WK9-Wound Dressings Flashcards
Why is the goal of wound healing to keep a moist wound environment ?
Facilitate all three phases of wound healing, Preserve endogenous growth factors, trap endogenous enzymes that participate in self or autolytic debridement, promote formation of more cosmetically appealing scars, reduce patient’s pain.
What happens if a wound is too moist ?
leads to maceration, additional skin damage, increased risk of infection
What happens if a wound is too dry ?
desiccation, decreased enzymes and growth factors, scab and crust formation
What are the general purposes of wound dressings ?
although purpose may vary, generally dressings: maintain a moist wound environment, absorb exudate, promote homeostasis, fill dead space in pothole like wounds to prevent abscesses from forming, provide thermal insulation, allow for debridement of necrotic tissue, prevent or treat infections
Differentiate between primary, secondary, and tertiary dressings.
Primary: primary dressings come in contact with the skin
Secondary: secondary dressings adhere primary dressing, absorb drainage, provide occlusive environment which prevents the exchange of air and gas with the outside environment, and provide protection and cushioning.
Tertiary: some wounds may require a third layer to secure dressings.
As an example:
Chlorapactin in gauze, primary dressing
ABD Pad: secondary dressing
Kirlex Wrap: tertiary dressing
Why should you try to minimize dressing change frequency ?
When dressings are changed the wound temperature cools which is counterintuitive to the healing process.
Infected wounds are a notable exception.
Order the moisture retentive dressings from most absorptive to least.
Alginates
Semipermeable foams
Hydrocolloids
Hydrogel
Semipermeable films
Order the gauze dressings from most absorptive to least.
Layers of gauze padding
Gauze pad
nonwoven gauze
woven gauze
What does the term occlusion mean in regard to wound dressings ?
Occlusive refers to a materials ability to allow things like sweat, blood, urine, or feces through it.
List dressings from most occlusive and impermeable to least.
Latex
Hydrocolloids
Hydrogels
Semipermeable foam
Semipermeable film
Impregnated Gauze
Calcium Alginates
Fine-Weave Gauze
Loose-Weave Gauze
Air
What are some clinical decision making factors for dressings and dressing supplements.
Amount of wound drainage: absorptive v non-absorptive
condition of wound bed: granular or necrotic
Present of wound infection
skin condition ( adhesives tolerable?: fragile v tough skin
Frequency of dressing changes: how long does it need to be on ?
Availability of wound dressings
Cost of dressing
Wound location: may affect dressing adherence
What WAS the patient using before ?
Describe the dressing class: Alginates
Fibers of alginate react with wound exudate to form a hydrophilic gel to provide a moist wound environment. Should be fluffed not stuffed, allowing for granulation tissue to grow.
What are the advantages of Alginate dressings ?
Advantages:
highly absorptive, encourages autolytic debridement, works well under compression bandages, can be used for infected wounds if changes daily, fibers emulsify in the wound and will not cause damage, can stop bleeding; useful after sharp debridement.
What are the disadvantages of Alginate dressings ?
Can rehydrate wound, requires secondary dressing, may require irrigation to completely remove
Describe the dressing class: Semipermeable foam
non-sticking, absorbent, sponge-like polymer
should not be used for infected wounds unless changed daily
What are the advantages of a semipermeable foam dressing ?
Keeps wound moist and warm, provides cushioning, permeable to gas but not bacteria, promotes autolytic debridement, will absorb moderate amount of drainage but won’t dry out wound, can be left in place for several days, can be used under compression dressings.
What are the disadvantages of semipermeable foam dressings ?
can roll at edges, adhesive kinds may damage periwound, may need secondary dressing, may macerate periwound as it absorbs fluid, especially if the dressing does not have wicking properties. Foam should be cut to size.
What dressings would be suitable for a venous insufficiency ulcer ?
Alginate and Semipermeable foams, hydrofibers
Describe the dressing class: Hydrofibers
a mix between alginates and hydrocolloids. It is a highly absorptive non woven pad, can be made of rayon/cellulose fibers.
What are the advantages of hydrofibers ?
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.
What are the disadvantages to hydrofibers ?
may fuse to bloody wound base and therefore should not be used after debridement, can dehydrate wound if there is scant drainage
Describe the dressing class: Hydrocolloids
” sticky boys”, adhesive wafers composed of gelation, pection, and cellulose; it is an occlusive dressing not to be used for infected wounds; not for wounds with exposed tendon or fascia
when applying should be warmed up in PTs hands for proper adherence
What are the advantages to hydrocolloids ?
Impermeable to bacteria and incotinence/waterproof
encourages autolytic debridement
absorbs minimal drainage
provides thermal insulation
hydrocolloids can also be used as tape on skin to which normal tape is affixed.
What are the disadvantages of hydrocolloids ?
edges can roll, adhesive can damage periwound, can cause hypergranulation, pectin causes odor upon removal– may be mistaken for infection, leaves residual in wound bed
Describe the dressing class: hydrogels
water or glycerin based gel, sheet, or impregnated gauze
a skin sealant may be required to protect the periwound, must be correctly sealed
used commonly on blisters, abrasions, skin tears, burns, donor sites, and mastitis
Describe the advantages of hydrogels
donates moisture to wound, painless removal, can soften eschar
Describe proper application of hydrogels
put hydrogel on the applicator and change applicators if more gel is needed to keep the tube of hydrogel clean.
What are the disadvantages of hydrogels ?
minimal absorptive qualities
non-adhesive which would require second dressing
may macerate peri wound.
Why are hydrogels a good dressing for those with arterial wounds ?
donates moisture to the typically dry wound bed.
