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Integumentary > Wound Dressings > Flashcards

Wound Dressings Flashcards

1
Q

Dressings Goals

A 
Maintain moist wound bed
Protect surrounding skin
Control exudate
Fill dead space
Protect wound from environment
Allow gas exchange so O2,H20,CO2 can pass through dressing
Maintain normal thermia
Impermeable to microorganisms
Non-traumatic with removal
Maintain correct ph
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2
Q

Moist Wound Healing

A 
Traps endogenous enzymes to facilitate autolytic debridement
Preserves endogenous growth factors
Reduces patient pain complaints
Reduces hypertrophic scarring
Faster healing
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3
Q

Protect Surrounding Skin

A

Use skin protectants at wound borders to prevent maceration
Make sure dressing adequately controls drainage.
Avoid aggressive adhesive, especially on fragile skin

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4
Q

What dressing to use to on extremity to protect surround skin?

A

circumferential dressing

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5
Q

What dressing to use to on abdomen to protect surround skin?

A

abdomen Montgomery straps can be left in place to avoid excessive skin trauma

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6
Q

Moisture barriers

A

Ointments or creams
Prevents peri-wound rashes/skin breakdown
Can apply to macerated skin

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7
Q

Moisturizers

A

Key component of basic skin care
Help restore barrier function of epidermis
Maintain/restore skin hydration
Avoid those with perfume or alcohol (possible skin reaction)
Apply to intact skin
Petrolatum may penetrate best
Ointments are more occlusive than creams or lotions

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8
Q

Too Moist

A

Maceration- skin becomes fragile and susceptible to colonization
May increase wound size
Increased chance of infection

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9
Q

Protect wound from environment

A

Adequate padding to prevent trauma
Adequate coverage to prevent exposure to contaminates
Adequate layers/absorption to prevent strike through drainage

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10
Q

Allow gas exchange

A

Adequate permeability to allow O2,H20,CO2 transfer

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11
Q

Impermeable to microorganisms

A

If strike through drainage occurs, allows conduit for bacteria
Insure adequate coverage to prevent environmental exposure

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12
Q

Non-traumatic with removal

A

Insure dressing can be removed without trauma to granulation tissue
Also important for pain control

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13
Q

What does maintaining the wound bed temperature at 98 degrees do?

A

mytotic activity increases increasing the proliferative response up to 108%.

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14
Q

What happens when the wound bed cools?

A

cellular activity drops dramatically

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15
Q

What does warmth stimulate?

A

adequate perfusion of tissue

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16
Q

Classes

A 
Semipermeable  Transparent Films
Hydrogels
Hydrocolloids
Foams
Absorptive Dressings/Alginates 
Gauze
Other specialized dressings
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17
Q

What are semipermeable film dressings?

A

Thin sheets of transparent polyurethane with adhesive backing

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18
Q

What do semipermeable film dressings allow?

A 
Allow visualization of wound bed
Permeable to water vapor, O2, CO2
Highly elastic and conformable
Keeps wound moist 
Protects against shear
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19
Q

What do semipermeable film dressings stop?

A

Impermeable to bacteria and water

Non- absorptive/non insulating

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20
Q

What are semipermeable film dressings used on?

A

Used on clean wounds
May use as secondary dressing
May leave in place > 5-7days

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21
Q

What should semipermeable film dressings not be used on?

A

Infected wounds
Wounds with moderate to heavy drainage
Patients with fragile skin

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22
Q

Semipermeable Film Dressings Precautions/Contraindications:

A

Skin sealant may be needed to protect periwound

Must maintain good edge seal

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23
Q

Semipermeable Film Dressings Common uses:

A 
Superficial or partial-thickness wounds
Skin tears
Donor sites
Areas of friction
Abrasions
Over IV catheters to allow bathing/whirlpool
Over wounds for ultrasound treatments
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24
Q

Benefits of Semipermeable Film Dressing

A 
Moisture-retentive dressing
Encourages autolytic debridement
Reduces friction, protects against shear
Allows visualization of wound bed
Waterproof
Cost less over time
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25
Q

Limitations of Semipermeable Film Dressing

A 
Adhesive may traumatize periwound upon removal
Cannot use on highly exudating wounds
Can be hard to apply
Should not use on infected wounds
Will not adhere to wet or oily skin
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26
Q

Hydrogels

A

Amorphous gel, sheet (Polymer gel with backing), or impregnated gauze
Gels are wound fillers and require secondary dressing

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27
Q

What comprised hydrogels?

