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Integ Fall 2024 > Wound Dressings > Flashcards

Wound Dressings Flashcards

1
Q

What is the goal for dressing wounds?

A
  • promote a moist healing environment
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2
Q

What does creating a moist healing environment do for a wound?

A
  • facilitates all 3 phases of healing
  • preserves endogenous growth factors
  • trap endogenous enzymes for autolytic debridement
  • promote formation of more cosmetically appealing scar
  • reduce patients pain
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3
Q

What happens if a wound is too moist?

A
  • maceration
  • additional skin damage
  • increased risk of infection
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4
Q

What happens if a wound is too dry?

A
  • desiccation
  • decreased enzymes/growth factors
  • scab/crust formation
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5
Q

What is the purpose of dressing a wound?

A
  • create/maintain moist wound environment
  • absorb exudate
  • promote homeostasis
  • fill dead space
  • provide thermal insulation
  • allow for debridement of necrotic tissue
  • prevent or treat infections
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6
Q

What else do dressings also have to be?

A
  • user friendly
  • affordable
  • able to remain in place for long periods of time
  • non-traumatic
  • thermally insulating
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7
Q

What does the primary dressing do?

A
  • contact w/ wound surface
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8
Q

What does the secondary dressing do?

A
  • adhere primary dressing
  • absorb drainage
  • provide occlusive environment
  • provide protection/cushioning

might need 3 layer to secure dressing

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9
Q

Are medications/topicals dressings?

A

NO
- includes enzymatic debriders or antimicrobials

minimize dressing change frequency

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10
Q

What are the 9 categories of dressings?

A

Most Absorptive -> Least absorptive:
- alginates
- semipermeable foams
- hydrocolloids
- hydrogel
- semipermeable films

Most Absorptive -> Least absorptive Gauze:
- Layers of gauze padding
- gauze pad
- nonwoven gauze
- woven gauze
- impregnated gauze dressings

Composite dressings
Interactive dressings
- both absorptive depend on component parts

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11
Q

What are the most occlusive and impermeable layers of dressings?

A

Most occlusive/impermeable -> least occlusive/permeable
- latex
- hydrocolloids
- hydrogels (sheets)
- semipermeable foam
- semipermeable film
- impregnated gauze
- calcium alginates
- fine-weave gauze
- loose-weave gauze
- air

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12
Q

What are things to remember with wound dressings?

A
  • dressing needs change as wound changes
  • there is NO one dressing that works for every wound
  • choices of dressings will depend on clinic availability
  • know WHY you are using what you are using
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13
Q

What factors should you consider with clinical decision making for dressings?

A
  • amount of drainage
  • condition of wound bed
  • presence of infection
  • skin condition (tolerate adhesives)
  • frequency of dressing changes
  • availability of wound dressings
  • cost
  • wound location
  • what WAS the patient using
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14
Q

What are alginates?

A

Calcium alginate:
- salts of alginic acid from brown seaweed
- come in sheets, ribbons, rope, and calcium alginate tipped applicators
- fibers react with wound exudate and form a hydrophilic gel to provide a moist wound environment
- NOT for wounds with exposed tendon, joint capsule, or bone (dries them out)

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15
Q

What are the advantages of alginates?

A
  • highly absorptive (20x its weight)
  • easy to use and fill in cavities or irregular wound shapes
  • encourages autolytic debridement
  • works well under compression
  • can be used on infected wounds
  • fibers will not cause irritation if left in wound
  • can stop bleeding
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16
Q

What are the disadvantages of alginates?

A
  • can dehydrate wound
  • requires a secondary dressing (to hold in place)
  • may require irrigation to completely remove
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17
Q

What are semi-permeable foams?

A
  • non-stick, absorbent, sponge-like polymer
  • pads, sheets, or pillow for cavity
  • some have adhesive boarders
  • some have waterproof outer layer to prevent strike through drainage
  • NOT for infected wounds unless changed daily
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18
Q

What are the advantages of semi-permeable foams?

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
  • can be left in place for several days
  • can be used under compression dressings
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19
Q

What are the disadvantages of semi-permeable foams?

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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20
Q

What are hydrofibers?

A
  • highly absorptive non-woven pads or ribbons of sodium carboxymethylcellulose or rayon/cellulose fibers
  • neither an alginate or hydrocolloid but has benefits of both
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21
Q

What are the advantages of hydrofibers?

A
  • absorbs moderate to large amounts of drainage
  • works well under compression
  • can stay in place for several days
  • interaction with wound exudate forms a gel
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22
Q

What are the disadvantages of hydrofibers?

A
  • may fuse to bloody wound base
  • can dehydrate wound if there is scant drainage
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23
Q

What are hydrocolloids?

