Dressings and Modalities Flashcards
Dressing Selection is based on what 3 criteria
color
depth
exudate production
Occlusive Dressings
- useful
- to maintain tissue hydration
- facilitates autolytic debridement
- wound healing with less pain
- Contraindicated
- infected wounds,
- deep ischemic ulcers,
- full thickness burns,
- very heavy exudate
- stage IV ulcers
Gauze
Useful during early debridement, wound w/ dead spaces or tunneling, necrotic tissue with exudate
_****Contraindicated over granulation tissue without some type of intermediate nonadherent dressing***_
- wet to dry: mechanical debridement of necrotic tissue and slough
- continuous dry: heavily exudated wounds
-
continuous moist: protection of clean wounds, autolytic debridement of eschar, delivery of topical needs
*
Gauze: Advantages
readily available and can be used with saline, gels, topical antimicrobials, infected wounds, good mechanical debride, and COST effective for large wounds
Gauze: Disadvantages
- can disrupt newly formed granulation tissue,
- p! on removal (wet to dry),
- labor intensive,
- may require 2ndary tissue if used improperly.
Alginates
derived from seaweed and react with exudate to form gel over wound.
- use with:
- moderate to large exudate
- combo exudate and **necrosis **
- (these wounds require packing and absorption)
Alginates: Advantages
- easy to appy
- supports debridement in presence of exudate
- fills dead space
- can be used with** infected wounds**
Alginates Disadvantages
need a 2ndary gauze or film dressing on top
not recommended for dry or light exudate
Films
clear adhesive membrane permeable to atmospheric oxygen and moisture vapor and impermeable to water, bacteria, and contaminants.
- Used to:
- maintain moist wound environment with min to mod exudate
- often in stage I or Stage II pressure ulcers
- abrasions and scalds
-
- *not to be used on wounds with fragile surrounding skin or infected wounds. **
Films: Advantages
- minimize friction
- transparent and comfortable
- excellent bacterial barrier
- promotes faster healing and autolytic
- visual evaluation of wound w.o removal
Films Disadvantages
- nonabsorptive
- application difficult
*
Foams
Cushion and protect the wound.
- Used for:
- these are hydrophilic (absorb moisture) on the wound side and hyrdophobic on the nonwound side
Foams advantages
- insulate wounds
- provide padding
- can absorb large amounts of exudate
- conformable
- easy to use
Foams Disadvantages
- require secondary dressing
- not for use with dry eschar or no exudate
- non transparent
Hydrocolloid
adhesive wafers that interact with wound to form gelatinous mass,
- Uses:
- partial and full thickness wounds
- **granular or necrotic **
- may be occlusive or semi-occlusive.
- absorbs minimal to moderate exudate
hydrocolloid advantages
- maintains moist environment
- excellent bacterial barrier
- nonadhesive to healing tissue
- conformable
- supports autolytic debridement
- reduces pain
- easy to apply
- time saving
- diminishes friction
hydrocolloid disadvantages
- not used over infected wounds
- nontransparent
- may soften or change shape with heat or friction
- edges may curl
- not for heavy exudate or fragile surrounding skin
Hydrogels
water or glycerin based gels
Hydrogels Advantages
- conforms to the wound
- rehydrates and maintains a moist wound
- promotes autolytic debridement
- soothing and cooling
- transparent
- nonadherent
- amorphous form can be used when infection is present
Hydrogels Disadvantages
- not used with high exudate production
- most require 2ndary dressing
- may macerate surrounding skin
Non-adherent
Gauze like dressings that do not adhere to the wound.
- often petroleum based (adaptic or tegaderm)
- impregnated with some time of solution to promote granulationi (scarlet red) or inhibit bacterial formation (xeroform)
- require 2ndary dressing and are nonabsorptive
Semi Rigid Dressings
Unna boot is pliable, non stretchable dressing impregnated with ointments;
- zinc oxide, calamine, gelatin
- used for venous insufficiency ulcers to control for edema and help with healing.
Modalities that increase would healing
- iontophoresis w/ zinc or histamine
- ultrasound: low intensity, pulsed 3x/wk
- E-stim: increase would healing or reduce bacterial contaminents.
- high volt current HVPC = most common, no side effects
- _low voltage, continuous direct = potential to harm _
- anode (+) promotes epithelial cel migration and reactivation of inflammatory phase
- cathode (-) promotes granulation, control inflammation, and inhibit certain bateria
- Vacuum-assisted closure (VAC): negative pressure system when wound is not healing, large exudate, infection (if continuous)
