Dressing and moisture Flashcards
(39 cards)
1
Q
Primary dressing
A
- also called contact layer
- comes in direct contact with wound
2
Q
secondary dressings
A
- placed over the primary dressing to provide increased protection, absorption, compression or occulsion
3
Q
tertiary layer or support needs
A
similar to the secondary layer
4
Q
functional categories of dressing
A
- maintain existing moisture balance
- add moisture
- absorb excessive moisture
5
Q
Not enough moisture vs too much moisture
A
not enough:
- dry wound bed
- painful
- slower healing
too much moisture:
- macerated periound
- possible increase in wound size
- slower healing
6
Q
what are Skin protection/moisture barriers used for
A
- excess exudate on the wound edges can lead to maceration and destruction of critical wound edges
- protect with skin barriers
- consider dressings that absorb and decrease fluid at the wound edges
7
Q
Skin and periwound care: skin sealants/moisture barriers
A
- protect skin from maceration
- minimal protection from adhesives
- some products may interfere with wound care modalities
- ointments cannont be used with adhesive dressing
8
Q
Skin and periwound care
moiturizers
what too consider and what do they do
A
- maintain hydration
- provide protective layer to minimize fluid loss through skin
- dry skin can lead to inflammation, cracking, scaling, fissuring
- also consider dehydration
9
Q
transparent film dressings
A
- maitain exisiting moisture
- transparent sheets of polymers
- adhesive on oneside
- semi-permeable: allows oxygen and water vapor to cross
- encourage autolytic debridement
- allow visualization of wound bed
- waterproof
can be primary or secondary
10
Q
transparent films
indications
A
- supports autolytic debridement
- maintains moist wound environment
- protection form shear, friction, bacteria
- allows visualiation
- can be primary or secondary dressing
`
11
Q
transparent films
disadvantages
A
- does not adhere well to moist skin
- difficulty to use with heavy exudate wounds
- contributes to periwound maceration
- contraindicated in infected wounds
12
Q
hydrocolloids
A
- maintain exisiting moisture
- occlusive waffer dressing composed of gel-forming polymers
- when applied to an exuding wound, exudate combines with the polymers to form a soft gel mass in the wound
may be good with arterial wounds
13
Q
describe hydrocolloid dressings
A
- come in wide ranges of sizes, shapes, and types
- consists of 3 layers (inner slightly adhesive, middle absorbent layer with geltain/pectin base, outer semiocclusive)
- the resulting gel is acidic, not conducive to bacterial growth
- can help to slowly absorb excess moisture
- good to use when a wound is going from higher to lower exudate levels
14
Q
hydrocolloid dressings
indications/pros
A
- moisture retentive
- encourage autolytic debridement
- impermeable to urine, stool, bacteria
- provide thermal insulation
- waterproof
- moderate absorption
15
Q
hydrocolloid dressings
disadvantages
A
- may traumatize fragile periwound skin
- unable to visualize wound
- may leave residue in wound bed
- require a primary dressing to fill wound space, fissues or undermining
- may roll in areas of friction
- not for infected wounds
16
Q
hydrogels
A
- made of complex organic polymers with a higher water content
- moisture donating products that enable rapid rehydration of a wound
- may contain other ingredients: alginates for absorption, antimicrobials to decrease bioburden, collagen and growth factors for enhanced wound healing
17
Q
types of hydrogels
A
- amorphous gels
- sheets
- gel-impregnated gauze or mesh
- gels are useful for dry, desiccated wounds or if wound desiccation is anticipated
- conforms to the shape of the wound
18
Q
hydrogels
Pros
A
- hydrate dry wound beds (moisture retentive/add moisture)
- encourage autolytic debridement
- rinse easily from wound surface
- soothe wounds and reduce pain
19
Q
hydrogels
disadvantages
A
- not for exudating wounds
- macerate periwound tissue if wound becomes too wet
- requires secondary dressing
- usually require daily dressing changes
- not for infected wounds
20
Q
dressing to absorb moisture
A
- gauze
- foam
- calcium alginates
21
Q
gauze
indications
A
- superficial or cavity wounds
- moderate to heavy drainage
- filler for dead space
- form of mechanical debridement
22
Q
gauze
disadvantages
A
- may shed, leaving lint in wound
