Exudating wounds (min to mod) Primary or secondary Sinus tracts, tunnels, cavities Infected wounds (w/antimicrobial) Granular wounds

Vicki's wound care Flashcards by Lux Smith

indications for alginates

want to have a lot of moisture because it wicks it up

looks like grandma’s whool sweater

helps prevents peri wound

trauma free removal

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what are the disadvantages of aliginates

Requires a secondary dressing à usually gauze on top
- can’t just put a it on and call it a day
Dessicates minimally exudating wounds
- otherwise you are going to dry it out.

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how long can you leave an alignate product

, can leave in place up to a week

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difference between a kelix and conform roll

Kerlix-roll, no stretch
Conform-roll, has some stretch

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what are some of the disadvantages if gauze

Can dry out wounds/evaporative à too dry
Wicks in all directions
Fibers shed
Requires secondary – inc $
Requires frequent changes – inc $
Traumatic removal when adhered – gets stuck
Poor temperature retention

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why do we use silver? why it better than hydrogen peroxide and what activates it?

disrupts bacteria

silver ions are continuously delivered

non cytotoxic and does not affact the host

(use to use hydrogen peroxide but that is a big no no now because it kills the good stuff too)

silver containing products are activated by moisture

know what it is becuase it contains “Ag” in it

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advantages of foam dressings

can help retain heat

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indications for foam

Exudating wounds (min to mod)
Primary or secondary
Sinus tracts, tunnels, cavities
Infected wounds (w/antimicrobial)
Granular wounds

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disadvantages of foam

Wicks in all directions
Requires secondary
Maceration over intact skin –> causes it to grow thinner and deteriorate
Less absorptive when compressed

May adhere

need to look at how much fluid and exudate you have

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indications

Hydrofera blue

Gentian violet/methlyene blue foam
- Rehydrate w/NS
- Bacteriostatic (even MRSA and VRE)
- Highly absorptive

Does not affect growth factor and enzymatic dressings

this is an instance where you would need to wet it

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inidcations for hydrocolloid

–Exudating wounds (min)

–Primary dressing

–Sinus tracts, tunnels

–Supports autolytic debridement

–Granular or necrotic

–Pressure ulcers–> MC to prevent from developing into stage 2 or 3 SACRAL AREA

–Protection from incontinence

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CHARACTERISTICS of hydrocolloid

–Absorbent (thick)

–Occlusive; autolytic environment

–Promote moist environment

–Protect from external contamination

–Infrequent dressing changes

–Various thickness and shapes

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disadvantages to hydracolloid

–Periwound maceration

–Growth of anerobes

–Odor of solublized necrotic tissue

–Broth often mistaken for purulence

can also leave on for a week

probably don’t want to use on really open wounds

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characteristics of hydrogel

–Dry and exudating wounds (min)

–Primary dressing REQUIRED

–Sinus tracts, tunnels

–Supports autolytic debridement

–Most wound types (including radiation)

–Infected wounds (w/antimicrobial) although most people just carry plain hydrogel.

can use in exposed tendon

–Soften eschar/necrotic tissue

–Hydrate wound bed

–Non-adherent

–Conformable (gel and sheets)

–Supports autolytic debridement

–Trauma/pain-free removal, sheets cool

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periwound disadvantages

–Periwound maceration

–Requires secondary

–Not for heavily draining wounds

–May need frequent changes

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non-adherent dressings

–Painful dressing changes

–Protect healthy tissue

–Painful dressing changes

–Protect healthy tissue

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disadvantages of non-adherent dressings

–Non-porous type may macerate

–Petrolatum type may macerate

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when would you use transparent film (tegaderm)

–Anchor IV sites

–Stage I pressure ulcers

–Reduce friction

–Donor site dressing for STSG (split thickness skin grafts)

nice for folks that want to take a shower

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benefits of transparent film

–Visualize tissue beneath dressing

–Very thin, comfortable

–Adhesive usually well tolerated

–Used to secure other dressings

disadvantages of transparent film

–Non-absorbent

–Adhesive may tear fragile skin

composite indications and benefits

–Post-op wound coverage

–Non-to-slightly exudating wounds

–primary

•Convenience combining products

–Save time combining products

composite disadvantages

–Adhesive may tear skin

–May macerate tissue if Telfa present

“pretty transparent film + gauze”

types of debriedmant

•Mechanical- gauze

•Sharp-tissue nippers, scalpal curret

•Enzymatic-

•Ultrasonic- pulse water (very comfortable but this is a specialized clinic thing)

•Biologic (yes, maggots)

optimal pressure for irrigating debriedmant

Mechanical
Sharp
Enzymatic
Ultrasonic
Biologic (yes, maggots)

whirpool irrigation is CI in

•Whirlpool is contraindicated in lower extremity wounds\* increase venous congestion and insuffiency

•Santyl collagenase is a

enzymatic debriedmant

when would enzymatic debiredmant be indicated how would you use it (what would you not use)

–Looks like vaseline. Use nickel thickness, cover w/NS moistened gauze •Use on necrotic tissue collagenase you can't just throw gause over it and you CAN'T USE WITH SILVER need to cover in NS moisened gauze need to change EVERY DAY use a tongue depressor

Topical products

**•Iodosorb**- iodine based used ot DM foot ulcer **•Iodoform**-gauze with iodine •**Acetic acid-vinegar** **•Dakins solution-** watered down bleach **•Betadine**

Iodosorb

baby poop for DM foot ulcers that can be left in for about a week

endoform, oasis, and integra

•Extracellular matrix (skin substitute) –Don’t use if sensitivity to porcine or bovine products –Must be undisturbed for several days (7 ideal) –Needs moist environment--hydrogel she has used endo derm to close stubborn wounds. it is better because it does not have as short of half life as others

•Human amniotic membrane

–Epifix you need granulation and slough off to use dermal substitutes use like the others

•Epibole

–This is tissue which has rolled under at the edges and causes wound to think it’s healed, but it’s not

management of a epibole

harp debridement of the edges, may need a scalpel, or may be able to just use a currette, or silver nitrate sticks

when would you see hypergranulation tissue

* Usually due to too much moisture * Treatment options-silver nitrate sticks, high density foam, antimicrobial dressings and or/surgical intervention

management of exposed tendon

* Only sharply debride black necrotic tissue tangentially * MUST keep it MOIST! Use plenty of hydrogel here! use hydroge;

whta would you use

santyl (enzymatic debriedmant)

what owuld you use on theis highly exudative wound

alginate

•Non-progressing ankle wound- what would you use

foam endoform cellutoam

•Diabetic foot ulcer

iodosorb (baby poop) debried

•Stage 1 pressure ulcer on sacrum

tegederm hydrocolloid

1st degree and 2nd degree

1st degree-bacitracin or tegaderm or regranix (growht factor)

Hypergranulation tissue mangement

silver nitrate sticks or foam

venous stasis mangement

compression

•Heel eschar

leave it alone and offload

Slough- what is it and how would you manage

* Matrix of cells, fibrin, bacteria, cell debris, leukocytes and exudate * May be yellow, white, gray, beige tan and or green (pseudomonas?--\> DAKINS * May be crusty, slimy, dry, rubbery, hard or soft * Fibrin slough-aka a thin layer of slough Non-viable and needs to be debrided not eschar not hypergranualtion or granulation (beefy tongue)