Wound Dressing Flashcards
what to consider when choosing a particular wound dressing? (13)
1) . cause
2) . severity
3) . environment
4) . size
5) . depth
6) . anatomic location
7) . volume of exudate
8) . risk or presence of infection
9) . pt medical status
10) . patient preference
11) . pt level of comfort
12) . cost-benefit analysis
13) . availability/durability
when first evaluating a wound, what is important to remove prior to indicating wound depth?
eschar (don’t remove this after the 1st eval, EVER)
wound types (6)
closed open (full or partial thickness) necrotic infected granulating epithelializing
closed wound: skin integrity? does dressing decrease infection risk? what type of dressing is used and why?
- skin integrity intact
- no evidence dressing decreases infection risk
- non adherent gauze absorbs exudate and prevents irritation
open wound: encourage what in this wound? what type of environment is best?
- encourage clean granulation
- moist environment without slough
necrotic wound: what to do first? then go to this type of dressing?
- surgically debride if possible
- then add hydrocolloid (duoderm) or hydrogels to help with further debridement
how do hydrocolloid dressings work? use? what type of environment?
when they contact exudate, their hydrophilic particles swell and form an inpermeable gel. The gel absorbs into necrotic tissue, rehydrates it, and causes it to separate from normal tissue (sloughs off afterwards)
- granulate lesions or debride necrotic tissue
- MOIST healing environment
how does duoderm work?
absorbs exudate and produces a moist environment without maceration of surrounding tissue
infected wounds: how to tx minor infections? extensive infections?
minor- normal saline irrigation
major- alginates
what are alginates derived from? how do they work?
brown seaweed; they are important for maintaining moisture!
- calcium alginate converts to soluble sodium salt & produces a hydrophilic gel when in contact with exudate. -Then remove gel with saline irrigation or bathing
- absorbs HEAVY exudate from deep wounds
granulating wound: requires what environment? removal of dressing shouldn’t do what to the wound?
MOIST environment
-removal of dressing shouldn’t damage tissue
granulating wound: what dressing works well?
Xeroform- but don’t let it dry out bc then it debrides new granulation tissue
*hydrocollloids/hydrogels with transparent film covering are good alternatives to impregnated gauze
epithelializing wounds: also called what? how do we treat these?
“abrasions”
- tx same as granulating wounds
- use telfa or transparent film that won’t remove new epithelial layer
three main stages of healing:
1) . Inflammatory
2) . proliferative
3) . maturation
inflammatory stage: what symptoms? how long does it last? what happens generally?
- edema, erythema, heat, pain
- lasts 4-6 days since injury
- macrophages migrate into wound and produce chemoattractants & growth factors (which facilitate wound healing)
proliferative stage: time frame? what type of tissue forms? what happens during this stage?
- day 4-24
- granulation tissue generated
- as granulation proliferates, fibroblasts stimulate production of collagen (tensile strength starts)
- cell migration causes wound to seal, epithelialization occurs and scar forms
maturation stage: time frame? what happens?
- day 21 to 24 months
- collagen fibers reorganize and mature (gain 80% of tensile strength here)
types of primary dressings (6)
alginates, biosynthetic, collagens, foams, hydrocolloids, hydrogels
primary vs secondary vs occlusive dressing
primary: one that comes directly in contact with wound bed
secondary: covers a primary dressing when primary doesn’t protect the wound from contamination
occlusive: covers wound from outside environment & keep all wound vapors at site
biosynthetic dressings: two types? used for what? what is it made of? how does it work?
- EZ derm or Glucan II
- temporary cover for burns and partial thickness wounds
- gel or semi-occlusive sheet (leave on for 1-10 days)
- helps wound healing by re-epithelialization
glucan II material?
smooth, gas permeable polymeric layer attached to mesh matrix
collagen dressings: used for? what does it do? what else do you apply with it? types?
- used for partial and full thickness wounds regardless of infection
- helps collagen and granulation tissue to organize the wound bed; also stimulates new tissue & debrides
- HAVE to apply secondary dressing for exudate absorption
- Fibrocol Plus, KOllagen, hyCURE
foam dressings: used for? what does it do? types?
- used as primary (directly on or absorption/insulation) or secondary dressing (overly wound packing)
- absorbent, non adhering, nonocclusive
- hydrophobic or philic
- Curafoam, self-foam, reston self adhering foam
hydrocolloids: not recommended for what injuries? you can use them under what?
- not recommended for infected wound, heavy exudate, or exposed tendons/bones
- can use them under compression product (unna boot)
why are dry dressings harmful?
they can pull off new tissue granulation
hydrogel dressings: made of? used for? how to apply? what type of environment? can be used in presence of what? does not do what? types?
- water or glycerin based amorphous gels
- used to manage partial/full thickness wounds, deep wounds, necrotic wounds, slough, minor burns, radiated tissue damage
- apply to wound DIRECTLY
- maintains MOIST environment
- can be used when infected
- DOESNT absorb exudate (due to high water content)
- Types: curasol, SK amorphous hydrogel, wound filler
types of secondary dressings?
transparent films, dressing gauze, flexible collodion, dressing stabilizer
transparent films: made of? impermeable to what? what does it do? shouldn’t be used with what? types?
- adhesive, semipermeable polyurethane membrane
- impermeable to bacteria
- allows water vapor to cross barrier
- shouldn’t be used on fragile skin or with infected wounds
- doesn’t require secondary dressing
- OpSite, polyskin II, tegaderm
dressing gauze: can be used for what types of dressings? uses? types?
- can be used as primary, secondary, or securing dressings
- used for cleaning, debriding, packing, covering
- Telfa (non-adherent): facilitate exudate transmittal away from wound
- can also be oil emulsions, petrolatum, saline, NaCl, xeroform, zinc-saline
flexible collodion dressing: made of? what does it do? use?
- made of nitrocellulose dissolved in alcohol (plastic like)
- applied to wound and forms thin, clear sealant layer
- good choice for scalp lacs instead of gauze
dressing stabilizer: purpose? types?
- has some elastic properties that add bulk/cushion
- Kling, Kerlix, ACE
how to treat: dirt or grease in wound? deep wounds? closed wounds?
Dirt/Grease: mild soap and irrigate with water
Deep wounds: irrigate to remove exudate, slough, necrotic tissue
Closed wounds: gentle cleansing with normal saline to remove clotted blood
primary dressing should be applied with what technique?
ASEPTIC
how to apply Kling/Kerlix?ACE?
apply distal to proximal
