Deck 1

Question 1

Bandages and its use.

Answer 1

1. Absorbent bandages
   - Indication: Open contaminated and infected wounds.
   - Contact layer: Hydrophilic material.
   - Adhesive or elastic tape for final covering.
2. Adherent bandages
   - Wet-dry: Absorb necrotic debris.
   - Wet-wet: Similar to wet-dry, except contact layer remains wet.
   - Dry-dry: Wound with loose necrotic tissue and debris.
3. Non-adherent bandages
   - Wet-dry, wet-wet and dry-dry.
4. Occlusive bandages
   - Allow wound fluid and normal body moisture to accumulate.
5. Tie-over bandages
   - Indicated for joint: Hip, shoulder, axilla or perineum.
   - Fixation of bandage with suture to the skin.
6. Stabilizating bandages
   - For immobilize fractures.
   - Robert-Jones bandages.
7. Post-operative or closed wound bandages
   - Bandages on area without open wound: To absorb fluid from drain, support incision, compress dead space and prevent trauma.
8. Pressure bandages
   - Control minor hemorrhages, oedema and granulation tissue.
9. Pressure relief bandages
   - Bandages prevent pressure over area: Over bony prominents.
   - Distribution of pressure around, rather than over wound.

Question 2

Contact surface classification.

Answer 2

Selection factors in contact layers:
- Phase of wound healing.
- Amount of exudates.
- Wound location and depth.
- Presence or absence of eschar.
- Amount of necrosis.
- Presence of infection.
Different types:
- Hydrophilic: Hypersonic saline, calcium algine, polyuretan foam, hydrogel, hydrocolloid and some topical medicines.
- Dry adherent: No longer recommended (painful to remove, wound dessication and also removal of healthy cells).
- Wet adherent: No longer recommended (damage of normal cells, wound dryness, pain and tissue damage during bandage changing, bacterial proliferation and tissue maceration).
- Adherent film/skin sealant: Transparent liquid spread over wound in a thin layer; made from natural ingredients; acts as a barrier (skin - granulation wounds - external environment); prevents skin irritation; change every 3-4 days.
- Non-adherent contact layer: Doesn’t stick to wound surface; used for moist wound healing; supports epitheliation and prevents dehydration; allows excess fluid to drain; prevents tissue maceration.

Question 3

Dressings based on purpose.

Answer 3

• Cleanse wound: Balanced electrolyte, saline solution.
• Absorb exudate: Absorption beads, pastes, powders, pads, foams, hydrocolloids, hydrogels, composite dressing.
• Autolytic debridement: Cover wound do allow endogenous enzymes in wound fluid to self-digest eschar and fibrinous slough.
• Add moisture to wound: Hydrogel, hypertonic saline dressing, medical honey.
• Maintain moist wound environment: Hyrophilic ointment, hydrocolloids, hydrogels, transparent films.
• Fill dead space: Absorption beads, pastes, powders, tapes.
• Reduce swelling to improve perfusion: Hypertonic saline.
• Prevent contamination: Impregnated anti-microbial gauze.
• Reduce bacterial numbers: Impregnated anti-microbial gauze, antibiotics.
• Cover and protect wound: Non-adherent, hydrophilic dressing.
• Protect surrounding skin from moisture and trauma: Moisture barrier ointments, skin sealants, transparent film dressings, bandages.

Question 4

Dressing based on wounds.

Answer 4

• Acute mild contamination and tissue damage:
- Haemostasis, debridement, reduce contamination and provide moist environment.
- Wound characteristic: Haemorrhaging < 6-8 hours old.
- Dressing: Calcium algine, hydrogel and hydrocolloid.
• Acute moderate-severe contamination and tissue injury:
- Reduce contamination and debride.
- Wound characteristics: Gross dirt debris in wound; contusion, avulsion, ischaemia; < 6-8 hours old.
- Dressing: Hydrogel and hydrocolloid.
• Exposed muscle, fascia and SC tissue:
- Provide moist environment, encourage granulation.
- Wound characteristics: Clean wound.
- Dressing: Calcium alginate and hydrogel.
• Necrotic:
- Promote debridement, provide moist environment and absorb exudates.
- Wound characteristics: Dry eschar or slough, excessive exudate and surface devitalised.
- Dressing: Hypertonic saline, hydrogel and calcium.
• Granular:
- Provide moist environment, encourage granulation.
- Wound characteristics: Irregular or incomplete granulation and minimal to moderate exudate.
- Dressing: Calcium and hydrogel.
• Needs epitheliation:
- Provide moist environment to promote and protect resurfacing.
- Wound characteristics: Healthy granulation; tissue is pink, smooth, dry and moist.
Dressing: Hydrogel sheet and hydrocolloid foam.

Question 5

Surgical infection - wound classification.

Answer 5

Clean, clean-contaminated, contaminated and dirty.

Question 6

Methods of injection.

Answer 6

1. Subcutaneus.
2. Intramuscular.
3. Intravenous.
4. Intradermal.
5. Intraperitoneal.
6. Intracardial.
7. Intaarticular.
8. Intrasynovial.
9. lntratracheal.
10. Subconjunctival.
11. Intaarterial.
12. Intrapleural.
13. Intramedular.