*PTA 200- Wound Management Objectives

Question 1

Discuss wound prevention

Answer 1

Prevention includes:

• repositioning every 2 hours
• pressure reduction with positioning or cushions (example: roho pillow)
• shifting weight
• lifting devices
• pillows
• head of bed elevation. (30 degrees for tube feeds, but never at 45 degrees)

Prevention also includes skin care and early treatment of skin:

• inspection of skin
• bathing
• incontinence
• moisturization

Question 2

Discuss factors that contribute to a patient’s risk of developing a wound

Answer 2

• Malnutrition
• Immobility
• Chronic Illness
• Advanced age
• Incontinence
• Altered Mental Status
• Diminished Sensation

Question 3

Why is wound prevention a multidisciplinary team effort?

Answer 3

Prevention is a multidisciplinary team effort because it is part of best practices. The collective wisdom of the team results in shorter wound healing times, a lower rate of wound related complications, and fewer amputations.

Question 4

Describe an abrasion wound:

Answer 4

a wound caused by rubbing or scraping the skin or mucous membrane. Examples; road rash, skinned knee, scrapes, carpet burns.

Question 5

Describe a puncture wound:

Answer 5

a wound caused by a pointed object or instrument. Examples; stab wounds, gunshot wounds, bites.

Question 6

Describe a laceration wound:

Answer 6

a cut; a wound produced by the tearing of body tissue.

Question 7

Describe a burn:

Answer 7

caused when the skin contacts dry heat (fire), moist heat (steam), chemicals, electricity, or radiation. Burns are classified according to their depth and size. (superficial, partial thickness, full-thickness).

Question 8

Describe an incision and explain what kind of surface area is created by an incisional wound.

Answer 8

a cut made by a sharp instrument such as a scalpel.

The surface area will be really small and will be approximated. It will heal by primary intention.

Question 9

Describe interventions for pressure ulcers

Answer 9

-prevention is the best intervention for pressure ulcers.

The five steps in pressure ulcer prevention includes:

1. Education
2. Positioning
3. Mobility
4. Nutrition
5. Management of incontinence

Question 10

Pressure Ulcer Prevention mnemonics; NO ULCERS, SKIN

Answer 10

N-nutrition and fluid status
O- observation of skin

U-up and walking or assist with position changes.
L- lift don't drag
C-clean skin and continence care
E- elevate heels
R- risk assessment
S- support surfaces

S-surface selection
K-Keep turning
I- incontinence management
N-nutrition

Question 11

Interventions for Vascular Insufficiency- venous ulcers

Answer 11

1. Initiate healthcare team with patient to address co-morbidities
2. Educate patient and caregiver
   - wound etiology
   - intervention strategies
   - risk factor modification
   - guidelines for patients with venous insufficiency ulcers.
3. Treat Cause
   - Apply compression if appropriate
   - instruct patients in methods to decrease edema
4. Treat Wound
   -Inflammation Control- use topical steroids to decrease inflammation or weeping.
   -Infection Control- choose absorptive dressings
   and use skin sealants.
   -Debridement
5. Treat Periwound
   - moisturize dry, scaling skin
   - infection control
   - absorb drainage
   - debridement

Question 12

Interventions for vascular insufficiency; arterial ulcers

Answer 12

1. Protect Surrounding Skin
   - moisturize dry skin
   - avoid adhesives
   - reduce friction between toes
   - provide padding to protect ischemic toes
2. Address wound bed
   - choose dressings to moisten wound bed
   - debride necrotic tissue if appropriate
3. Maximize circulation
   - avoid compression
   - choose footwear to accommodate for bandages and decrease stress to wound.
4. Educate patient/caregivers
   - wound etiology
   - intervention strategies
   - risk factor modification
   - foot care guidelines

