wound management Flashcards by Okemadu Christian Ukachukwu

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)

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what are the different ways that wounds are classified?

Number of skin layers affected

clean

contaminated + non-infected

contaminated + infected

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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

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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.

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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

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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

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list types of dressing? 11

Low adherent
VP dressings
Alginate
Hydrocolloid
Hydrogel
Foam
Polysaccharides
Polysaccharides
Enzymatic
Capillary
Silicone

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place these dressing types in order of their Ability to absorb Exudate

Low adherent/VP dressings > Hydrocolloid/Hydrogels > Foam/Polysaccharides > Alginate

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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

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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

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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

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when is dry dressing used?

This is used for heavily exuding wounds as has a fluid repellant backing

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Adhesive edging = ____________

mepore and primapore, cosmopore E

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knitted viscose type [Tricotex and NA dressings] the open structure allows ______________________

free passage of exudate through to the secondary dressing

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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]

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______________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

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__________________require moisture to function correctly, therefore not used on dry sloughy wounds or those covered with necrotic tissue.

alginate dressing

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_______________guluronic acid gel less readily and form firmer less mobile gels

alginate

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______ is used to describe a family of wound management products containing gel-forming agents such as sodium carboxymethylcellulose and gelatin

Hydrocolloid

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in _______________ is the removal-due to nature tends to be virtually pain free

alginate

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______ 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