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822: Integumentary > Dressing Selection and Bandaging > Flashcards

Flashcards in Dressing Selection and Bandaging Deck (118):
1

What are the 6 benefits of moist wound healing?

- facilitates all 3 phases of healing
- decreases the intensity and length of the inflammatory phase
- traps endogenously produced enzymes within the wound bed, facilitating autolytic debridement
- preserves endogenously produced growth factors within the wound fluid
- reduces patient pain complaints
- results in a more cosmetically appealing scar

2

What are 3 consequences if the wound is too moist?

- Maceration
- Additional skin damage/ulcer
- Increased chance of infection

3

What are 2 consequences if the wound is too dry?

- Crust formation
- Lack enzymes/ growth factors

4

What did Heather Hettrick compare a perfectly moist wound to?

al dente pasta

5

What are 5 functions of wound dressings?

- Create moist environment
- Provide thermal insulation
- Hemostasis
- Control edema
- Eliminate dead space within wound bed

6

Wounds heal faster if the environment is maintained between __ and __ decrees Celsius.

37-38

7

Why is maintaining wound temperature between 37 and 38 degrees important?

It enhances tissue perfusion by causing vasodilation.

Increases oxygen saturation and decreases hemoglobin's affinity for oxygen.

8

Wound temperature decreases with each dressing change and may remain decreased for up to __ minutes after a dressing change.

90

9

Why must dead space within a wound be eliminated?

to prevent premature wound closure and abscess formation

10

What are the 2 basic types of wound dressings?

- primary
- secondary

11

Describe a primary wound dressing

It comes into direct contact with the wound and, therefore, is sometimes called the contact layer

12

Describe a secondary wound dressing

It is placed over the primary dressing to provide protection, cushioning, absorption, or occlusion

13

True or False

Alli Volkens spent countless hours making these notecards therefore should be the only one who uses them to study.

TRUE!

If you did not contribute please kindly remove yourself and make your own cards.

14

A moist wound heals _-_ times faster than a dry wound

3-5

15

What is an example of a primary dressing that does not require a secondary dressing?

Band-Aid

16

What type of dressings are specialized synthetic or organic dressings that are typically more occlusive than gauze?

Moisture-Retentive Dressings

17

What does occlusion describe?

The ability of the dressing to transmit moisture vapor and gases from the wound bed to the atmosphere.

18

Describe truly occlusive and truly nonocclusive substances.

A truly occlusive substance, such as latex, is impermeable to water, vapor, or bacteria.

A truly nonocclusive substance, such as air, is completely permeable to water, vapor, and bacteria.

19

Moisture-retentive dressings have a ____ moisture vapor transmission rate than gauze. What does this mean?

lower

They are better able to trap wound fluid rich in enzymes, neutrophils, growth factors, and macrophages within the wound bed.

20

Lower moisture vapor transmission rates are associated with _____ wound healing and _____ pain complaints.

faster

lower

21

What are 2 common fears associated with the use of moisture-retentive dressings?

- infection
- trauma to the wound bed and surrounding skin

22

What are the 4 reasons why occlusive dressings have lower infection rates compared to nonocclusive dressings?

- they serve as a bacterial barrier
- they require less frequent dressings changes
- facilitate the neutralization of micoorganisms by retaining macrophages and neutrophils
- facilitates the removal of necrotic tissue and debris microbes feed upon by preserving endogenous enzymes within the wound fluid

23

The risk of infection when using moisture-retentive dressings can be further reduced by following a few simple guidelines. What are they?

- should be changes if the barrier properties become compromised
- more frequent dressing checks should be performed in immunocompromised patients due to the risk of silent infections
- discontinue if the signs of infection are detected

24

What are the 2 exceptions in which moisture-retentive dressings can be used on infected wounds?

Semipermeable foams and alginates

25

What prevents the moisture-retentive dressing from adhering to the wound bed?

the interaction of the dressing with the wound fluid

26

How should moisture-retentive dressings be removed in order to reduce the risk of skin trauma?

The edge of the dressing should be lifted up near the corner and then stretched longitudinally to decrease the dressing's adhesion to the skin's surface

27

On the wound dressing continuum of occlusion what is the least occlusive and what is the most occlusive?

Least: traditional gauze

Most: hydrocolloids

28

What are the 8 main categories of wound dressings on the market today?

- gauze dressings
- impregnated gauze dressings
- semipermeable films
- hydrogels
- semipermeable foams
- hydrocolloids
- alginates
- composite dressings

29

What are the 2 types of gauze dressings?

woven and nonwoven

30

What is woven gauze made from?

cotton yarn or thread

31

What is nonwoven gauze made from?

synthetic fibers pressed together

32

Do nonwoven or woven gauzes have greater absorbency?

nonwoven

33

What is loose weave gauze used for?

he mechanical debridement of wet-to-dry dressings by trapping foreign material, debris, and slough within the pores

34

Where does gauze fit on the permeable and occlusive continuum?

Highly permeable
Relatively nonocclusive

35

What does gauze promote in wounds with minimal exudate?

desiccation

36

Is gauze a primary or secondary dressing?

can be either

37

When is gauze the dressing of choice?

