wound dressing selection

Question 1

moist wound healing indications:

Answer 1

indicated only for healable wounds

Question 2

healable wounds require:

Answer 2

correctly identifying and addressing wound etiology

adequate immune function

sufficient perfusion to tissues

mitigation of client-specific risk factors

Question 3

moist wound healing contraindications:

Answer 3

dry eschar-covered wounds on lower limbs

if dry eschar becomes soft/boggy, refer to an NSWOC/Wound clinician

safest action is to support a dry wound environment until healability can be confirmed

Question 4

moist wound healing improves wound healing:

Answer 4

rates by 50% when compared to dry wound bed environments

moist level you want = similar to whites of your eye

hydrating/adding moisture using gels, pastes, ointments

maintaining moisture by using dressings that absorb and hold moisture in the wound bed

absorbing excess moisture using absorbent dressings, which pull moisture off the wound bed and “hold it”

Question 5

autolysis

Answer 5

one method of debridement

uses enzymes in wound exudate to achieve a clean wound bed

softens and breaks down devitalized/necrotic tissue

Question 6

debridement is only for:

Answer 6

healable wounds

do not debride dry eschar-covered wounds on the lower limbs

Question 7

most dressings can be used to support autolytic debridement, such as:

Answer 7

wound gels

hypertonic dressings

honey-based antiseptic/antimicrobial dressings

dressings that retain moisture = occlusive, semi-occlusive, moisture retentive (hydrocolloid or paste dressings) or foam dressings

Question 8

prevent MASD (moisture associated skin damage)

Answer 8

clean and moisturize

keep periwound skin dry and intact by using skin barrier films and protectants

select appropriate wound bed products to wick and absorb wound exudate

Question 9

prevent MARSI (medical adhesive related skin injuries)

Answer 9

select correct size of dressing

prepare periwound skin

apply and remove dressing

consider non-adhesive options for those at risk - such as gauze wraps or tubular stockings

Question 10

non-adhesive options (for those at risk for MARSI)

Answer 10

gauze wraps
cast padding
self-adherent wrap
elastic bandaging

tubular stocking or net sleeves

Question 11

medical tapes

Answer 11

silicone = most gentle option
*not suitable for securing critical medical devices

paper, plastic, and paper/plastic hybrids

fabric

Question 12

film dressings

Answer 12

used as adhesives to “window pane” dressings

allows breathability while securing the dressing

covering entire dressing with film with create an occlusive dressing

Question 13

primary dressings = come into direct contact with wound bed

** most require a secondary/cover dressing

Answer 13

non-adherent contact layers

wound fillers

Question 14

non-adherent contact layers

Answer 14

petrolatum
silicone
paraffin
lipido-colloid
antimicrobial impregnated
- sliver
- povidone iodine
- chlorhexidine

allow exudate to move through them to the secondary/cover dressing

Question 15

wound fillers

Answer 15

gauze
alginates
gelling fibres
hydrogel
hydrophilic paste
hypertonic dressings

Question 16

non-adherent contact layers are used when:

Answer 16

friable/fragile or painful wound bed

tissue graft or flap

underlying structures

surgical implants

minimal exudate

Question 17

petrolatum

Answer 17

jelly made from mineral oil

used as a barrier to protect skin and to lock in moisture

Question 18

silicone

Answer 18

low rates of sensitivity and skin reactions

tackiness allows for multiple adhesive contact points with skin = does not shift once in place

hydrophobic = does not adhere to moist areas = reducing wound bed trauma

Question 19

paraffin

Answer 19

derivative of petrolatum

acts as moisturizer to prevent drying out wound bed and periwound skin

shortest wear time (24hrs) of non-adherent contact layers

Question 20

antimicrobial impregnated

Answer 20

used to prevent or treat wound infection

Question 21

lipido-colloid

Answer 21

matrix forms a gel in presence of wound exudate to provide a moist interface between wound and dressing

Question 22

when selecting products and treatments for wounds, you must consider the following factors:

Answer 22

1) client considerations

2) needs of wound bed and periwound skin

3) products that are available to you

Question 23

Ms. C Barton and her 16 yr old niece Leanne come to your outpatient clinic to have a minor burn on Leanne’s arm looked at. The wound is clean but painful, and the periwound is warm and firm. The dressing is being changed at the clinic twice a week.

Which non-adherent contact layer would be most appropriate?

Answer 23

silver-impregnated

wound is showing inflammatory signs of local wound infection and requires a topical antiseptic/antimicrobial with 3-7day wear time

Question 24

M.E.ahoney has a skin tear on her forearm after bumping it on the over-bed table. The wound is cleansed, bleeding is controlled, and the skin flap can be fully approximated.

Which would be the most appropriate to apply?

Answer 24

petrolatum

supports a moist wound bed and can be in place for up to 7 days = allows flap to reattach

Question 25

secondary covers/dressings:

Answer 25

can be used independently or used over a non-adherent contact layer or wound filler

maintain or absorb exudate
- many have moisture vapor transmission characteristics

maintain thermal insulation

protect the wound bed from contamination and trauma

Question 26

types of secondary covers/dressings

Answer 26

acrylic
hydrocolloid
composite
foam

Question 27

acrylic dressings

Answer 27

absorb small amounts of exudate = allow it to evaporate through breathable top layer
* do NOT cut these dressings

semi-occlusive
*do NOT use on infected wounds
*do NOT use for medium-large amounts of exudate

have an extended wear time

Question 28

hydrocolloid products

Answer 28

absorb and retain small amounts of moisture

can be used to protect intact or fragile skin from adhesives

can have a distinctive odour
*diff than odour infection

available in sheet/wafer dressings, powders, or pastes

Question 29

composite

Answer 29

multiple layers contained in one dressing

many shapes and sizes

come w/ and w/o adhesive borders - impact risk of MARSI

have a top sheet

cannot be cut

Question 30

foam

Answer 30

function best with thin exudate

absorb scant to high levels of exudate depending on composition of dressing

provide moist wound environment by wicking and holding exudate in dressing

provide adequate thermal insulation to support wound healing

cost effective when used correctly

most have 5-7 day wear time

do NOT use on foot wounds or those with diabetes or any arterial insufficiency = keep wound bed too moist

Question 31

Ms. D Dix has an abrasion on her back form being pulled up in bed. There is a small amount of exudate and no signs of symptoms of infection. You want to be able to monitor the wound, and would like to avoid frequent dressing changes.

What’s the best choice?

Answer 31

acrylic dressing

can absorb small amounts of exudate, wound would be visualized, dressing is long-wear (7-21 days)

Question 32

Ms. H.W> Johnson-Brown presents at her Primary Care Clinic with a wound on her lower leg that she has had for several months. She had vascular studies that show chronic venous disease. She cannot tolerate wraps, but does wear over-the-counter compression stocking (most days). Wound is draining moderate amounts of thin serous drainage.

Which would be the best secondary dressing to select?

Answer 32

best choice: foam

could work: composite

not suitable: acrylic or hydrocolloid

Question 33

charcoal dressings

Answer 33

cover up wound odor but do not treat cause of odor

silver in the dressing will not treat wound infection - it kills bacteria in dressing only

should be in close contact with wound to be effective

can be folded to fit around contracture digits, and tubes

do not cut

Question 34

zinc

Answer 34

zinc-impregnated gauze

anti-inflammatory and soothing effects when treating dermatitis and eczema

can dry out leading to traumatic removal = only considered non-adherent if it is moist