wound management Flashcards
explain moist wound healing and timeline of healing
3-5x faster
facilitates all 3 phases
explain what moist wound healing does specifically
traps endogenous enzymes to facilitate autolytic debridement
benefits of moist wound healing
preserves endogenous growth factors
reduced patient pain
more cosmetically appealing scars
negatives associated with too dry wound healing
crust formation
lack enzymes / growth factors
explain the negatives of too moist wound healing
maceration
additional skin damage
increased chance of infections
functions of wound dressings
moist environment
thermal insulation
barrier for microorganisms
hemostasis
edema control
eliminate dead space in wound bed
if dead space is not taken up, what can happen
abscess formation
what is the contact layer
primary dressing that comes in direct contact with wound
what can the secondary dressing provide
protection
cushion
absorption
occlusion
why are composite dressings called such?
combine primary and secondary dressing in one
explain which types of wounds moisture retentive dressings can be used on
superficial, partial or full thickness
granular or necrotic
explain infection rates in relation to occlusive or nonocclusive dressings
occlusive = lower infection rates
how do moisture retentive dressings negate infection
bacterial barrier
lower risk of cross-contamination
retains macrophages/neutrophils
endogenous enzymes can remove necrotic tissue / debris
guidelines for moisture retentive dressings to reduce chance of infection
change dressing if barriers are compromised
do not use if infection is present
removed after 5-7 days
if a wound is infected, what dressing can be used
semipermeable foams / alginates
antimicrobial dressing
relationship between moisture-retentive dressings and wound
interaction of dressing with wound fluid prevents the dressing from adhering to the wound bed
how to reduce risk of maceration with moisture-retentive dressings
maintain moist, not wet environment
topical skin protectants should be applied to all intact skin covered by dressings
how do wrinkles in dressings compromise healing
wound fluid can escape
microbes can enter
how is the continuum of wound dressing scale measured
least to most occlusive
of the moisture retentive dressings, tell me a list of the least to most absorptive dressings
semipermeable films
hydrogels
hydrocolloids
semipermeable foams
alginates
gauze dressings are described as
highly permeable
relatively nonocclusive
compare absorption of woven and nonwoven gauze
non woven = more absorptive
common use of gauze dressings
infected and uninfected wounds of any size, shape, depth, or etiology
woven gauze precautions
may require more force of removal
may leave residue leading to granulomas
dehydrated gauze can adhere to the wound bed
benefits of gauze dressings
available
low cost
can be used on all types of wounds
- can be used alone or with other treatments
absorptive
cushioning
can keep adhesives from direct skin contact
limitations of gauze
costly over time
can adhere to wound be d
can leave particulate matter in the wound bed
highly permeable / can be more likely for infection
common uses for gauze
infected wounds
wounds requiring packing / requiring frequent dressing changes
highly exudative wounds
what can mesh be impregnated with
petrolatum
bismuth
zinc
hydrogel
saline
what do impregnated gauze dressings do
create a nonadherent contact layer
increase occlusive nature of gauze dressing
explain what wound type a petrolatum-impregnated gauze can be used on
contact layer on granulating wound beds
- with a secondary gauze and +/- topical agent
typically burn wounds
what would petrolatum impregnated gauze help with
inhibit dehydration of deep structures within wound bed
dressings with bismuth are considered to be? what may the be used as?
cytotoxic to inflammatory cells
- may be used as a sensitizing agent or to increase inflammatory response
iodine impregnated gauzes are
cytotoxic and only mildly antimicrobial
benefits of impregnated gauze dressings
decrease trauma to wound bed
decrease pain or trauma during dressing changes
increase occlusive nature of dressings
limitations of impregnated gauze
more costly
require secondary gauze
present a barrier to cell migration
minimal absorptive qualities
common uses of impregnated gauzes
burns
granulating
epithelizing
wounds with exposed deep tissue
bloody wounds
painful wounds
what are semipermeable film dressings
thin sheets of transparent polyurethane with adhesive backing
semipermeable dressings are permeable to _______ but impermeable to
water vapor, oxygen, carbon dioxide
bacteria and water
precautions to application of semipermeable film dressings
secure a 1-2 cm border of intact periwound skin
apply without tension or wrinkles in skin
how to prevent maceration using semipermeable film dressings
skin sealant
how to prevent bacteria using semipermeable film dressings
maintain good edge seal
contraindications of semipermeable dressings
infected wounds
moderate-heavy exudate
fragile skin/skin sensitivities
semipermeable dressing benefits
moisture retentive
autolytic debridement
reduce friction
visualization of wound bed
waterproof
cost less over time
limitations of semipermeable dressings
skin trauma during changes
certain exudative wounds
difficulty in application
non-infected wounds only
common uses of semipermeable dressings
skin tears
donor sites
areas of friction
abrasions
IV catheters
wounds for US treatments
what are sheet hydrogels permeable to
gas and water
- will be less effective to bacteria compared to semipermeable
common use of sheet hydrogel
minimal - mod draining wounds
diabetic foot ulcers
total contact casts / splints
dry wounds
how are sheet hydrogels used in total contact casts
padding
pressure and sheer force decrease
contraindications of sheet hydrogels
heavy draining wounds
bleeding wounds
infected wounds
what is a precaution of sheet hydrogels? what is the solution?