When a wound requires daily or more frequent dressing changes. Therefore, gauze is commonly used on infected wounds or wounds being treated with enzymatic debriding agents.

38

Woven gauze may leave a residue or lint within the wound bed, the body may respond to this foreign material by forming what?

a granuloma

39

How should rolled gauze be applied?

Snugly but without tension and arranged on a slight angle rather than straight across

40

In what type of wound are Telfa dressings used?

superficial, nondraining wounds closed by primary or secondary intention

41

Impregnated gauzes are mesh gauze dressings into which materials such as what 4 things have been incorporated?

- Petrolatum
- Bismuth
- Zinc
- Hydrogel
- Saline

42

Describe what impregnated gauze is used as?

It is used as a nonadherent contact layer which requires a secondary dressing, typically regular gauze

43

Gauze impregnated with ____ such as paste bandages, or Unna's boot, are used primarily in the treatment of venous insufficiency ulcers

zinc

44

In what type of wound are petrolatum-impregnated gauzes common used for and why?

Burn wounds because they allow for pain-free removal

45

In what types of wounds can bismuth impregnated gauze NOT be used in and why?

Venous insufficiency ulcers, because bismuth is cytotoxic to inflammatory cells and may be a sensitizing agent, that is, it may cause irritation, dermatitis, or an increased inflammatory response

46

Describe the structure of semipermeable film dressings

Thin, flexible sheets of transparent polyurethane with an adhesive backing

47

What are semipermeable films permeable to and what are the impermeable to?

Permeable to water vapor, O2, CO2

Impermeable to bacteria and water

48

Are semipermeable film dressings a good choice for deep wounds with excessive drainage?

No, because they have little absorptive/insulating capabilities

49

What are 2 benefits of semipermeable film dressings?

- Allow visualization of wound bed
- Highly elastic and conformable

50

How should semipermeable film dressings be applied?

Should be secured to a 1-2 cm border of intact skin, and should be applied without tension or wrinkles.

51

How long can semipermeable film dressings be left on?

5-7 days

52

In what type of wounds are semipermeable film dressings used?

Superficial wounds such as skin tears, lacerations, and abrasions.

Partial-thickness wounds, sutured wounds, and donor graft sites

53

In what other situations can semipermeable film dressings be used?

- To cover catheter sites or wounds to allow for bathing
- Areas of friction
- Within total contact casts and splints

54

In what situations should you not use semipermeable film dressings?

- Infected wounds
- Wounds with moderate to heavy drainage
- Patients with fragile skin

55

Hydrogels are __-__% water or glycerin based wound dressings that are available in sheets, amorphous gels, or impregnated gauzes

80-99

56

Hydrogels are able to absorb ______ amounts of fluid by swelling. They are also able to
_____ moisture to dry wounds.

minimal

donate

57

What are hydrogels permeable to? What does this result in?

gas and water, making them less effective bacterial barriers than semipermeable films or hydrocolloids

58

How may hydrogels decrease pain?

They feel cool when applied to the skin or wound

59

In what type of wounds are sheet hydrogels indicated for?

Superficial and partial thickness wounds such as abrasions, skin tears, blisters, donor sites, radiation burns, thermal burns, pressure ulcers, diabetic ulcers, mastitis, and surgery sites

60

Why may hydrogels be chosen for use?

- to assist in autolytic debridement
- to moistens the wound bed for improved healing time

61

In what type of wounds should hydrogels not be used in?

- Heavily draining wounds
- Infected wounds
- Bleeding wounds

62

What should be used in combination with hydrogels to prevent maceration?

a skin sealant

63

What are semipermeable foam dressings made of?

Polyurethane foam with a hydrophilic wound side and a hydrophobic outside

64

What are semipermeable foam dressings permeable to? What are they impermeable to?

Permeable to gas but not to bacteria

65

What 4 advantages to semipermeable foam dressings?

- provide thermal insulation
- provide cushioning
- easy to apply and remove

66

Semipermeable foams are especially useful in managing what type of wounds?

Pressure ulcers, especially stage II and III

67

Semipermeable foams are not indicated in what types of wounds?

- dry or eschar-covered wounds
- arterial ulcers
- heel ulcers

68

In what type of wounds are semipermeable wounds used?

- wounds with minimal to heavy exudate
- granulating slough covered partial and full-thickness wounds
- donor sites
- ostomy sites
- minor burns
- skin grafts

69

What do hydrocolloids contain?

Hydrophilic colloidal particles such as gelatin, pectin, and carboxymethylcellulose with a very strong film or foam adhesive backing

70

Describe how hydrocolloids absorb fluid

They absorb fluid slowly byswelling into a gel-like mass

71

Upon a removal of a hydrocolloid a residue remains which often leads clinicians to believe what?

That the wound is infected due to the foul smell

72

What are hydrocolloids impermeable to?

water, O2, and bacteria

73

What is the name of the most highly studied hydrocolloid due to the fact that it is an effective barrier against urine, stool, MRSA, hepatitis B, HIV-1, and Pseudomonas?

DuoDerm

74

What are hydrocolloids used to treat?

