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Fall 2023 Integumentary > Week 9 Dressings > Flashcards

Week 9 Dressings Flashcards

1
Q

Why is the goal moist wound bed for healing?

A
  • facilitates all 3 phases of wound healing
  • preserves endogenous growth factors (which send cells to the wound area to try and heal)
  • Trap endogenous enzymes for autolytic debridement
  • Promote formation of more cosmetically appealing scar
  • Reduce patients pain
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2
Q

What happens if a wound is to moist?

A
  • maceration
  • Additional skin damage
  • Increased risk of infection
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3
Q

What happens if a wound bed is to dry

A
  • Desiccation
  • Decreased enzyme/growth factors
    -Scab/crust formation
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4
Q

What is the purpose of wound bed dressings?

A
  • Create/maintain moist wound environment
  • Absorb exudate
  • promote homeostasis
  • Fill dead space
  • Provide thermal insulation
  • Allow for debridement of necrotic tissu e
  • Prevent or treat infection
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5
Q

Primary dressing

A

The dressing that comes in contact with the wound

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6
Q

secondary Dressing

A
  • adhere to primary dressing
  • Absorb drainage
  • provide occlusive environment
  • provide protection/cushionin
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7
Q

T/F primary dressings always need a secondary dressing

A

False

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8
Q

Most Occlusive to least occlusive

A

Latex
Hydrocolloids
Hydrogels
semipermeable foam
Semipermeable Film
Impregnated Gauze
Calcium Alginate
Fine woven gauze
Loose woven gauze
Air

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9
Q

Alginates: Advantages

A
  • NOT for wounds with exposed tendon, joint capsule, or bone
    Advantages:
  • Highly absorptive,
    -easy to use and fill cavities or irregular wound shapes,
  • encourages autolytic debridement,
    -works well with compression bandages,
  • can be used on infected wounds,
    -can remain on wound for several days
  • Fibers will NOT cause irritation if left in wound
  • Can stop Bleeding
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10
Q

Alginates: Disadvantages

A
  • Can dehydrate the wound
  • Requires a secondary dressing
  • May require irrigation to completely remove
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11
Q

Alginates General Information

A
  • NOT for wounds with exposed tendon, capsule, bone
  • Calcium alginate= salts of alginic acid from brown sea weed
  • Fibers react with wound exudate and form a hydrophilic gel to provide a moist wound enviornment
  • Fluff don’t stuff
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12
Q

Semi-permeable Foams General

A
  • Nonstick, absorbent, sponge like polymer
  • Not for infected wounds unless changed daily
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13
Q

Semi-permeable Foams Advantages

A

-Keeps wound moist and warm
- Provides cushioning
- Permeable to gas but not bacteria
- Promotes autolytic debridement
- Will absorb moderate amounts of drainage but not dry out a minimally draining wound if left in place for extended period of time
- Can be left in place for several days
- Can be used under compression dressing

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14
Q

Semi-permeable Foam Disadvantages

A

-Adhesive type may damage periwound
- Can roll at edges
- May need secondary dressing
- May macerate periwound as it absorbs fluid

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15
Q

Hydrofibers General

A
  • Highly absorbent non-woven pads or ribbons of sodium carboxymethyl cellulose or rayon/cellulose fibers
  • neither an alginate or a hydrocolloid but has benefits of both
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16
Q

Hydrofibers Advantages

A
  • Absorbs moderate to large amounts of drainage
  • Works well under compression dressings
  • Can stay in place for several days
  • Interaction with wound exudate forms a gel
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16
Q

Hydrofibers Disadvantages

A
  • May fuse to bloody wound base
  • Can dehydrate wound if there is scant drainage
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17
Q

Hydrocolloids General

A
  • Adhesive wafers composed of gelatin, pectin and carboxymetholcellulose
  • During application, best to warm it to get it to adhere
  • Occlusive dressing
  • Not for infected wounds
  • DuoDerm-barrier against incontinence and MRSA, Hep-B, HIV, and pseudomonas
  • NOT for wounds with exposed tendon aand fascia
18
Q

Hydrocolloids Advantages

A
  • Impermeable to bacteria and incontinence/waterproof
  • encourages autolytic debridement
  • Absorbs minimal amount of drainage
  • provides thermal insulation
19
Q

Hydrocolloids Disadvantages

A
  • Edges can roll
    -Adhesive can damage periwound
  • Can cause hyper granulation
  • pectin causes odor upon removal-mistaken for infection
  • Leaves residual in wound bed
20
Q

Hydrogels General

A
  • Not indicated for infected wounds
  • Commonly used on blisters, abrasions, skin tears, burns, donor sites, mastitis
  • Will dehydrate if not covered correctly
  • Skin sealant may be required for peridowound protection
  • Water or glycerin based gel, sheet, or impregnated gauze
21
Q