A

30-90% water or glycerin-based

Some have adhesive borders

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28
Q

How long do hydrogels last?

A

up to 3 days

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29
Q

What are hydrogels used for?

A

Used to maintain adequate wound moisture
Used over abrasions, donor sites, and partial thickness burns
Non-adherent, reduces heat in burns, soothing
Can be used as coupling medium for US

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30
Q

What can hydrogels absorb?

A

small amounts of exudate and facilitate autolytic debridement

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31
Q

What are hydrogels permeable to?

A

gas and water

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32
Q

What should hydrogels not be used on?

A

Heavily draining wounds

Infected wounds

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33
Q

Sheet Hydrogels:

Precautions/Contraindications

A

Absorb fluids slowly

Skin sealant may be needed to protect periwound

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34
Q

Hydrogel sheets

A 
Minimally/moderately exudating wounds
Blisters/abrasions/skin tears
Burns (thermal and radiation)
Donor sites
Mastitis
To decrease pressure/shear or provide padding in casts
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35
Q

Hydrogel amorphous

A

Add moisture to wound bed
Soften eschar
Coupling agent for ultrasound

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36
Q

Benefits of hydrogel

A

Moisture-retentive dressing
Encourages autolytic debridement
Non- or minimally adherent

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37
Q

Limitations of hydrogel

A

May dehydrate
Cannot use on highly exudating wounds
Generally require secondary dressing
Should not use on infected wounds

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38
Q

What are hydrocolloids?

A

Contain hydrophilic colloidal particles with a strong film or foam adhesive backing to create a relatively occlusive dressing

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39
Q

What do hydrocolloids do?

A

Create an effective barrier against urine, stool
React with wound moisture to absorb or create a gel that maintains a moist wound bed
Wide range of absorptive abilities within this class

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40
Q

What do hydrocolloids react with?

A

wound moisture to absorb or create a gel that maintains a moist wound bed
Dressing residue may appear purulent and malodorous

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41
Q

Hydrocolloids and periwound?

A

Adhesive may be traumatic if delicate peri-wound skin

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42
Q

Hydrocolloids:

Precautions/Contraindications

A 
Bleeding or heavily draining wounds
Infected wounds
Dry wounds, arterial ulcers, third-degree burns, or wounds with minimal drainage ( may aid in increasing wound moisture if surrounding skin is stable enogh)
Wounds with exposed tendons/fascia
Patients with poor skin integrity
Caution on immunocompromised patients
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43
Q

Common uses of hydrocolloids:

A

Partial- to full-thickness wounds
Granular or necrotic wounds
Minor burns
Venous insufficiency ulcers
Pressure ulcers including special shapes for sacral and coccygeal ulcers
On peri-wound as an attachment for adhesive tape

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44
Q

Benefits of hydrocolloids:

A 
Moisture-retentive dressing
Encourages autolytic debridement
Provide thermal insulation
Waterproof
Absorb moderate amounts of drainage
Impermeable to urine, stool, bacteria
Provide moderate absorption
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45
Q

Limitations of hydrocolloids:

A 
Adhesive likely to traumatize peri-wound
May roll in areas of friction
Should not use on infected wounds
Leaves residue in wound bed
May cause hypergranulation (too much moisture)
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46
Q

Semipermeable Foams:

A

Permeable to gas but not to bacteria
Provide thermal insulation
Absorbent

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47
Q

How long can semipermeable foams last?

A

Can last up to 7 days depending on exudate

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48
Q

Polyurethane foam

A

Hydrophilic wound side
Hydrophobic outside
Some have semipermeable film backing

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49
Q

Shape of semipermeable foams:

A

Conform to irregular surfaces
Provide padding (protection)
Keeps wound moist
Non-adherent)

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50
Q

Semipermeable Foams:

Precautions/Contraindications

A

No specific contraindications
Make sure there is adequate moisture
Protect peri-wound skin if there is excessive moisture

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51
Q

Semipermeable Foams Common Uses:

A 
Minimally to heavily exudating wounds
Donor/ostomy sites
Minor burns
Granulating or slough-covered partial- to full-thickness wounds
Neuropathic ulcers
Venous insufficiency ulcers
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52
Q

Benefits of semipermeable foams:

A 
Moisture-retentive dressing
Encourage autolytic debridement
Provide thermal insulation
Provide cushioning
Absorb moderate amounts of drainage
Available with and without adhesive
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53
Q

Limitations of Semipermeable foams:

A

Adhesive may traumatize peri-wound
May roll in areas of friction
Should not use on infected wounds unless changed daily

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54
Q

What are alginates?

