wound management Flashcards
what are the Number of skin layers affected by the types of wounds?
Superficial (epidermis - only) Partial thickness (epidermis + dermal tissue) Full thickness (epidermis + dermal tissue + subcutaneous and fat below)
what are the different ways that wounds are classified?
Number of skin layers affected
clean
contaminated + non-infected
contaminated + infected
what are the two different process of wound healing?
Cellular, physiological, biochemical and molecular processes:
Healing by Primary intention e.g. a cut.
Place edges together (? Stitches) will reattach from internal parts outward
Secondary intention –e.g. injury,
need to re-grow skin from bottom of wound up
Contraction of wound
what are the three stages of wound healing?
Inflammation:
Clotting first, then…
pain heat redness swelling.
Repair:
Proliferation – collagen,
Organisation - epithelial tissue, angiogenisis
Maturation
Keratin, increased layer thickness, contraction.
what are the Factors Altering Effectiveness of healing
Diet: Many building blocks required, including: Protein Vitamin A Vitamin C (ascorbic acid) Zinc Copper
Drugs:
Steroids
Prostaglandin inhibitors
Immune modulators
Clinical conditions:
Diabetes
Anaemia
Others??
Local factors:
Microenvironment
Tissue temperature
Secondary trauma from dressing adherence
what make an ideal dressing?
Optimum environment Moist environment Allows gaseous exchange Impermeable to bugs Free of particles Safe to use Non-adherent Acceptable to patient High absorption Cost effective Standardised Constant properties Non-inflammable Sterilisable Mechanical protection Comfortable Infrequent changes Availability Allows monitoring
list types of dressing? 11
Low adherent VP dressings Alginate Hydrocolloid Hydrogel Foam Polysaccharides Polysaccharides Enzymatic Capillary Silicone
place these dressing types in order of their Ability to absorb Exudate
Low adherent/VP dressings > Hydrocolloid/Hydrogels > Foam/Polysaccharides > Alginate
state facts about Low adherent dressing
Modern alternative to ‘dry dressings’
Lightly exuding, superficial wounds
Plastic film, knitted viscose or with fluid repellent backing
Plastic film (with/without Ad. Border): Cutilin Cosmopor E Melolin Mepore Release Neosafe Skintact Primapore Solvaline N
Knitted Viscose: Impregnated or not Iodine, chlorhexidine even honey! (Activon Tulle) Most commonly see Jelonet (paraffin), Inadine (iodine) Non-impregnated dressings NA Ultra NA Dressing Paratex Setoprime Tricotex
state facts about Vapour Permeable wound dressing
Sterile, thin, hypoallergenic
Prophylactic for pressure sores
Clean skin around wound prior to application
Skill needed for application
Many available on DT, e.g. Bioclusive C-View Mefilm OpSite Flexigrid Tegaderm
Also available with absorbent pad:
Alldress, Mepore Ultra, Opsite Plus
when is Vapour Permeable wound dressing suitable
Only suitable for relatively shallow wounds
Often used as a secondary dressing over alginate, hydrocolloids etc.
Can get adhesive trauma on removal
when is dry dressing used?
This is used for heavily exuding wounds as has a fluid repellant backing
Adhesive edging = ____________
mepore and primapore, cosmopore E
knitted viscose type [Tricotex and NA dressings] the open structure allows ______________________
free passage of exudate through to the secondary dressing
state facts about alginate dressing?
Physical properties of dressings depend upon Ca and Na ions and ratio of mannuronic/guluronic monomers:
Sorbsan-gel like
Kaltostat-firmer, less gel like
Method of removal therefore will vary
Used primarily on medium to heavy exuding wounds
Used in cavity wounds
Again many available-12 listed just in DT:
E.g. Algisite M, Curasorb, Tegagen
Also combined with absorbent backing:
Sorbsan Plus
Or combined with a hydrocolloid:
Seasorb Soft, urgosorb pad
firmer products lifted directly out from wound [Tegagel and Kaltostat]
gels can be irrigated with saline [sorbsan, kaltogel]
______________is Produced from calcium and sodium salts of alginic acid, a polymer obtained from seaweed that is composed of mannuronic and guluronic acid residues
alginates
__________________require moisture to function correctly, therefore not used on dry sloughy wounds or those covered with necrotic tissue.
alginate dressing
_______________guluronic acid gel less readily and form firmer less mobile gels
alginate
______ is used to describe a family of wound management products containing gel-forming agents such as sodium carboxymethylcellulose and gelatin
Hydrocolloid
in _______________ is the removal-due to nature tends to be virtually pain free
alginate
______ is used to describe a family of wound management products containing gel-forming agents such as sodium carboxymethylcellulose and gelatin
Hydrocolloid
________________Often combined with adhesives and applied to a carrier to form an absorbent, self adhesive waterproof dressing
Hydrocolloid
state facts about Hydrocolloid dressing?
natural or synthetic polymers
NaCMC or pectin in an adhesive matrix
interactive-exudate changes dressing to gel
used as primary dressings for many different wound types
leg ulcers, burns, pressure sores
NOT on heavily or infected exuding wounds
Products available look similar but do behave differently
why is Hydrocolloid dressing a Wide choice?
standard’, thin, with or without borders, different shapes, impregnated or as paste!
standard, e.g. Comfeel, Granuflex
thin, e.g. Tegasorb thin, Askina Biofilm (most say thin after name-helpful)
Shaped-sacral or heel
Impregnated, e.g. Contreet (silver)
Paste, e.g. Comfeel paste
___________Require secondary dressing
hydrogels
_____________Change every 1 to 3 days
hydrogels
_____________-has been reported that on application cools surface of wound and said to cause a reduction in pain
hydrogels
On very dry wounds it is usual to change the dressing at least once a day for _______
hydrogels
_____________-has been reported that on application cools surface of wound and said to cause a reduction in pain
hydrogels
state facts about hydrogels?