Question 13

Foot care guidelines for patients with arterial ulcers

Answer 13

1. Protect your feet and legs from:
   - trauma-inspect your feet, wash and dry carefully, trim nails straight across
   - chemicals-do not use home remedies
   - excessive heat and cold-do not use heating pads, soak feet in hot water, use heavy socks to protect against the cold.
   - any open wounds- wear bandages, do not put pressure on open areas when walking.
2. Live Healthy
   - eat a balanced diet
   - exercise regularly
   - if you smoke, quit
   - control medical conditions such as diabetes

Question 14

Correctly measure a wound and document in objective in a SOAP format

Answer 14

• Length x width as linear distances from wound edge to wound edge and then multiplied for surface area in one of two ways: Clock method - head being 12 o’clock and landmarks would be defined and the corresponding widest and longest areas of the wound is measured and then surface area is calculated.
• Depth - Depth of the wound can be described as the distance from the visible surface to the deepest point in the wound. If the depth varies, you would want to record the deepest site, so you may have to take multiple measurements.Typically, a sterile, cotton-tipped applicator (6”) is used. The applicator is inserted gently into the deepest portion of the wound. The thumb and forefinger grasp the applicator at the point corresponding to the skin surface.
• Tunneling and/or undermining (how deep and time)
• Color
• Slough (% of surface area)
• Any structures such as bone - measure l x w and which bone
• Odor
• Pain if present
• Periwound area (color, epiboly, etc.) (use clock method ex. 3-6 o’clock)
• Drainage- amount, color and consistency (serous-clear, watery plasma, sanguinous- bloody, sero-sanguinous- plasma and red blood cells, purulent- thick, white blood cells may be yellow, green or brown, if infected)
• Which stage (if pressure ulcer) or thickness
• Edema (only if present)
• Maceration (if present)
• Location

Question 15

Demonstrate the correct application and safe removal of the following dressings on your lab partner’s arm: a dry to dry dressing on an 1 inch imaginary incision area and a semipermeable film dressing to an imaginary ½ inch long superficial skin tear.

Answer 15

Clean skin with “skin prep”, use clean method, make “window pane” with tape, slowly pull tape off to remove or to remove film pull toward you.

Question 16

When shown a wound picture, identify wound characteristics including but not limited to color, type, stage, infection and etiology.

Answer 16

Color: red, yellow, black, pink, gray, white, etc.
Stage: I, II, III, and VI
Thickness: Superficial, Partial, and Full Thickness
Infection: Necrosis, eschar tissue present
Etiology: Venous insufficiency, DM, burn, poor skin integrity, pressure, etc.
Practice identifying pictures from BB

Question 17

When shown a wound picture, identify wound characteristics including but not limited to color, type, stage, infection and etiology.

Answer 17

Type: Granular- a collagen matrix which contains different types of cells that contribute to wound healing, such as: endothelial cells, fibroblasts, lymphocytes, platelets, and epidermal cells. This tissue has a red, beefy, shiny, granular appearance.

• Necrotic eschar- a slough produced by gangrene.
• Exudate- a fluid with a high content of protein and cellular debris which has escaped from blood vessels and has been deposited in tissues or on tissue surfaces, usually as a result of inflammation.
• Epithelial tissue- Re-establishment of an epidermis on top of the granulation tissue; epithelial margins will begin to migrate toward the center of the wound; This process is sometimes referred to as a “contraction” of the wound… where the surface area of the wound reduces in size. When epithelialization is complete, a scar results.
• Slough- necrotic fatty tissue in the process of being separated from viable portions of the body.
• Maceration- a term used for moisture saturated skin, usually in the periwound area.

Question 18

discuss the requirements of and demonstrate the creation of a sterile field.

Answer 18

The field is designed to maintain the sterility of objects contained within the field, such as dressings or bandages, and to prevent contamination of the objects.

• Contamination occurs when any time a sterile item physically contacts a nonsterile item.
• Do not talk, sneeze, or reach across a sterile field
• Do not turn your back to the field
• Do not leave the field unattended
• A 1-inch border along the edges of the field is considered to be nonsterile
• The gloves, front of the gown above waist level, and both sleeves of the gown are the only portions of your protective clothing that are considered sterile.
• Position the items on the field so the items to be used first are nearest you.
• The area below the surface of the sterile field are considered nonsterile.