A

Salts of alginic acid from marine brown algae and giant kelp
React with serum and wound exudate to form a hydrophilic gel to provide a moist wound environment
Absorbs 20x its weight

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55
Q

What do alginates require?

A

Require secondary dressing

56
Q

Characteristic of alginate?

A

Highly absorbent, used on highly exudating wounds

Engineered hydro-fibers (Aquacel) are 30% more absorptive and non-wicking

57
Q

Alginates:

Precautions/Contraindications

A 
Full-thickness burns (third degree)
Dry or minimally draining wounds
Wounds with exposed:
Tendon
Joint capsule
Bone
58
Q

Common Uses of Alginate:

A

Highly exudating wounds
Venous insufficiency ulcers
Tunneling wounds
Swabs to probe, fill, measure wound depth

59
Q

Benefits of Alginate:

A 
Encourages autolytic debridement
Highly absorbent
Infected and uninfected wounds
Biocompatible
Nonadherent
60
Q

Limitations of Alginate:

A

Require secondary dressing
Use with extreme caution with exposed deep tissue to prevent desiccation
Should change daily on infected wounds

61
Q

Kinds of gauze dressing:

A

woven (cotton)

nonwoven (synthetic, more absorbent)

62
Q

Characteristics of gauze dressing:

A

Highly permeable
Relatively nonocclusive
Finer weave/smaller pores decrease wound bed trauma
Air permeable, allows drying of wound (such as for wet to dry mechanical debridement)
Primary or secondary dressing
Inexpensive for one-time or short-term use

63
Q

Gauze Dressings:

Precautions/Contraindications

A

May require more force for removal
May leave residue or lint
If dehydrates, will adhere to wound bed
Roll gauze should be applied at an angle, snugly but without tension
Telfa dressings are reserved for superficial, nondraining wounds

64
Q

Gauze Dressings Common Uses

A

Infected and noninfected wounds
Wounds of all sizes, shapes, depth, or etiologies
Wounds requiring packing
Wounds requiring frequent dressing changes
Highly exudating wounds

65
Q

Benefits of Gauze:

A

Universally available
Low one-time cost
Can use on infected and uninfected wounds
Can use alone or with other dressings/topical agents
Can add more layers to increase absorption
Provides cushioning
Roll gauze keeps adhesives off patients’ skin

66
Q

Limitations of Gauze

A 
Costly over time 
May adhere to wound bed 
May leave particulate matter in wound bed 
Highly permeable 
Require more frequent dressing changes
67
Q

What can mesh gauze dressing be impregnated with?

A 
petrolatum
bismuth
zinc
hydrogel
saline
68
Q

Petrolatum

A

Vaseline gauze/Adaptic- non-adherent to protect granulation, can be used as a secondary dressing to increase occlusiveness.

69
Q

Bismuth

A

Scarlet red, Xeroform- were thought to promote epithelialization, unsure if chemicals may actually impede healing. If they become dry can be traumatic to remove

70
Q

Characteristics of impregnated gauze dressing?

A

Nonadherent contact layer
Require a secondary dressing
Increase occlusiveness of a gauze dressing

71
Q

Dressings with bismuth

A

Cytotoxic to inflammatory cells

May cause inflammatory response in patients with venous insufficiency ulcers

72
Q

Iodine-impregnated gauze

A

Cytotoxic

Only mildly antimicrobial

73
Q

Common uses

Impregnated Gauze Dressings

A 
Granulating wounds
Epithelializing wounds
Wounds with exposed tendons 
Wounds that bleed easily
Burns
74
Q

Benefits of

Impregnated Gauze Dressings

A

Decrease wound bed trauma with dressing changes
Decrease pain of dressing change
May increase occlusiveness of gauze dressing

75
Q

Limitations of

Impregnated Gauze Dressings

A

More costly than plain gauze
Require secondary dressing
May present a barrier to keratinocyte migration
Have minimal absorptive capabilities

76
Q

Other dressings:

A 
silver dressings
hyper-osmolar dressing
hyaluronic acid
charcoal
honey
collage
composite dressing
tissue adhesive
77
Q

Silver dressings-

A

decreases microbial load against gram+ and gram-, antifungal, inactivates enzymatic debriders