- permeable to moisture and bacteria
- if becomes dry, removal can cause trauma
23
Q
foam
Pros/indications
A
- less frequent dressing changes
- moisture retentive/absorbs moderate amounts of drainage
- thermal insulation
- cushioning
- adherent and non-adherent forms
- no residue
- primary or secondary dressings
24
Q
foam
disadvantages
A
- foam memory may make it harder to conform to wound surface
- adhesive may traumatize skin
- may roll
- not on infected wounds
- may macerate if becomes saturated
25
# calcium alginate
indications/uses
- Autolytic debridement
- highly absorptive
- infected or uninfected wounds
- conform to wound or fill wound spaces/cavities
- non-adherent
- available with silver or honey for bioburden management
26
# calcium alginate
limitations
- requires secondary dressing, to secure in place
- adheres to the wound bed if exudate is inadequate to create gel effect
- not suitable for dry eschar or low exudating wounds
27
# Miscellaneous dressings
Hydrofiber dressings
- highly absorbent
- most of all dressings - similar to calcium alginates
28
# Miscellaneous dressings
charcoal
- controls odor
29
# topical antimicrobial dressing
silver
- proven antimicrobial activity
- silver sulfadiazine is used in treatment of burns
- other forms inorganic compounds (silver oxide and silver nitrate) can be embedded into dressings
- wide variety of dressings deliver systems can be combined with other treatments
## Footnote
- broad-spectrum and inactivates almost all bacteria
- may be used to reduce bacteria and colonized and infected wounds or use to reduce risk of infection
30
# Topical antimicrobial dressing
medical grade honey
- manuka honey - derived from tea plants
- antimicrobial
- can change the wound pH and jump start immune response
- can enhance debridement
| `
31
cadexomer iodine
- paste or sheet dressings
- allow controlled release of 0.9% iodine
- reduces bioburden without being cytotoxic
- cannot be used with collagenase
32
collagen dressings: advantages
- provide temporary scaffolding and attracts cells to wound
- creates moist wound environment
- easy to apply
- cost effective advanced wound care
33
collagen dressings: when can it NOT be used
- not for 3rd degree burns
- not effective on necrotic tissue
- cultural restrictions as use bovine or porcine products
34
advanced dressings: biologics
| what is it/appligraft, allograft, osaasis, dermagraft
- specialized material derived from living organisms to harness healing properties
- appligraft: bovine type 1 collagen w/ living fibroblasts and keratinocytes
- allograft: cadaver skin to facilitate granulation while awaiting skin graftint
- oasis: porcine small intestine and collagen matrix
- dermagraft: living fibroblasts and ECM mesh scaffold
35
advanced dressings: procellera
- embedded with silver and zinc that creates microbatteries when activated by moisture (microcurrent) to attract epithelial cells
36
Growth factors: what do they do and how can they be used for dressings
| regranex Gel
- small proteins that act as signals for intracellular communication
- stimulate mirgation/proliferation for formation of new tissue
regranex gel
- used for LE neuropathic ulcers
- need adequate blood supply
- applied in thin layer covered with moist dressing
37
Pain during dressing changes
- minimize pain during dressing changes
- can have them do deep breathing, distraction, and rest breaks
- pain medication
- tape or adhesive dressing: take skin off the tape, pull in direction of hair growth, maybe moisten prior
- allow patient to assit with dressing removal (reduces anxiety)
38
Timing for pain medication if using during dressing changes
- oral meds: 30 minutes prior to
- IM injection: 10 minutes prior
- IV injections: immediately prior to
- topical anestheics: 15-20 min
- topical injections: per MD
- TENS: place proximal to wound during debridement
39
How to choose ideal wound healing
- provides moist wound environment
- manages exudate
- facilitate autolytic debridement
- minimizes pain
- prevents contamination by being impermeable to environmental bacteria (areas of incontinence)
- comparable with suppot needs (under contact cast or compression)
- Provides antimicrobial poperties if needed
- insulates and maintains optimal temperature
- prevents contamination
- easily applied and removed
- available and cost effective