A
  • adhesive wafers composed of gelatin, pectin and carbomxymethol-cellulose
  • during application, best to warm it to get it to adhere
  • occlusive dressing
  • NOT for infected wounds
  • NOT for wounds with exposed tendon or fascia (will stick to it)

DuoDerm: barrier against incontinence AND MRSA, Hep-B, HIV, and pseudomonas

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24
Q

What are the advantages of hydrocolloids?

A
  • impermeable to bacteria and incontinence/waterproof
  • encourages autolytic debridement
  • provides thermal insulation
  • can be placed where tape attaches to for repeat dressing changes
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25
Q

What are the disadvantages of hydrocolloids?

A
  • edges can roll
  • adhesive can damage periwound
  • can cause hypergranulation
  • pectin causes odor upon removal (mistaken for infection)
  • leaves residual in wound bed
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26
Q

What are hydrogels and what are they commonly used for?

A
  • water or glycerin based gel, sheet, or impregnated gauze
  • skin sealant may be required for periwound protection
  • will dehydrate if not covered correctly
  • NOT indicated for infect wounds
  • commonly used on blisters, abrasions, skin tears, burns, donor sites, mastitis
27
Q

What are the advantages of hydrogels?

A
  • donates moisture
  • painless removal
  • can soften eschar
28
Q

What are the disadvantages of hydrogels?

A
  • minimal absorptive qualities
  • non-adhesive requiring secondary dressing
  • may macerate periwound
29
Q

What are semipermeable films?

A
  • transparent polyurethane membrane
  • breathes like skin, allowing vapor exchange
  • good for minimally draining wounds, abrasions, skin tears, or partial thickness wounds
  • if channel develops in wound change film
  • NOT for infected wounds
30
Q

What are the advantages of semipermeable films?

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
31
Q

What are the disadvantages of semipermeable films?

A
  • no absorptive qualities
  • poor thermal insulation
  • may tear off periwound skin
32
Q

What are silicone dressings?

A
  • newer technology
  • thin and thick foam
  • replacing transparent films and hydrocolloids
  • consider usage when have skin tears and fragile skin
  • can reduce friction and sheer injuries (especially on sacrum)
33
Q

What is gauze?

A
  • Woven or non-woven
  • primary or secondary dressing
  • comes in packing strips for tunneling and undermining
  • commonly used for wounds that are infected, require frequent dressing changes, require packing, are highly draining
  • non-adherent gauze also available for superficial, non-draining wounds (bandaid)
34
Q

What are the advantages of gauze?

A
  • readily available
  • inexpensive for short term use
  • increased layers increase absorption
  • provides cushioning
  • can be used with topical agents
  • roll gauze secondary dressing keeps adhesives off of skin
35
Q

What are the disadvantages of gauze?

A
  • poorly maintains moist environment due to lack of occlusiveness
  • traumatize wound bed upon removal
  • require more frequent dressing changes
  • higher infection rate than occlusive dressings
  • needs to be held in place
36
Q

What is the difference between woven and non-woven gauze?

A

Woven:
- made of cotton
- can leave lint fibers in wound bed which can cause irritation (a granuloma)
- less absorptive

Non-woven:
- made of synthetic
- more absorptive

37
Q

What can gauze be impregnated with?

A
  • petroleum: no odor involved
  • bismuth: cytotoxic to inflammatory cells; NOT for VI ulcers -> causes adverse reaction
  • iodine: cytotoxic
  • Zinc: uno-boots for VI ulcers
  • Hydrogel
38
Q

What is impregnated gauze?

A
  • gauze impregnated with something (usually a antimicrobial)
  • requires secondary layer
  • makes gauze non-adherent
  • increases occlusiveness of gauze dressing
  • good on granulating wounds
39
Q

What are composite dressings?

A

A combination of 2 or more dressing types
EX:
- inner layer: non-adherent
- middle layer: absorptive (hydrogel, semipermeable foam, hydrocolloid, or alginate)
- outer layer: bacterial barrier (semipermeable film)

40
Q

What are interactive dressings?

A

Create a moist wound environment AND interact with the cells on the wound bed to further promote wound healing

2 types of interactive dressings:
- antimicrobials (silver, honey based dressings)
- biologics & biosynthetics (collagen and polyacrylate dressings)

impregnated gauze could be an interactive dressing

41
Q

What are a couple antimicrobial dressings/gels?

A
  • silver
  • cadexomer iodine
  • honey
  • Anasept, Blast X, etc.
42
Q

How is silver used in wound care and what is it indicated for?

A
  • impregnated into different kinds of dressings and gels
  • indicated for infected wounds or those with high bioburden
  • used for gram + and - bacteria (MRSA and VRE)
  • continuous release so can be left in place for up to 7 days

MUST REMOVE FOR MRI OR RADIATION THERAPY

43
Q

How is cadexomer iodine use and what are some contraindications?

A

Very similar to silver with continuous 72 hr release
Contraindications:
- patients with thyroid disease
- allergy to shellfish
- large cavity wounds

44
Q

How is honey use?