78
Q

Hyper-osmolar dressing example

A

Mesalt- Heavily draining/infected wounds- by osmosis draws out exudate

79
Q

Hyaluronic acid

A

“natures moisturizer” enhances granulation

80
Q

Charcoal

A

Controls odor

81
Q

Antimicrobial Wound Dressings

A

Silver or cadexomer iodine
Incorporated into all classes of dressings
Broad-spectrum antimicrobial
Decrease wound bioburden

82
Q

Antimicrobial Dressings:

Precautions/Contraindications Silver:

A

Blue-black wound bed discoloration
Monitor for signs of hypersensitivity/ADR
Do not moisten with saline

83
Q

When can you not use antimicrobial silver?

A

Can’t use with electrical stimulation ??
Remove before MRI
Not for neonates
Cytotoxic, may delay re-epitheliailization

84
Q

Antimicrobial Dressings:

Precautions/Contraindications Cadexomer iodine

A

Sensitive to iodine
Thyroid disease
Large cavity wounds (Need to monitor dosage to avoid toxicity)

85
Q

Antimicrobial Dressings Common Uses:

A 
Partial- and full-thickness chronic wounds
Donor sites
Burns
Venous insufficiency ulcers
Neuropathic foot ulcers
Pressure ulcers: heavily colonized
Traumatic wounds
86
Q

Benefits of Antimicrobial Dressings

A

Broad-spectrum antimicrobial
Available in wide variety of dressing classes
Adhesive and nonadhesive forms
May be primary or secondary dressing
Consider for heavily colonized pressure ulcers

87
Q

Limitations of Antimicrobial Dressings

A

Paucity of research

High cost

88
Q

Honey-Impregnated Dressings

A

Leptospermum, also known as Manuka honey
Purported Ways to Improve Healing
Antimicrobial

89
Q

What to consider with Honey-Impregnated Dressings?

A

Consider to control wound bioburden

Consider to control wound odor

90
Q

What does honey impregnated dressings stimulate?

A

May stimulate growth factors

Stimulates angioblasts, fibroblasts, monocytes

91
Q

What does honey impregnated dressings control?

A

Reduces inflammation and edema

Osmotic action controls drainage

92
Q

Collagen

A

Provide an extracellular framework for multi-cellular animals
Primary protein present in the skin, providing strength and structure
Present in the reticular layer of the dermis providing the skin with its strength, interwoven with elastin to provide flexibility

93
Q

Collagen Dressing

A 
Minimal exudates 
Can use on infected wounds
Partial and full thickness
Need to watch for allergic reaction
Stimulates cells to proliferate
Hemostatic
Attracts fibroblasts and macrophages
Increases tissue strength
Decreases effect of MMP’s
Can be from any source
94
Q

Kinds of collage dressing:

A

Sheets, ropes, and pad dressings

Gel, paste, powder, or particles

95
Q

What is collagen dressing used for?

A

Consider for nonhealing category/stage III or IV pressure ulcers
Partial- or full-thickness wounds

96
Q

When is collagen dressing contraindicated?

A

if sensitive to collagen

97
Q

Collagen Purported Ways to Improve Healing

A

Stimulates macrophages, angioblasts, keratinocytes, platelets
Protects growth factors
Provides scaffolding for cell proliferation/migration
Maintain moist wound environment
May encourage balance between MMPs and TIMPs

98
Q

Inner contact layer of composite dressing:

A

Nonadherent

Prevents wound bed trauma

99
Q

Middle layer of composite dressing:

A

Absorbs moisture, wicks, maintains moist wound bed

Hydrogel, semipermeable foam, hydrocolloid, or alginate

100
Q

Outer layer of composite dressing:

A

Bacterial barrier

Commonly a semipermeable film

101
Q

Tissue Adhesives

A

Skin glues
Primary wound closure without staples or sutures
Use on acute linear wounds without tissue loss
Must protect wound from tension early on

102
Q

Function of Primary Dressing:

A

Direct contact with wound
Antimicrobial
Non-adherent/non-traumatic
Maintains moisture balance

103
Q

Function of Secondary Dressing:

A 
Over primary dressing
Can provide
Protection
Cushioning
Absorption 
Occlusion
104
Q

The Future of Wound Management:

Growth Factors

A

Cytokines, interleukins, colony-stimulating factors
Growth-promoting substances that enhance cell size, proliferation, or activity
In humans, wounds treated with certain growth factors improved significantly more than wounds treated with a placebo

105
Q

What are growth factors limited to?