propylene glycol is a common irritant
- skin sealant
benefits of hydrogel dressings
moisture retentive
autolytic debridement
pressure reduction
minimally adherent
limitations of hydrogels
may dehydrate
not on highly exudative or infected wounds
skin irritation
typically require a secondary dressing
common uses of hydrogels
pressure ulcers
blisters
abrasions/tears
burns (thermal/radiation)
donor sites
total contact casts
what can amorphous hydrogels be used for
softening eschar
semipermeable foams are described as
polyurethane foam with a hydrophilic wound side and a hydrophobic outside
what are semipermeable foams permable to
gas not bacteria
what are semipermeable foams used for
donor sites
ostomy sites
minor burns
diabetic ulcers
VI ulcers
what wound characteristics indicate semipermeable foams
minimal-heavy exudate
granulating or slough covered
partial and full thickness wounds
contraindications of semipermeable foams
dry/eschar covered wounds
arterial ulcers
heel ulcers in bed bound pt
fragile skin integrity
known skin sensitivities
benefits of semipermeable foams
moisture retention
autolytic debridement
thermal insulation
cushioning
absorptive
limitations of semipermeable foams
adhesives / skin trauma
non infected wounds only
hydrocolloids are made of
colloidal particles with strong film or foam adhesive backing
hydrocolloids absorb
exudate slowly
swelling into gel like mass
hydrocolloids are impermeable to
water
oxygen
bacteria
contraindications of hydrocolloids
bleeding / heavy drainage wounds
infected wounds
dry wounds (AI, 3rd degree)
exposed deep tissue wounds
poor skin integrity
benefits of hydrocolloid
moisture retentive
autolytic debridement
impermeable
limitations of hydrocolloid
periwound damage
residue in wound bed
hypergranulation
roll in areas of frictionc
common uses of hydrocolloid
pressure ulcers
burns
VI wounds
what do alginates do
react with serum / wound exudate to form hydrophilic gel
how do alginates prevent infection
moist wound environment can trap bacteria
can get cleaned out during dressing changes
indications of alginates
moderate-high drainage
partial to full thickness
packing cavities
granular/slough covered
can alginates be used on infected wounds?
yes, requires daily change
contraindications of alginates
full-thickness burns (3rd)
exposed deep tissue wounds
neonates <38 weeks at birth
benefits of alginates
autolytic debridement
highly absorbant
infected and uninfected
biocompatible
non adherent
limitations of alginates
secondary dressing
common uses of alginates
highly exudative wounds
VI uclers
tunneling
composite dressings have ____ layers
3
inner contact
middle
outer
inner contact layer of composite dressings
- characteristic
- goal
non adherent
prevent wound bed truama
middle layer of composite dressing
- characteristic / types
- goal
hydrogel, semipermeable foam, hydrocolloid, alginate
absorbs moisture / maintains moist wound bed
outer layer of composite dressings
- characteristic
- goal
semipermeable film
bacteria barrier
common antiseptic agents
silver
cadexomer iodine
silver antimicrobial dressings are best at
reducing wound bioburden
what wounds does the FDA approve silver dressings for
partial to full thickness
timeline of silver antimicrobial dressings
in short term
- assist with infection control
contraindications of silver antimicrobial
neonates
with estim
moisten dressing with saline
patients sensitive to sulfa drugs
MRI
benefits of silver dressings
broad spectrum antimicrobial
limitations of silver
lack of research
high cost
potential toxicity and limitations of other interventions
common uses of silver antimicrobial dressings
burns
donor sites
neuropathic ulcer
pressure ulcer
traumatic wound
VI ulcer
charcoal dressings are used to control
odor
honey can be used to ____ in wound care? what is the example
control bioburden
wound odor
leptospermum
how do honey-impregnated dressings work
high osmolality draws fluid into wound surface
acidic environment promotes protease and growth factor
what do hony impregnated dressings enhance during healing
angiogenesis
fibroblast proliferation
decrease prostaglandin synthesis
common use of honey-impregnated dressings
infected/colonized wounds
stage 2 or 3 pressure ulcers
diabetic foot ulcer
VI ulcer
collagen dressings are used for
nonhealing category 3/4 pressure ulcers
partial to full thickness wounds
various ulcers/surgical wounds
what do moisture barriers do
prevent perineal rashes/skin breakdown
prevent adhesives from sticking
benefits of skin sealants
protection from maceration
minimal protection from adhesives
growth factors are described as
growth promoting substances that enhance cell size, proliferation or activity
what cells do growth factors directly affect
cytokines
interleukins
colony stimulating factors
types of growth factors
becaplermin gel
small intestinal submucosa
what is becaplermin gel used for
recalcitrant stage 3 and 4 injuries
what wounds are small intestinal submucosa indicated on
partial thickness ulcers
grafts can help
retain skin’s natural barrier properties
encourage autolytic debridement
healthy granular wound bed
what wounds can skin grafts be indicated
extensive surface area
large full-thickness burns
chronic wound
skin substitutes are used in what types of wounds
nonhealing
uninfected
partial to full-thickness
VI / neuropathic ulcers
burns / truama
thought process with a draining wound
need to absorb moisture
protect from maceration
thought process with a non-draining wound
provide moisture
prevent evaporative loss
skin sealant to protect periwound
if a warm wound environment is present, what needs to be done
cover with dressing
what to think about if presented with dead space in a wound
fill the cavities ;)
prevent premature wound closure and abscess formation
depending on drainage, alginates or gauzes
something to always remember when packing dead space
leave a wick to take out next dressing change
