infected wounds EXCEPT - 3
- Semipermeable foams
- Alginates
- Antimicrobial dressings
Benefits of nonwoven gauze
Synthetic fibers, greater absorbency
Benefits of loose woven gauze
Aids in mechanical debridement of wet-to-dry by trapping debris and slough in large pores
Superficial, nondraining wounds closed by primary or secondary intention, dressing?
Telfa - nonadherent gauze with little absorptive capabilities
To facilitate healing by preventing wound bed trauma during dressing changes use
Petrolatum-impregnated gauze
To treat venous insufficiency ulcers use
Zinc impregnated gauze
What is xeroform gauze
Combo of bismuth and petrolatum
T or F. It is NORMAL for brownish fluid to accumulate beneath a semipermeable film dressing.
TRUE
Semipermeable film dressings should not be used on
cavity wounds or wounds with moderate to heavy drainage or those with frail skin
Superficial wound such as skin tear, laceration and abrasion use
semipermeable film
What would you use to soften a black eschar covered wound?
Amorphous hydrogel covered by a semipermeable film
Partial thickness wounds, sutured wounds and donor graft sites use
semipermeable film
T or F. Semipermeable films should be used on infected wounds.
False
Amorphous hydrogels can be used as a coupling agent for
Ultrasound
Sheet hydrogels can be used as padding for
contact casts and splints
Abrasions, skin tears, blisters, donor sites, radiation burns, thermal burns, pressure ulcers, diabetic ulcers, mastitis, and surgery sites use
sheet hydrogels
Hydrogels should not be used on
heavily draining wounds or infected wounds
Semipermeable foam is permeable to ____ but not to ___
permeable to gas but not to bacteria
Pressure Ulcers stage II and III use
semipermeable foam
Granulating or slough-covered partial and full thickness wounds use
semipermeable foam
T or F. Semipermeable foams can be used on infected ulcers.
True, but they should be changed daily
Semipermeable foams are not indicated for
dry or eschar covered wounds
Should you use a semipermeable foam on an arterial ulcer?
no, they tend to be very dry
How do hydrocolloids absorb exudate?
Slowly by swelling into a gel-like mass
Benefits of hydrocolloids
provide thermal insulation, impermeable to water, O2, and bacteria
Hydrocolloids are indicated for
partial and full thickness wounds
T or F. Hydrocolloids can be used on both granular and necrotic wounds.
True
Hydrocolloids are MC used on
pressure ulcers - can be used on burn and venous insufficiency ulcers
Hydrocolloids are contraindicated for
bleeding and heavily draining wounds, infected wounds
dry wounds - arterial ulcers, or 3rd degree burns
Hydrocolloids may cause
hypergranulation
What are alginate dressings?
Salts of alginic acid from brown seaweed converted into calcium/sodium salts
How to alginate dressings work?
They react with serum and wound exudate to form a hydrophilic gel –> moist environment and traps bacteria
How much can alginate dressing absorb?
20x their weight in exudate
Which is better, alginate tipped applicator or cotton swabs? why?
Alginate - they do not cause an inflammatory response if wisps are left behind
Do alginates require a secondary dressing?
Yes, they are highly permeable and nonocclusive
Can you use alginates on infected wounds?
yes
Alginates are not indicated for
dry or minimally draining
Alginates are not recommended for
full thickness, or neonates born less than 38 weeks gestation, the dressing may alter electrolyte balance
Silver dressings with greater than ___mg/l have the best results
20mg/l
T or F. There is a great amount of research showing that silver is effective against multiple organisms within the same wound or against biofilms.
False
When is a good idea to use silver?
Pressure ulcers that are heavily colonized in patients at high risk of infection
Can saline be used in combination with silver
No, it will deactivate the silver
Primary reason to use charcoal dressings
odor control
Benefits of Honey dressings
decrease wound pain, reduce wound healing time, improve scar formation
Collagen dressings are good for
Stage III or IV pressure ulcers
If a patient is sensitive to _____ or _____ then collagen dressings are contraindicated
bovine or porcine tissue
Are collagen dressings better than hydrocolloids?
No, study showed that there is no benefit to collagen, but they cost 40% more
Tissue adhesives are appropriate for
acute linear wounds without tissue loss
Growth factors are limited to
chronic wounds that do no respond to standard interventions
Are growth factors recommended for pressure ulcers?
No, there is not enough evidence supporting this
Why are biological dressings believed to be better than moisture-retentive?
They restore the skin’s natural barrier properties, prevent water loss, heat loss, protein and electrolyte loss and bacterial contamination
When would you use a skin substitute (skin graft)?
nonhealing, uninfected partial and full thickness venous ulcers, neuropathic ulcers, burns and traumatic wounds
What is the primary goal of skin substitutes?
achieve rapid wound closure and restore normal skin function
Autolytic debridement, you would use moisture-retentive or gauze dressing?
Moisture-retentive, keep for several days
Enzymatic debridement, you would use moisture-retentive or gauze dressing?
Gauze, it must be changed 1-3 times a day
What is the most common reason for a granulating wound to be heavily draining?
Infection is present, may be the only sign of silent infection (think immunocompromised)
Why would you want to use enzymatic debridement on a necrotic nondraining wound?
- It can assist with debridement
2. Helps attaining and maintaining a moist environment
Which has a higher bioburdern? Granular or necrotic wound?
Necrotic - be aware of infection especially with draining because wet wound bed is ideal environment for microbes to proliferate
Infected wounds are best covered with what dressing?
gauze - can change them daily or more
Should you use tape whenever possible to secure dressings?
No, avoid using tape. May be too aggressive, and traumatize even healthy skin
Which type of wounds are alginate ropes good for?
a. minimal draining
b. nondraining
c. moderate to copious draining
d. wounds with exposed tendon/bone
c. moderate to copious draining
Can tubular dressings be used if sterile techniques are required?
NO, tubular dressings are clean dressings, not sterile
Why do occlusive dressings have lower infection rates compared to nonocclusive? 4 ways
- Bacterial barrier
- Impermeable to urine and stool
- Facilitate neutralization of microorganisms
- Facilitate removal of necrotic tissue and debris
What type of dressing can be used over IV catheters or over wounds for ultrasound treatments?
Semipermeable film
T or F, semipermeable foams are permeable to gas and bacteria.
False - semipermeable foams are permeable to gas but NOT bacteria
DuoDerm is an example of what type of dressing?
hydrocolloid
It is an effective barrier against urine, stool, MRSA, hepatitis B, HIV-1, and Pseudomonas.
Typically composite dressings have how many layers?
- Inner: nonadherent, prevents wound bed trauma
- Middle: maintain moisture (hydrogel)
- Outer: bacterial barrier (semi foam)
When would you be cautious about using cadexomer iodine? - 3
- Sensitive to iodine
- Thyroid disease
- Large cavity wounds
If a wound is infected you should avoid using, occlusive or nonocclusive dressings?
occlusive
How do you prevent an abscess forming?
pack the wound with a dressing (gauze)
