Module 7 - Advanced Wound Care

Question 1

What are the 7 principles of sterile asepsis?

Answer 1

• A sterile object remains sterile only when touched by another sterile object. • Only sterile objects may be placed on a sterile field. • A sterile object or field out of the range of vision or an object below a person’s waist is contaminated. (Remain tripod stance) • A sterile object or field becomes contaminated by prolonged exposure to air. • When a sterile surface comes in contact with a wet, contaminated surface, the sterile object or field becomes contaminated by capillary action. • Fluid flows in the direction of gravity. • The edge of a sterile field or container is considered to be contaminated.

Question 2

Sterile vs clean technique

Answer 2

o Sterile – Absence of microorganisms Ex. Hospital o Clean – minimizing microorganisms Ex. home

Question 3

What are the four phases of wound healing and body processes?

Answer 3

1- inflammatory phase (hemostasis and phagocytosis) 2 - Proliferative phase (Collagen strengthens wound, produces scar tissue Granulation tissue is highly vascular) 3 - maturation phase early (Collagen reorganized into more orderly structure) 4 - maturation phase late (Scar tissues has ≤ 80% of original tissue strength)

Question 4

Describe wound healing by Primary intention

Answer 4

• wound is clean with straight edges (surgical wound). - edges can be approximated - healing is rapid and primarily collagen synthesis -scar usually thin and flat

Question 5

Describe wound healing by secondary intention

Answer 5

• wound is large and irregular with considerable tissue loss (pressure ulcer, deep abrasion)

Question 6

Describe wound healing by tertiary intention

Answer 6

Question 7

When would you use a wet to dry dressing? Action?

Answer 7

• Mechanical wound debridement
• Disrupts wound bed, pulls healthy granulation tissue with non-viable tissue

Question 8

When would you use a wet to moist dressing? Action?

Answer 8

• Frequent dressing changes
  
  • Cools wound bed
  • Disrupts granulation tissue

Question 9

When is a transparent film dressing used?

Answer 9

Small superficial wounds - Trap moisture, self adhesive

Question 10

2 Benefits of a nonadherent contact dressing?

Answer 10

• Protects granulation tissue
• Allows moisture to evaporate

Question 11

Uses of a soft silicone dressing

Answer 11

• Removed without trauma to wound or periwound
• Decreases pain

Question 12

Benefits of a hydrocolloid dressing

Answer 12

• Maintains wound bed moisture
• Impermeable to external contaminants – Adhesive and occlusive
• Can be left in place 5 to 7 days
• Preventive dressing for high friction area

Question 13

Use of Hydrogel dressing

Answer 13

• Give moisture to wound bed (water, glycerin-based)
• Absorbs small amount of exudate
• Soothing
• Softens necrotic tissue

Question 14

uses of foam dressing

Answer 14

• Nonadhesive
• Left intact for up to 7 days
• Useful for large amounts of drainage or autolytic debridement

Examples:

• Calcium Alginate – Highly absorbent
• Hydrofibers – Highly absorbent, may contain silver

Question 15

What is the purpose of surgical drains?

Answer 15

• To permit drainage of fluids and air
• To promote healing
• Prevent infection/abscess formation
• To drain a known/anticipated fluid collection

Question 16

Describe a Penrose drain

Answer 16

• Simplest type of drain
• Soft, open tube
• Used for thicker drainage
• Drainage absorbed into outer dressings
• May or may not be sutured
• Sterile safety pin is placed to prevent slippage back into wound
• Shortened as per physician’s orders

Question 17

Describe a T-Tube drain

Answer 17

• Biliary drain
• Named because of it’s shape
• Used following cholecystectomy (or exploration of the CBD)
• Placed in common bile duct
• Drainage bag hangs outside the body
  
  • Bile is highly irritating – need to prevent contact with patient’s skin
  • Average drainage 700-1200 ml/day
• Generally sutured to the skin
• May have a 3 way valve to allow flushing

Question 18

examples of passive drainage systems (2)

Answer 18

• Penrose drain
• T-Tube
  
  • Drainage is by gravity, capillary action
  • No suction

Question 19

examples of Closed drainage systems

Answer 19

• Hemovac
• Jackson Pratt
• Blake Drain
• V.A.C. – Vacuum assisted closure
  
  • Negative pressure (suction) in a closed system
  • Advantages
    
    • Decreased risk of infection due to closed system
    • Ability to accurately measure drainage

Question 20

What type of drainage system is used for a larger volume (500ml) and what type for small volume (100ml)

Answer 20

Hemovac - Larger

Jackson Pratt - smaller

Question 21

hemovac drain is used for…

Answer 21

• abdominal & orthopedic surgeries

Question 22

Jackson Pratt drain is used in a variety of surgeries and is placed where?

Answer 22

• Placed in a separate puncture site or at the edge of the surgical wound
• sutured in place

Question 23

The Blake drain is used in….. describe

Answer 23

• Used in abdominal and thoracic surgeries
• Tubing has 4 channels along the sides, with a solid core center
• Drains by gravity or attached to reservoir bulb suction
• May or may not be sutured to the skin
• No flushing
• Notify physician if drainage exceeds 300 ml/shift