Question 19

discuss the requirements of and demonstrate the creation of a clean field.

Answer 19

Preventing the spread of pathogenic microorganisms

• Wash hands
• Utilize gloves, gown, and mask when indicated
• Use clean equipment
• Handling linens in ways that prevent germs from spreading

Question 20

Discuss the considerations for choosing a dressing, dressing size, various modes of securing wound dressings and precautions regarding tape use at a would site.

Answer 20

Choosing a dressing-
Protection: prevent additional wound contamination, keep microorganisms in the wound from infecting other sites, prevent from further injury, and provide a “barrier”to the outside environment.
Absorption of wound drainage (necrotic tissues, blood, etc.)
Moisture retention
Mechanical debridement (non-specific)

Dressing size- Needs to be at least 2” around wound

Modes of securing wound dressing- tape and secondary dressings holding primary dressing in place.
Tape precautions- injuries and allergies. When securing the dressing, care should be taken to avoid additional insult to the skin from the tape or adhesive. You need to be aware that tape should be applied without excessive pulling or tension; and also ASSESS THE AREA UNDER AND AROUND THE TAPE FOR ANY ALLERGIC REACTION. Paper tape is best.

Question 21

Identify primary and secondary dressings and suggest appropriate dressing(s) when given a wound example.

Answer 21

Primary dressing: next to wound
Secondary dressing: often serve to hold primary dressing in place
Stage I- (re-positioning)
Stage II- Hydrocolloid
Stage III- Calcium alginate
Stage IV- gauze or calcium alginate
Skin tear- semipermeable film or impregnated (vaseline) gauze and roll gauze (as secondary dressing) (if skin integrity is in question)
Neuropathic/Diabetic ulcer- hydrogel with secondary gauze
Arterial ulcer- hydrogel with secondary gauze
Venous ulcer- semipermeable foam or calcium alginate with short stretch bandage
Red wound- collagen wound bandage

Question 22

Identify the various topical solutions used in conjunction with dressings.

Answer 22

Sterile Saline Solution: frequently used in the irrigation of wounds; doesn’t sterilize or disinfect or harm, just moistens. It is commonly used with gauze dressings. (Not considered a topical agent but included here for convenience.)
Povidone-Iodine Solution (Betadine): Antimicrobial, used on necrotic tissue, some sources say that this product has really lost it’s value that it once had claimed.
Sodium Hypochlorite Solution (Household Bleach): Used as an antimicrobial agent in controlling sepsis; used in whirlpool baths in a .25 percent to .5 percent solution. Can be cytotoxic if not properly diluted.
Chloramine-T (Chlorazene) Less irritating than sodium hypochlorite. Chlorazene products are available pre-packaged for use in specific-sized whirlpool tanks.
Dakin’s Solution Mixture of sodium hypochlorite and boric acid. (Clorox and baking soda) This solution is bactericidal. Should never be used more than 1 week and some sources say 4 days. Dakins can cause maceration. For wounds w/ excessive slough.
Acetic Acid Solution
Neosporin Ointment, Silvadene, and Furacin
Hydrogen Peroxide: Because of it’s effervescent action, H2O2 is a mechanical cleansing agent and a non-specific debriding agent.
Hydrogen peroxide has little bactericidal actions, but it may be helpful to loosen dried exudate or debris on a superficial wound surface/approximated wound incision. It shouldn’t be applied to “clean wounds” because it may destroy granulation tissue. Also, it should never be “poured” into wound tunnels, because of the gas build-up potentially causing an air embolus.

Question 23

Describe intervention for diabetes/neuropathy ulcers

Answer 23

As with other ulcers, neuropathic ulcer treatment consists of coordination, communication, and documentation of patient/client related instruction and individual procedural interventions.