Composed of;
water [95%]
Carboxymethylcellulose polymer [1-2%]
interact with Aq solutions & has ability to absorb or donate water
Primary indication for cleansing of sloughy or necrotic wounds
Not for v heavily exuding wounds
As a ‘paste’ or in a sheet form
Paste type
ActivHeal, Granugel, Intrasite etc
Sheet form
Curagel Island, Hydrosorb Comfort (Ad)
ActiformCool, Curagel etc (No Ad. Bdr.)
state facts about foams?
All DT foam dressings have very different performance characteristics
Can influence type of wound used on
Tielle Lite cf Tielle
Also construction differs between manufacturers:
Lyofoam-wound exudate by capillarity
Allevyn-foam sandwich
Spyrosorb-foam coated with adhesive
Tielle-foam located in centre of an adhesive moisture vapour permeable membrane
___________________ transmits absorbed fluid laterally rather than front to back. Size of _____________-should always be selected which overlaps the edges of the wounds by about 2-3cm
Lyofoam
_____________has limited absorbency but highlt permeable to moisture vapour. Used on lightly exuding wounds or wounds in final stages of healing
Spyrosorb-
____________is suitable for moderatley exuding wounds despite its limited absorbent capacity
Tielle
state 3 types of foam dressing?
Tielle
Spyrosorb
Lyofoam
state facts about Enzymatic dressing?
Varidase
Streptokinase/streptodornase
For necrotic [eschar] or sloughy tissue
Vial, kept in fridge. If shaken enzymes denatured
with regards to enzymatic dressing:
____________ is often cross hatched with a sterile scalpel to facilitate action or sometimes injected under the ___________
Eschar
with regards to enzymatic dressing:
____________-brings about dissolution of blood clots and_____________ breaks down nucleoprotein, a DNA-protein complex emanating from dead cells or pus
Streptokinase
streptodornsase
state facts about Biosurgery in wound healing?
Maggotts: are being used for necrotic tissue, larvae of blowfly Lucilia sericata]
considerable success in wounds which are in awkward positions
Debridement of necrotic and sloughy tissue
left in situ for 3 days
usage becoming more widespread
burns, pressure sores, diabetic foot ulcers,
necrotising fascititis
state wound types
and try to imagine what they look like, browse it or check it out on the lecture slide
Discoloured, unbroken skin Superficial wounds Maladorous wounds Oedamatous wounds xuding wounds Necrotic or sloughy Infected Granulating
dry skin can be treated with_______________
emoillents
preventative measures can be taken such as_____________ for pressure areas in discoloured unbroken skin
VPM
state facts about Superficial wounds?
Most likely to be dealt with by community pharmacists
Many dressings available
Choice depends on many factors
cost, availability, acceptability, ease of application, exudate formation
Dressing options include:
low adherent
VP
Hydrocolloids
what are the signs of Malodorous wounds infection
Signs of infection
pyrexial
pus formation
cellulitis
what to consider with Malodorous wounds?
Patient distress
Generally implies infection
Signs of infection other than odour?
Occlusive dressing[s] discontinued Infection must be removed Systemic Abs preferred Pseudomonas isolated-Flamazine BUT Topical Abs or antiseptics best avoided Toxicity Rapidly deactivated Allergic contact dermatitis Increasing resistance
what are the treatment options for Malodorous wounds?
Treatment Options Activated charcoal dressings E.G., Carboflex, Lyofoam C Silver Acticoat Or Both (Actisorb Silver 220)
Metronidazole gel
anabact [0.75%] bd-fungating tumours
metrotop [0.8%] od/bd
both require secondary dressing
Sugar paste
Prevents bacterial growth due to high osmolarity
state things to consider with Exuding wounds?
Initial healing produces large volume of exudate
Heavy exudation
Associated with extensive pressure sores or leg ulcers, burns, skin graft donor sites
Strike through-skin maceration, discomfort, prone to infection
Skin protection? Secondary dressings?
state things to consider with Necrotic/sloughy Wounds
Removed before healing can commence
Yellow, green or grey slough-once dehydrated -brown or black tissue
Debridement: Txt choices include
hydrogels, hydrocolloids, Varidase, Maggots
Multifactorial on choice
E.g. location, extent, time, location, user skill, patient choice
state things to consider with Oedamatous Wounds
Healing will not occur until oedema removed
Generally leg ulcers
Drugs
Elevation/compression
Sloughy!!!!
Could surgically debride.
Could try Varidase
Maggots would work
I would try intrasite gel with secondary pad on top. Chang every other day,
?could try hydrogel as well.
state thins to consider with Granulating Wounds?
Granulation is good!
Deep granulating wounds-packing
potential abscess formation Pink and healthy looking
Hypergranulation
