Wound care

Question 1

Wound definition

Answer 1

• Break in the continuity of the skin
• Defined as any process which leads to the disruption of the normal architecture of the skin

Question 2

Two basic types

Answer 2

• Closed
• Open
• Further classification of open wounds according to the depth
  
  • Superficial
  • Partial-thickness
  • Full-thickness

Question 3

Causes

Answer 3

• Trauma- includes bed sores
• Surgical intervention
• Disease process

Question 4

Aims of wound treatment

Answer 4

1. Partial comfort- although could be used for most patient’s wound care it is more suitable for ‘end of life’ patient where no active treatment is suitable. Can be associated with odour control
2. Absorption: for wound with large exudate where the main objective is containing the fluid
3. Infection control: for infected wound. It can be associated with odour control
4. Odour control
5. Debridement active treatment
6. Promote granulation: Active treatment- post or concurrent to debridement
7. Promote epithelialisation: Active treatment- concurrent to grannulation

Question 5

TIME

Principles of improved would healing

Answer 5

Question 6

Physiological process of wound healing

Answer 6

• Vascular
  
  • Damage vessels constrict
• Inflammatory
• Proliferation
• Maturation

Question 7

Stages in Healing

Answer 7

Question 8

Factors affecting the healing process

Patient factors

Answer 8

• Good nutrition/hydration
• Adequate blood supply
• Age
• Well-controlled underlying medical conditions (diabetes)
• Medication (immunosuppressant)
• Smoking/substance misuse
• Vascular insufficiencies
• Stress

Question 9

Factors affecting the healing process

Wound environment

Answer 9

• Moist
• Temp (37’C)
• Adequate tissue oxygenation
• Low bacterial count
• Clean wound surface
• Duration of wound
• Mechanical stress
• Wound size
• Foreign bodies

Question 10

Classification of wounds

Answer 10

• When cells are injured and die, the resultant structural changes to the tissues are commonly described by colour
• Necrotic (slough is produced faster than can be removed, the excess dehydrates on the wound’s surface
• Slough (dead tissue)
• Infected
• Granulation
• Epitheliasation

Question 11

Exudate- necrosis

Answer 11

Question 12

Sloughy- exudate

Answer 12

Question 13

Infected wound exudate

Answer 13

Question 14

Granulation exudate

Answer 14

Question 15

Epithelialisation exudate

Answer 15

Question 16

Dressing types

Answer 16

• Activated charcoal
• Alginates
• Antimicrobial (Including antibacterial)
• Adhesive
• Compression dressings
• Foam
• Hydrocolloid
• Hydrofibres
• Hydrogels
• Non-adherent
• Larval
• Super absorbent
• Negative pressure dressings

Question 17

Challenges to wound care

Answer 17

• Malodourous wounds
• Skin grafts
• Diabetic foot ulcers
• Overgranulating

Question 18

Other factors to consider in wound care

Answer 18

• Pain
• Size
• Depth

Question 19

Skin tears/ Lacerations

Answer 19

Question 20

Ideal dressing

Answer 20

• The ideal dressing should
• Maintain a moist environment at the wound/dressing surface
• Absorb excess exudate and toxic substances
• Allow gaseous exchange
• Be impermeable to micro-organisms
• Aid maintenance of a controlled temperature
• Be free from particles and other contaminants
• Allow removal without trauma

Question 21

Alginates e.g. Sorbsan, Algosteril

Answer 21

• Obtained from seaweed
• Absorb exudate
• Moderate to heavily exuding wounds
• Flat sheets or packing for cavity wounds
• Need a secondary dressing to hold in place
• Available with silver for infected wounds

Question 22

Hydrofibre

Aquacel

Answer 22

• Hydrocolloid fibres to allow greater absorption
• Heavily exudating wounds
• Prevents maceration
• Not haemostatic so not when bleeding
• Flat sheets or packing for cavity wounds
• Need a secondary dressing to hold in place
• Available with silver for infected wounds

Question 23

Hydrocolloids

Tegaderm

Answer 23

• Suspension of polymers (Gelatin/pectin in an adhesive matrix
• Interact with the exudate to produce a gel
• Lightly exuding wounds or dryer wounds depending on individual dressing property
• Promote granulation
• Complete dressings in a variety of sizes and shapes
• Waterproof

Question 24

Hydrogels

Aquaform gel

Answer 24

• Donate liquid to dry sloughy wounds to promote debridement
• Available as tubes of gel or as a sheet
• Requires a secondary dressing
• Avoid in infection and unsuitable if large exudate

Question 25

Foam Dressings

Tegaderm

Answer 25

• Foam backing suitable for all exuding wounds
• Vary in their ability to absorb exudate
• Also used to provide a protective cushion in fragile skin
• Complete dressings (with adhesive border) or not
• Can be used as secondary dressings

Question 26

Film dressings

IV3000

Answer 26

• Allow passage of water vapour and oxygen but impermeable to micro-organisms and water
• Comfortable and provide protection
• Partial-thickness wounds with minimal exudate
• Specialist films to hold IV cannulae in place

Question 27

Paraffin impregnated Gauze

e.g. Jelonet

Answer 27

• Cotton and viscose impregnated with yellow or white soft paraffin
• Greasy, waterproof and non-stick
• Primary dressing
• Partial-thickness burns, dermabrasion

Question 28

Perforated absorbent dressing

Melonin

Answer 28

• Simple dressings
• Superficial wounds e.g. cuts/grazes
• A tendency to dry out if no exudate
• With or without adhesive border
• Used as a secondary dressing where border present

Question 29

Options for debridement

Answer 29

• Medical term for the removal of slough (dead tissue) on the wound surface to promote granulation

Question 30

Maggot/Larvae therapy

Answer 30

• Sterile larvae from the greenbottle fly
• Remove sloughy, necrotic and infected tissue
• Used in difficult to treat wounds where other options fail
• Saliva contains chemicals that break down dead tissue into a liquid form that the larvae can digest
• No effect healthy tissue
• Prescribable on FP10 prescription as a biofilm dressing or free range
• Biofilm preferred by patients