Interventions might include:

• patients must be throughly informed of the disease process and medical management of diabetes.
• pt must be educated in proper shoe wear and foot care guidelines.
• local wound care; daily application of petrolatum-based moisturizer to feet
• modalities such as negative pressure wound therapy, ultrasound, and e-stim, as well as growth factors (oasis), may be useful for wounds that are slow to heal.
• total contact casting is efficient for treating grades 1 and 2 for neuropathic ulcers. Total contact casts are essentially modified short leg casts.
• patients with fragile skin may benefit from a walking splint.
• patients not meeting criteria for total contact casting may benefit from a padded ankle-foot orthoses or walking shoes.
• therapeutic exercise- gait and mobility training. Patients should be taught how to ambulate by using a non-weight bearing pattern to eliminate continued trauma to the affected area. More commonly pt is taught partial weight bearing due to lack of strength/endurance.
• range of motion exercises- specifically targeting great toe extension, talocrural dorsiflexion and subtalar joint motions.
• temporary inserts for shoes made of felt or foam can be customized to unweight ulcerated areas and better distribute forces over surfaces of the foot.

Question 24

Describe and discuss wound classification by thickness

Answer 24

Classification by thickness- designed for use with wounds whose primary cause is something other than pressure. This is typically the classification system for burns, skin tears, lacerations, surgical wounds, and vascular ulcers. (superficial, partial, full)

Classification by thickness-
superficial- into only the dermis
partial-wounds extends through the first layer of skin (epidermis) and into, but not through the second layer (dermis)
full- extend through the epidermis and dermis, and may involve subcutaneous tissue, muscle, and possibly bone. (grafting/flaps are necessary).

Question 25

Describe and discuss wound classification by color

Answer 25

Classification by color- designed for use with traumatic, surgical, and other wounds healed by secondary intention.

primary intention- healing occurs where edges have been closely approximated by sutures or staples.

secondary intention- healing in wounds that start out with large surface areas with distracted edges, or wounds in which a large amount of tissue has been lost.

delayed primary intention- refers to a wound left open for several days before wound is closed with suture.

Question 26

Classification by color; describe red, yellow, and black wounds.

Answer 26

Red Wound-indicates a clean, healthy granulation tissue. When a wound begins to heal, a layer of pink granulation tissue covers the wound bed, which later becomes beefy red.

Yellow Wound- indicates the presence of exudate or slough produced by microorganisms and the need for cleaning. Exudate can by yellow, creamy yellow, yellowish green, or beige.
Exudate- a fluid with a high content of protein and cellular debris which has escaped from blood vessels and has been deposited in tissues or on tissue surfaces as the result of inflammation.
Slough-necrotic fatty tissue in the process of being separated from viable portions of the body.

Black Wound-indicates the presence of eschar. Necrotic tissue slows healing and provides a site for microorganisms to proliferate.
Eschar- a slough produced by gangrene.

*a wound can display two or more colors at once. Intervention would then be based on the least desirable color present.

Question 27

Describe wound measurement for; length, width, depth, tunneling

Answer 27

Length x Width= the length and width of any wound is measured as linear distances from wound edge to wound edge and the multiplied for surface area. It included peri-wound opening tissue if affected.

Depth- can be described as the distance from the visible surface to the deepest point in the wound. If the depth varies, record it at the deepest site.
A sterile cotton-tipped applicator is used and inserted into the deepest portion of the wound. Grasp the applicator at the point corresponding to the skin surface.

Tunneling and Undermining- need direction via clock/head at 12:00 and depth.

Question 28

What do you include for your documentation for measurement of pressure ulcers for Stage I, Stage II, Stage III, Stage IV?

Answer 28

Stage I- document and describe length and width
Stage II- document and describe length, width, and depth.
Stage III- document and describe length, width, depth, and tunneling if present.
Stage IV- document and describe length, width, depth, tunneling (if present), and underlying support structures (fascia, muscle, and bone)

Question 29

What do you include in your wound description for documentation regardless of classification system utilized?

Answer 29

1.)Location- identify anatomical location of skin breakdown; specific to bony prominances, joints, etc.