Hydrogels Advantages

A
  • Donates moisture to wound
  • Painless removal
  • can soften eschar
22
Q

Hydrogel Disadvantages

A
  • Minimal absorptive qualities (can donate moisture)
  • Non-adhesive requiring secondary dressing
  • May macerate periwound
23
Q

Semipermeable Films General

A
  • Not for infected wounds
    -Good for minimally draining wounds, abrasions, skin tears or partial thickness wounds
  • Breaths like skin, allowing vapor exchanges/doesn’t allow bacteria and urine in
  • Indications for change= if channel develops
24
Q

Semipermeable Films Advantages

A
  • Self adhering
  • Can see wound
    -Waterproof/incontinence proof
    -Impermeable to bacteria
  • May be used as secondary dressing
  • Can stay in place for 5-7 days
25
Q

Semipermeable Films Disadvantages

A
  • No absorptive qualities
  • Poor thermal insulation
  • May tear off periwound skin
26
Q

Silicone Dressings

A
  • Consider usage when having skin tears and fragile skin, skin grafts
  • Can reduce friction and sheer injuries
27
Q

Gauze General

A
  • Non-woven is more absorptive
  • Woven gauze can leave lint fibers in the wound
  • Finer weaves decrease wound bed trauma
  • Usually used in wounds that are infected, require frequent dressing changes, require packing, are highly draining
28
Q

Gauze Advantages

A
  • Readily available
  • Inexpensive
  • Increased layers= increased absorption
  • Provides cushion
  • Can be used with topical agents
  • Roll gauze secondary dressing keeps adhesive off of skin
29
Q

Gauze Disadvantages

A
  • Poorly maintains moist enviornment due to lack of occlusiveness
  • Traumatize wound bed upon removal
  • Require more frequent dressing changes
  • Higher infection rate than occlusive dressing
  • needs to be held in place
30
Q

Impregnated Gauze

A
  • Petroleum= used with burns/ exposed tendon, wont allow tendon to dry out
  • Bismuth= antimicrobial properties by being cytotoxic to inflammatory cells
  • Iodine= cytotoxic/don’t use it for a prolonged time
  • Zinc
  • Hydrogel= helps donate moisture to a wound and is very soothing
  • Requires a secondary layer
  • Good on granulating wounds
31
Q

Composite Dressing

A
  • combination of 2 or more dressing types
  • Inner layer non-adherent
  • middle layer= absorptive
  • outer layer= bacterial barrier
32
Q

Interactive Dressings

A
  • Create a moist wound enviornment AND interact with the cells on the wound bed to further promote healing
    1. Antimicrobials (silver, honey based dressings)
    2. Biologics and Biosynthetic (collagen and polyacrylate dressings)
  • Impregnated gauze can be an interactive dressing
33
Q

Antimicrobial Dressings: Silver

A
  • Fights off bacteria
  • impregnated for infected wounds or those with high bioburden
  • For gram + and - bacteria
  • Continuous release so it can be left in place for up to 7 days
  • May stain skin or cause sensitization
  • No sound research to support its use
34
Q

Antimicrobial Dressings: Cadexomer Iodine

A
  • its for antimicrobial properties
  • Very similar to Silver Characteristics
  • Continuous 72 hour release
    Contraindications/precautions:
  • Patient with thyroid disease
  • Allergy to shellfish
  • large cavity wounds
35
Q

Antimicrobial Dressings: Honey

A
  • Typically used on a chronic wound that needs a jump start if it is stagnant
  • Antimicrobial
  • Lowers wound pH which is good for chronic wounds
  • Augments Autolytic debridement
36
Q

Antimicrobial Dressings: Collagen Dressing

A
  • For wounds that need a jump start
  • Stimulates macrophages, angioblasts, keratinocytes, and platelets
  • Provides collagen framework for cells to grow
  • Consider for non-healing category III/IV pressure ulcers
  • can donate fluid or absorb drainage
  • For clean, uninfected wounds that have just stagnated and need a jump start
37
Q

Charcoal

A
  • used for odor
  • NOT used for wounds with an acute infection
38
Q

Skin sealant

A
  • Prevents skin stripping upon dressing removal
    -Enhances dressing adhesion
  • Protects skin from maceration
  • Pad, swab, or spray used to paint a thin layer of protectant agent onto periwound
39
Q

Moisture Barriers

A
  • Ointments or creams
  • Often used to prevent perineal rashes/skin breakdown
  • Can be used on macerated skin
40
Q

Types of ways to keep a dressing in place

A
  • Tape=
    Tubigrip=
    Abdominal Binder=
    Montgomery Straps=
41
Q

Growth Factors

A
  • Growth promoting substance that enhance cell size, activity, or proliferation
  • Extremly costly
42
Q

Biological and Biosynthestic Dressings

A
  • dressings derived from natural tissues
  • maintain skins natural properties and promote autolytic debridement
  • Skin grafts : Auto(from yourself)/ Xeno (from an animal)/ Allo (Cadaver)

Fall 2023 Integumentary (10 decks)

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