Describe the dressing class: semipermeable films
transparent membrane which breathes like skin, allowing vapor exchange but not allowing urine or bacteria in
good for: minimally draining wounds, abrasions, skin tears, or partial thickness wounds
Not to be used for infected wounds
What are the advantages of semipermeable films ?
self adhering, can see wound, waterproof, impermeable to bacteria, may be used as a secondary dressing, can stay in place for 5-7 days
What are the disadvantages of semipermeable films ?
no absorptive qualities, poor thermal insulation, may tear off periwound skin.
What dressing is fairly new technology and can be used to reduce friciton and sheer injuries on fragile skin and skin grafts ?
silicone dressings
Describe the dressing class: Gauze
gauze can be woven or non-woven, each has specific uses and strengths, often used as primary or secondary dressing, can be used to pack tunneling wounds, also commonly used in wounds that are infected and that require frequent dressing change
non-adherent gauze is available, called Telfa, for superficial nondraining wounds.
Differentiate between woven and non-woven gauze.
woven gauze can leave lint fibers in the wound bed which can cause chronic irritation
non-woven gauze is more absorptive
finer weaved or smaller pored gauze is better for decreasing wound bed trauma upon removal
What are the advantages of gauze
readily available
cheap
increased layers increase absorption
provides cushioning
can be used with topical agents
rolling gauze as secondary dressing decreases adhesive contact with skin
What are the disadvantages of gauze ?
poorly maintains moist environment due to lack of occlusiveness.
traumatizes wound bed when removed.
requires more frequent change
higher infection rate than more occlusive dressings
needs to be held in place
What is one important thing to remember when packing a wound with gauze ?
moisten gauze w/ warm saline
Briefly describe impregnated gauze and its implications to a wounds healing.
impregnated gauze is gauze that has something on it like:
petroleum, bismuth, iodine, zinc, or hydrogel
petroleum prevents drying out of wound
bismuth is antimicrobial, but cytotoxic to inflammatory cells, it may cause adverse reactions in those with VI ulcers
Iodine is cytotoxic and should be used acutely
Zinc
Hydrogel is moisture donating and soothing to wounds, would need a secondary layer
What is a composite dressing ?
A combination of 2 or more dressings
inner layer non-adherent
middle layer absorptive
outer layer bacterial barrier
What is an interactive dressing ?
interactive dressings are dressings which have been given a solution or property that allows them to promote a moist wound environment and interact with wound cell beds to promote healing
Briefly describe the kind of interactive dressings available: Antimicrobial Dressings/Gels
SIlver: impregnated or gel, indicated for infected wounds or those with high bioburden, broad spectrum antimicrobial for both gram + and - bacteria, like MRSA, and VRE, poor evidence
Cadexomer Iodine: antimicrobial properties, cytotoxic must be used only when necessary, do not use if patient has thyroid issues, shellfish allergy, or large cavity wounds
Honey: honey has antimicrobial properties, lowers wound pH which is good for CHRONIC wounds, highly osmotic, drawing exudate, bacteria and slough toward dressing, augments autolytic debridement.
Describe collagen dressings
derived from animal collagen, can donate fluid or absorb drainage, provides collagen framework for cells to grow, only should be used in clean, moist, uninfected wounds
stimulates macrophages, angioblasts, keratinocytes, and platelets.
What is charcoal used for in wound care ?
Used for wound odor, especially cancerous wounds that tend to give off a strong foul odor
When would a debriding agent be used ?
when necrotic tissue debridement is necessary but healthy tissue must remain intact, when sharp debridement is not allowed
do not play chemist and mix agents
What are skin sealants and moisture barriers and what are they used for ?
pad, swab or spray used to paint a thin layer of protectant onto the periwound, prevents skin from stripping, enhances dressing adhesion, protects skin from maceration
used in VI ulcers
What are some considerations when applying dressings ?
contaminate dressing materials as little as possible
open dressing packages by pulling ends apart
wash hands frequently
changes gloves regularly
note the date of the last dressing application
position patient comfortable and explain procedure
date time and initial dressing when done
don’t play chemist
For the following wound description, list possible dressing and debridement options: Granular and non-draining
gauze with topical agent such as hydrogel
For the following wound description, list possible dressing and debridement options: Granular and draining
gauze, alginate, semipermeable foam, hydrocolloid
For the following wound description, list possible dressing and debridement options: Necrotic and non-draining
surgical, sharp, enzymatic, or autolytic debridement if not infected
gauze with topical agent such as hydrogel, impregnated gauze, transparent film
For the following wound description, list possible dressing and debridement options: Necrotic and draining
surgical, sharp, enzymatic, or autolytic debridement if not infected
gauze, alginate, semipermeable foam, hydrocolloid if not infected
What are some recommendations for wound dressing infected wounds ?
avoid occlusion dressings, re-bandage daily using gauze, alginate, semipermeable foam
Generally dressings should be changed
as needed for strike through drainage, using clinical reasoning unless infected, if so change everyday; change the dressing as the wound needs
How do you dress a wound ?
pack lightly from bottom up, packing packing tunnels and caves
ensure all aspects of wound bed are addressed; tackle the worst part of the wound first
Analyze the purpose of your dressing
Consider costs
What are some yay’s of wound dressing ?
draining=absorptive dressing, cover with ABD, or dry gauze
dry= moisture donating dressing
dry eschar: leave alone, remove pressure source
change dressing on strike through or protocol
define what the gauze is impregnated with
What are some nay’s of wound dressing ?
multiple stacked, absorptive dressings
moist dressing covered by absorbent dressing
occlusive dressing over a crater
