Wound Interventions: Topical Agents

Question 1

Topical antimicrobial therapy is what

Answer 1

Applied to the surface of the wound to destroy the pathogens infecting the wound

Question 2

Topical antimicrobial therapy preparation types

Answer 2

Ointment (oil in water)
Creams (oil in water emulsions) - contain more water than oil
Solutions
Impregnated dressings
Antimicrobial beads (surgically implanted)

Question 3

Silvadene AKA

Answer 3

Silver sulfadiazine

Question 4

Silvadene is what

Answer 4

silver nitrate plus sodium sulfadiazine

Question 5

Silvadene is what preparation type

Answer 5

cream

Question 6

Silvadene effect is what

Answer 6

Bactericidal effect
Acts on cell wall
Broad spectrum

Question 7

Silvadene - do not use on pt with

Answer 7

Sulfa allergies

Question 8

Silvadene - up to ___% of pts develop ___

Answer 8

15% develop leukopenia

Question 9

Silvadene - research is divided on its effect on what

Answer 9

Fibroblasts and keratocytes - most say it is helping with granulation and epithelialization

Question 10

Silvadene - My react with

Answer 10

other agents like Betadine

Will brun the skin when the interaction occurs

Question 11

Neomycin Sulfate works how

Answer 11

Ointment or cream
Inhibits protein synthesis
Most effective against staph

Question 12

Neomycin - Often combined with

Answer 12

bacitracin and polymexin B sulfate to make neosporin - this inc its effectiveness against both staph and strep

Question 13

Neomycin - negatives to it

Answer 13

Significant incidence of allergic sensitivity

Resistance may develop

Question 14

Gentamycin is what

Answer 14

effective against gram neg bacteria including e coli and pseudomonas
Ointment or cream

Question 15

Gentamycin - negatives

Answer 15

pt who have a sulfa allergy
Development of resistance is a big problem
Often cause hypersensitivity reactions at the skin level
Systemic toxicity is possible in pts with impaired renal or liver function

Question 16

Wound cleaners (non enzymatic topical agents) - characteristics

Answer 16

Solution that lowers the surface tension or particulate matter within the wound
NOT FDA regulated
All are cytotoxic
Will delay wound healing

Question 17

Wound cleaners (non enzymatic topical agents) - contraindicated in

Answer 17

clean wounds, or tunneling wounds

Question 18

Topical antiseptic agent used for what

Answer 18

Applied to wound in order to prevent infection and decrease bacterial load
Might also act as a chemical debriding agent
Ex - betadine

Question 19

Hydrogen peroxide

Answer 19

Foaming effervescence

Considered to be cytotoxic to fibroblasts (when used while they are active)

Question 20

Povidine Iodine (Betadine)

Answer 20

Cytotoxic at .05% concentrations
Reacts with other topical agents particularly silver sulfadizine
Use on intact skin in prep for procedures
Can also use to stop epithelialization and dry wound edges

Question 21

Acetic acid

Answer 21

Vinegar

.003% cytotoxicity

Question 22

Dakins soluation

Answer 22

Sodium hypochlorite (bleach)
Very cytotoxic at any concentration

Question 23

Chloramine T

Answer 23

Chlorazene
Not used topically
Is an additive for whirlpools and used to clean surfaces

Question 24

Moisture control (dehydration)

Answer 24

Astringents!

• Tea (tannins)
• Witch hazel
• Silver nitrate
• Calamine lotion
• Epsom salts (Mg sulfate)
• Baby powder/talcum powder/corn startch

Question 25

Maggot debridement

Answer 25

Selective
May have antimicrobial effects
Less pain
Dec odor
Might have itching or tingling sensations

Question 26

Documentation

Answer 26

Type of debridement
Tissue type debrided, amount, SA
Pt tolerance, if used analgesia
Dressings applied