A

Limited to chronic wounds that are recalcitrant to traditional interventions
Extremely costly

106
Q

Biosynthetic Dressings and Skin Substitutes

A

Derived from natural tissues
Retain the skin’s natural barrier properties
Encourage autolytic debridement
Help create healthy granular wound bed

107
Q

Skin Grafts:

A

Provide skin coverage
Wounds with extensive surface areas
Large full-thickness burns
Chronic wounds

108
Q

Types of skin grafts:

A

Allograft, xenografts, autografts

109
Q

Drawbacks of skin grafts:

A

Limited supply
Very costly
Short shelf life
Possible cultural/religious concerns

110
Q

Indications for skin substitutes:

A

Nonhealing, uninfected partial- and full-thickness ulcers
Burns
Traumatic wounds

111
Q

Skin substitutes:

A

No immune response
Temporary or extended wound coverage
Used in highly specialized areas of wound care, such as burn clinics

112
Q

Skin Substitutes Types:

A 
Alloderm
Apligraf
Biobrane
Dermagraft
Epicel
GRAFTJACKET
Integra
Transcyte
113
Q

Draining

A

Absorb moisture

Protect the surrounding wound from maceration

114
Q

Nondraining

A

Provide moisture
Prevent evaporative fluid loss
Since moisture will be added to the wound, a skin sealant should be used to protect periwound

115
Q

Granular and Nondraining

A

Healing as expected
Protect granulation tissue
Obtain/maintain moist environment
Protect surrounding tissue

116
Q

Dressing options for granular and nondrainig:

A

Gauze, impregnated gauze
Transparent film
Hydrogel

117
Q

Dressing options for granular and draining:

A

Gauze
Alginate
Semipermeable foam
Hydrocolloid

118
Q

Granular and Draining

A

Observe for infection
Protect granulation tissue
Absorb exudate
Protect surrounding tissue

119
Q

Necrotic and Nondraining

A

Soften eschar
Remove eschar
Obtain/maintain moist environment
Protect surrounding tissue

120
Q

Debridement options for Necrotic and Nondraining

A

Surgical
Sharp
Enzymatic
Autolytic*

121
Q

Dressing option for Necrotic and Nondraining

A

Gauze, impregnated gauze
Transparent film
Hydrogel
Hydrocolloid

122
Q

Necrotic and Draining

A

Observe for infection
Absorb exudate
Remove eschar
Protect surrounding tissue

123
Q

Debridement options for Necrotic and Draining

A

Surgical
Sharp
Enzymatic
Autolytic*

124
Q

Dressing options forNecrotic and Draining

A

Gauze
Alginate
Semipermeable foam
Hydrocolloid*

125
Q

Wound Infection

A

Should avoid occlusive dressings

Rebandage daily

126
Q

Good dressing options for wound infection:

A

Gauze
Alginate
Semipermeable foam

127
Q

Small wound

A

gauze or moisture-retentive dressings

128
Q

Large wound

A

gauze dressings

129
Q

Deep wound:

A

lightly fill to prevent abscess formation

130
Q

Tunneling:

A

gauze dressings and frequent dressing changes

131
Q

Objectives of Comprehensive

Wound Management

A 
Granular wound bed
Moist wound bed
Warm wound environment
Manage infection
Eliminate dead space
Protect peri-wound
Enhance patient’s ability to heal
132
Q

Bandaging Procedure:

Wounds with Dead Space

A

Packing material should be confined to
wound bed
Use sterile instruments and packing materials to fill wound
Leave a wick

133
Q

Dressings for hands:

A

If a large wound or infected, use roll gauze
Figure-eight wrapping
Minimize bandage bulk to allow use of extremity

134
Q

Dressing for Arms and Legs:

A

Nonadherent dressings if poor skin integrity or significant body hair
Secure with roll gauze, self-adherent elastic wraps, or elastic netting

135
Q

Dressing for Trunk

A

Secure with roll gauze, an elastic netting vest, or both
Use short-stretch compression wraps with caution to allow adequate respiration
Large wounds, consider a burn vest
Montgomery straps

136
Q

Dressing for ankle/foot:

A 
Can bandage like hand wounds
May drain more, so may need more absorptive dressing
Ensure adequate room for footwear
Consider temporary footwear 
Consider assistive device

Integumentary (18 decks)

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