2. )Surrounding Skin Description-
   - color
   - whether or not the skin is moist, weepy, dry
   - whether or not there are signs of infection (red,swollen, warm, painful, exudate, strong odor)
   - lack of pain
   - whether or not there is an epithelial edge

3.)Drainage- amount: light, moderate, heavy or scant, copious, large.

4.)Color and Consistency-
Serous: clear, watery plasma
Sanguinous: bloody
Sero-Sanguinous: plasma and red blood cells
Purulent: thick, white blood cells may be yellow, green or brown if infected.

5.)Odor: pungent, strong, foul, fecal, musty

Question 30

What else can you include in your wound documentation in addition to everything else listed in previous slide?

Answer 30

Wound Tracing- clear food wrap next to wound

• transparency over food wrap
• transparency is copied
• commercial 2- part transparencies are also available.

Photography- patients must sign a release to be photographed.

Question 31

Discuss wound management according to color system

Answer 31

Black Wounds:
Primary Goal- removal of necrotic tissue/eschar.
Tx Strategies-
sharps or surgical debridement, hydrotherapy, chemical or mechanical debridement, occlusive dressings if not infected or penetrated to muscle, bone or tendon (occlusive dressings can moisten eschar after scoring), topical agents w/dressings if infected.

Yellow Wounds:
Primary Goal- cleansing and absorption of exudate.
Tx Strategies- blunt debridement, mechanical debridement if infected, whirlpool or pulsatile lavage, wound irrigation, occlusive dressings (if not infected), electromodalities

Red Wounds:
Primary Goal- protection, keep wound moist.
Tx Strategies- occlusive dressings, electromodalities. Hydrotherapy is contra-indicated. Do not use antiseptic agents either.

Question 32

Discuss basic goals of wound management

Answer 32

• to protect the wound and surrounding tissue from additional trauma.
• to reduce strain on the tissues near the wound
• to protect the tissue in the area of the wound from mechanical stress.
• to reduce the number of pathogenic microorganisms in and around the wound.
• to decrease or reduce the formation of scar tissue.

Question 33

Describe the first stage in wound healing

Answer 33

First Phase/Stage: Inflammatory phase or defense phase. The body’s initial reaction to the insult is inflammation. This phase is characterized by edema, erythema, heat, and pain.

This phase typically lasts from 4-6 days, however it can last up to 2 weeks.

Functions of the inflammatory phase:

• limit tissue damage
• removed injured or damaged cells
• repair injured tissue

Important to note, inflamed wounds may or may not be infected, and infected wounds may or may not be inflamed

Question 34

Describe the second stage in wound healing

Answer 34

Second Phase/Stage: Proliferative Phase or regeneration phase. This process involves the body reacting to specifically repair the wound by replacing damaged tissue. There are 2 major events in the proliferative phase; granulation tissue formation and re-epithialization.

This phase typically last from 4-24 days, however it can last much longer depending on what is inhibiting the wound.

Question 35

During the proliferative stage of healing, there are 2 main events that take place. Describe those events.

Answer 35

1.)Granulation tissue formation- granular tissue is a collagen matrix which contains different types of cells that contribute to wound healing, such as: endothelial cells, fibroblasts, lymphocytes, platelets, and epidermal cells.

As this type of tissue proliferates, fibroblasts stimulate the ongoing production of collagen.

• Collagen is what gives tissue its tensile strength and ultimately, its structure.
• Neovascularization also occurs during this phase. This is where a new blood supply is generated.
  2. )Re-Epithelialization- re-establishment of an epidermis on top of the granulation tissue. Epithelial margins will begin to migrate toward the center of the wound; This process is sometimes referred to as CONTRACTION of the wound. This is where the surface area of the wound reduces in size. When epitheliazation is complete, a scar results.
• Why don’t we back stage pressure ulcers? Because it isn’t the same tissue.

Question 36

Describe the third stage in wound healing

Answer 36

Phase 3: Remodeling or Maturation Phase. Primarily the collagen fibers continue to reorganize, remodel, mature, and gain tensile strength. This process will continue until the scar tissue has regained approximately 70% of the skins’ original tensile strength.

