Dressings and Modalities

Question 1

Dressing Selection is based on what 3 criteria

Answer 1

color

depth

exudate production

Question 2

Occlusive Dressings

Answer 2

• 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

Question 3

Gauze

Answer 3

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
  *

Question 4

Gauze: Advantages

Answer 4

readily available and can be used with saline, gels, topical antimicrobials, infected wounds, good mechanical debride, and COST effective for large wounds

Question 5

Gauze: Disadvantages

Answer 5

• can disrupt newly formed granulation tissue,
• p! on removal (wet to dry),
• labor intensive,
• may require 2ndary tissue if used improperly.

Question 6

Alginates

Answer 6

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)

Question 7

Alginates: Advantages

Answer 7

• easy to appy
• supports debridement in presence of exudate
• fills dead space
• can be used with** infected wounds**

Question 8

Alginates Disadvantages

Answer 8

need a 2ndary gauze or film dressing on top

not recommended for dry or light exudate

Question 9

Films

Answer 9

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. **

Question 10

Films: Advantages

Answer 10

• minimize friction
• transparent and comfortable
• excellent bacterial barrier
• promotes faster healing and autolytic
• visual evaluation of wound w.o removal

Question 11

Films Disadvantages

Answer 11

• nonabsorptive
• application difficult
  *

Question 12

Foams

Answer 12

Cushion and protect the wound.

• Used for:
  
  • these are hydrophilic (absorb moisture) on the wound side and hyrdophobic on the nonwound side

Question 13

Foams advantages

Answer 13

• insulate wounds
• provide padding
• can absorb large amounts of exudate
• conformable
• easy to use

Question 14

Foams Disadvantages

Answer 14

• require secondary dressing
• not for use with dry eschar or no exudate
• non transparent

Question 15

Hydrocolloid

Answer 15

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

Question 16

hydrocolloid advantages

Answer 16

• maintains moist environment
• excellent bacterial barrier
• nonadhesive to healing tissue
• conformable
• supports autolytic debridement
• reduces pain
• easy to apply
• time saving
• diminishes friction

Question 17

hydrocolloid disadvantages

Answer 17

• 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

Question 18

Hydrogels

Answer 18

water or glycerin based gels

Question 19

Hydrogels Advantages

Answer 19

• 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

Question 20

Hydrogels Disadvantages

Answer 20

• not used with high exudate production
• most require 2ndary dressing
• may macerate surrounding skin

Question 21

Non-adherent

Answer 21

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

Question 22

Semi Rigid Dressings

Answer 22

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.

Question 23

Modalities that increase would healing

Answer 23

• 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)