A
  • used with chronic wounds
  • antimicrobial
  • lowers wound pH which is good for chronic wounds
  • highly osmotic, drawing exudate, bacteria and slough toward dressing
  • augments autolytic debridement
45
Q

What are collagen dressings?

A
  • derived from animal collagen
  • stimulates macrophages, angioblasts, keratinocytes and platelets
  • can donate or absorb drainage
  • provides collagen framework for cells to grow
  • for CLEAN, MOIST, UNINFECTED WOUNDS

consider for non-healing category III/IV pressure ulcers

46
Q

What is charcoal used?

A
  • used for those with odor
  • NOT for infection
  • used for malodorous wounds and psychological aspects (get rid of the smell)
47
Q

What do debriding agents do?

A

NOT A DRESSING
- breakdown necrotic tissue without disturbing healthy tissue
- slow debridement when sharp debridement not allowed
- used for enzymatic debridement

EX: collagenase, panafil, accuzyme

48
Q

What are skin sealants?

A
  • pad, swab or spray used to paint a thin layer of protectant agent onto preiwound
  • prevents skin stripping upon dressing removal
  • enhances dressing adhesion
  • protects skin from maceration

used with VI ulcers

49
Q

What are moisture barriers?

A
  • ointments or creams
  • often used to prevent perineal rashes/skin breakdown
  • can often be used on macerated skin

often used with incontinence in nursing homes

50
Q

What are some ways to keep dressings in place?

A
  • tape
  • tubigrip
  • abdominal binder
  • Montgomery straps
51
Q

What are growth factors?

A
  • growth-promoting substances that enhance cell size, activity, or proliferation
  • extremely costly
52
Q

What are biological and biosynthetic dressings?

A
  • dressings derived from natural tissues
  • maintain skins natural properties and promote autolytic debridement
  • Skin grafts: auto (self), xeno (animal), allo (cadaver)
53
Q

What are skin substitutes?

A
  • engineered tissue that does not trigger rejection
  • rapid closure of wounds
  • used with significant burns all over body
54
Q

What are some dressing generalities?

A
  • contaminate dressing materials as little as possible
  • open dressing packages by pulling ends apart
  • wash hands frequently
  • change gloves regularly
  • note the date of last dressing application prior to removal
  • date, time, and initial dressing on tape BEFORE on patient
55
Q

What are some clinical decisions for draining and non-draining wounds?

A

Draining -> absorb moisture -> protect surrounding tissue

Non-draining -> provide moisture & prevent evaporation -> skin sealant for periwound protection

56
Q

What are some dressing options for granular & non-draining wounds?

A
  • gauze (with topical agent such as hydrogel)
57
Q

What are some dressing options for granular & draining wounds?

A
  • gauze
  • alginate
  • semipermeable foam
  • hydrocolloid (probably not)
58
Q

What are some dressing options for necrotic & non-draining wounds?

A

Gauze with topical agent such as:
- hydrogel
- impregnated gauze
- transparent film
- hydrocolloid

59
Q

What are some dressing options for necrotic & draining wounds?

A
  • gauze
  • alginate
  • semipermeable foam
  • hydrocolloid if NOT infected
60
Q

What are some considerations for infected wounds when it comes to dressing?

A
  • avoid occlusive dressings = infection festers under dressing
  • re-bandage daily
  • options for dressings: gauze (could be impregnated to fight infection), alginate, semipermeable foam
61
Q

What are some size considerations when it comes to dressings?

A
  • small: gauze or moisture-retentive dressings
  • really large: gauze dressings
  • deep: lightly fill to prevent abscess formation (fluff don’t stuff)
  • tunnel: rope gauze into tunnel and frequent changes
62
Q

What are some considerations when it comes to frequency of dressing changes?

A

As needed for strike-through drainage
Infected: daily or more than once a day
Based on dressing type:
- transparent film/hydrocolloid: > 5 days depending on wound
- alginate: 3-7 days, when strike through drainage, depends on wound
Based on antimicrobials:
- collagenase santyl: daily
- medihoney: 3 days

change wound according to dressing that needs to change most frequently

63
Q

What are some “yay’s” of wound dressing?

A
  • dry eschar: leave alone, remove pressure source
  • absorptive dressings covered with dry gauze/ABD pad
  • change according to protocol or strike through drainage
  • hydrocolloids not used as secondary dressings and not replaced too often (too sticky - same w/ transparent films)
  • ALWAYS moisten gauze with packing a wound, even a draining wound
  • treat infection and change dressings regularly
  • dont cool or heat infections
64
Q

What are some “nay’s” of wound dressing?

A
  • Mutiple absorbent dressings on top of each other
  • moist dressing covered by absorbent dressing
  • occlusive dressing over a crater = fills with fluid and traps moisture

Integ Fall 2024 (8 decks)

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