This phase typically lasts from 21 days to 2 years.

Question 37

What are the factors that impede healing; local and systemic?

Answer 37

Local Factors: refers to something happening in and around wound.

• pressure
• dry environment- wounds will heal 3-5 times faster and less painfully in a moist environment than a dry one.
• trauma and edema
• infection vs contamination- organisms greater than 10 to the 5th power per gram of tissue are considered “infected”.(when a pressure ulcer of a full thickness wound fails to heal, the pt should be evaluated for osteomyelitis)
• critical colonization- declining granulation, state immediately before infection. (Sterile to clean to contaminated to critically colonized to infected.)
• necrosis- dead, devitalized tissue can impede healing. 2 types of necrotic tissue may appear in a wound; slough and eschar.

Systemic Factors:

• age
• body build
• chronic diseases
• nutritional status- you need protein, vitamin C and zinc to heal a wound.
• vascular insufficiencs
• immunosuppression and radiation therapy; slow healing.
• other common drugs can impede healing (NSAIDS)

Question 38

Describe and compare physical therapy interventions and modalities available for wound care. Also, identify when they are appropriate including correlation to tx of specific wound classification categories.

Answer 38

1. )Compression Therapy-
   a. ) IPC Pump
   b. ) Wraps

2.) Ultrasound- FDA approved for soft tissue injury (wounds). Thermal effects can cause necrosis. Thermal US is NOT used in wound management.

3.E-Stim- High Voltage Pulsed Current (HVPC)
FDA approved for; increased circulation aka perfusion which is best for wound healing. Muscle spasms, muscle re-education, increased joint ROM, Pain. You must note that EMS is being applied to increase circulation or decrease muscle spasms. Not “for wound healing”.

4. ) Therapeutic exercise- to gain strength to increase bed mobility and ambulation ability. Also to prevent contractures.
5. ) Positioning in bed and wheel chairs- Examples of position devices; low air loss bed, low profile air mattress, high profile air mattress, joy cushion for wheel chair, roho cushion. NO DONUTS.
6. ) Patient and Staff Education

Question 39

Describe the following terms; selective and nonselective debridement, mechanical, chemical, enzymatic, autolytic, sharp and surgical debridement. Also list what PPE is needed for mechanical debridement.

Answer 39

Debridement= the removal of necrotic, dead or devitalized tissue.

Selective vs Non-Selective-
Selective- removes specific tissue
Nonselective- removes non-specific areas of tissue.

Mechanical Debridement (non-selective)- the use of force to remove devitalized tissue. Can be accomplished by:

• blunt- moist, soft, sterile mechanical devices (gauze/brush) and swabbing action to remove necrotic tissue.
• Gauze Dressings- wet to dry, wet to wet, dry to dry (only with infection)
• Hydrotherapy-whirlpool; appropriate only with Stage III and Stage IV pressure ulcer + 50% or more necrotic.
  - Pulsatile Lavage- 8-15 psi- one person per room, PPE.

Non-Selective Debridement cont’d;

• Surgical Debridement-defined as a blunt or sharp debridement performed by a MD under general or local anesthesia.
• Chemical Debridement- compounds used to eliminate non-selective types of necrotic tissue. Examples; Dakins, Silver Nitrate (for epiboly)

Selective Debridement;
Enzymatic- accuzym and panafil,(non-reimbursable)
santyl-specific to collagen (reimbursable)

Autolytic- uses moisture retentive dressing and body enzymes to eliminate specific necrotic tissue. Foul odor but not infected.

Sharps- removal of specific dead or necrotic tissue from a wound using sharp instruments such as forceps, scissors or scalpels.

Use gloves, a gown and a mask to prevent the spraying of irrigation fluids and debris onto you.

Question 40

Compare and contrast the following dressing types: gauze dressings (dry to dry, wet to dry, and wet to wet), occlusive dressings (semipermeable films, semipermeable foams, semipermeable hydrogels, and impermeable hydrocolloids), and biosynthetic dressings

Answer 40

Gauze
Wet-to-Dry - One layer of gauze with saline or other topical agent covered by a second layer moistened with the same material. Danger: pain upon removal; possible detachment of viable epidermal surface cells.
Wet-to-Wet - Both layers are moistened from wetting agent and they are continually bathing the wound surface. They are not allowed to dry. Least painful but may cause maceration and least effective with mechanical debridement
Dry-to-Dry - Gauze is applied directly to wound surface (two layers). Most effective; most painful; most danger of removing viable tissue.

Question 41

Compare and contrast the following dressing types: gauze dressings (dry to dry, wet to dry, and wet to wet), occlusive dressings (semipermeable films, semipermeable foams, semipermeable hydrogels, and impermeable hydrocolloids), and biosynthetic dressings

Answer 41

Occlusive Dressings
On a continuum regarding impermeability to water.
See-through films allow better visualization of the wound – not all occlusive dressing are “see-through”
fewer dressing changes (cost effective)
ability to shower/bathe without removal of dressing.
They maintain tissue hydration. Occlusive dressings have proven to provide a more favorable environment for the wound to heal resulting in more efficient epithelialization.

Semipermeable Films (SPFs)
Constructed from transparent polyurethane or similar synthetic films, coated on one surface with a water-resistant hypoallergenic adhesive.  SPFs are highly elastic and conform easily to body parts; they are also generally resistant to shear and tear.  Films are used with minimal exucade i.e. skin tears

Semipermeable Foams (SPFos)
These dressings have hydrophilic properties on the wound side of the dressing and hydrophobic characteristics on the other.  SPFos allow for absorption of the wound’s exudate, so they are more appropriate for moderate to high exudate wounds.

Semipermeable Hydrogels (HDGs) -Hydrogels are capable of absorbing mostly minimal amounts of exudate (depends upon the actual hydrogel composition they may absorb moderately). HDGs provide a suitable wound microenvironment. HDG dressings are oxygen permeable, and provide some cushioning to the wound via the layer of the gel. If they are non-adhesive they must be held in place by a secondary dressing.

Impermeable Hydrocolloids (HDCs) (Duo-Derm) These dressings combine the hydrogels with an adhesive inner surface. The outer layer is water and bacteria impermeable; they are also impermeable to oxygen and gas. These dressings absorb exudate and expand into the wound, conforming to the wound’s contours.

Hydrocolloid Absorption Powders, Pastes, and Granules
These products help absorb excessive wound exudate and control bacteria; also assist in wound cleansing and odor reduction.

Question 42

Compare and contrast the following dressing types: gauze dressings (dry to dry, wet to dry, and wet to wet), occlusive dressings (semipermeable films, semipermeable foams, semipermeable hydrogels, and impermeable hydrocolloids), and biosynthetic dressings

Answer 42

Biosynthetic and Biologic Dressings
These dressings are composed of tissue derived from animal or human sources in varying degrees, i.e., Skin grafts; Primarily used with patients who suffered burns.

Calcium Alginate – dressing formulated from “seaweed”, highly absorptive and can be used on an infected wound. Forms a gel layer when moistened.

Collagen wound dressings – Minimally absorptive, used on clean red wounds to promote collagen production. (Fibrocol)

Question 43

Discuss reimbursement issues related to wound management interventions.

Answer 43

Electrical Muscle Stimulation (EMS) – High Voltage Pulsed Current (HVPC)- Not “for wound healing” documentation must note EMS applied to ↑circulation or ↓ muscle spasm. 
FDA approved for
Increased circulation (perfusion)
Muscle spasm
Muscle re-ed
Increased joint ROM
Pain

Reimbursement concerns:
Approved for pressure ulcers stage III and IV or full thickness wounds.
Standards of care = use on wounds that have not shown progress in 30 days
Wound must improve in 30 days with EMS or treatment should be D/C
Patient’s pathology must be managed. For example, Diabetics – controlled blood sugar levels.

To be continued….. (I emailed debbie asking about this objective)