- pressure ulcers (majority)
- minor burns
- venous insufficiency ulcers

75

How often should hydropcolloid wound dressings be changes?

every 3-8 days

76

In what type of wounds are hydrocolloids not recommended?

- Arterial ulcers
- 3rd degree burns
- Wounds with minimal drainage
- wounds with exposed fascia (stage IV PU)

77

Hydrocolloids are contraindicated in what type of wounds?

infected wounds

78

The use of hydrocolloids has been associated with ____granulation (hyper or hypo)

hypergranulation

79

What are alginates made of?

Salts of alginic acid from brown seaweed and converted into calcium/sodium salts

80

What do alginates react with when placed within the wound?

serum and wound exudate to form a hydrophilic gel to provide a moist wound environment

81

Where do alginates fit on the permeability and occlusive continuum?

Highly permeable and nonocclusive

82

Do alginates require a secondary dressing?

Yes

83

What are the 3 forms alginates are available in and what are each used to treat?

1) alginate sheets are placed on wound beds to absorb drainage
2) alginate ropes are used to lightly fill wound tunnels or areas of undermining
3) alginate-tipped applicators are used to fill wound cavities and tunnels, perform culture swabs, and measure wound depth

84

An alginate can absorb __ times its weight

20

85

In what type of wounds are alginates used in?

- VI ulcers
- pressure ulcers
- neuropathic ulcers
- burns
- infected wounds

86

When alginates are used on infected wounds how often should the dressing be changed?

at least daily

87

In what types of wounds are the use of alginates not recommended?

- full thickness (3rd degree) burns
- wounds with exposed tendon, joint capsule, or bone

88

How many layers do most composite dressings have?

3

89

Describe the inner layer of composite dressings

It is nonadherent, preventing trauma to the wound bed during dressing changes

90

Describe the middle layer of composite dressings

It absorbs moisture and wicks it away from the wound bed to prevent maceration while maintaining a moist wound environment

91

What does the middle layer consist of?

Hydrogel, semipermeable foam, hydrocolloid, or alginate

92

Describe the outer layer of composite dressings

It serves as the bacterial barrier and is commonly composed of a semipermeable film

93

What are 2 types of antimicrobial wound dressings?

- Silver
- cadexomer iodine

94

What do silver dressings do to the wound bed?

They turn the wound bed a blue-black color which must not be mistaken for eschar

95

True or False

Silver dressings cannot be used in conjunction with electrical stimulation

True

96

Cadexomer iodine must be used cautiously in patients with what type of disease?

thyroid

97

What is the key function of charcoal dressings?

control odor by absorbing odor-producing gases released by bacteria

98

What type of honey can be impregnated in a dressing?

Leptospermum, also known as Manuka honey

99

What are the 2 proposed benefits of honey-impregnated dressings?

- control wound bioburden
- control wound odor

100

What are the 5 purported ways honey-impregnated dressings improve healing?

- Antimicrobial
- Stimulates angioblasts, fibroblasts, monocytes
- Reduces inflammation and edema
- Osmotic action controls drainage
- May stimulate growth factors

101

Collagen dressings should be considered in what stage of pressure ulcer?

III or IV

102

What are the 5 purported ways collagen dressings improve healing?

- Stimulates macrophages, angioblasts, keratinocytes, platelets
- Protects growth factors
- Provides scaffolding for cell proliferation/migration
- Maintain moist wound environment
- May encourage balance between MMPs and TIMPs

103

What do skin sealants do?

Make the skin tacky to provide a better edge seal

104

Skin sealants must be used on _____ skin

intact

105

What do moisture barriers do?

Prevent perineal rashes/skin breakdown

106

What 3 things do moisturizers do?

- help restore the barrier function of the epidermis
- provide a soothing protective film over intact skin
- increase the water content of the epidermis

107

_____-based moisturizers are particularly effective in the management of calluses, dry skin in individuals with diabetes, and burn scars.

Petroleum

108

Are ointments or creams/lotions more occlusive? Explain why...

Ointments, because they are mixtures of water and oil. Whereas lotions are primarily water

109

When staples or sutures are not used to close a primary wound, what is used?

tissue adhesive/skin glue

110

Growth factors include what 3 things?

- cytokines
- interleukins
- colony-stimulating factors

111

In what type of wounds are growth factors used?

chronic wounds that are recalcitrant to traditional interventions

112

What is a disadvantage to using growth factors?

Extremely costly

113

What is the name of the growth factor approved for use on diabetic foot ulcers?

Becaplermin

114

What is the name of the growth factor approved for use on PT chronic ulcers?

Porcine/Oasis

115

Biosynthetic dressings encourage what type of debridement?

autolytic

116

What are the 3 types of skin grafts?

- allograft (tissue taken from a cadaver)
- xenografts (tissue taken from an animal)
- autografts (tissue taken from unaffected area of the patient)

117

If the wound is infected what are 3 dressing options?

- gauze
- alginate
- semipermeable foam

*avoid occlusive dressings

118

What type of dressing should be used if the intent is to leave it on for 3 or more days?

Adhesive, moisture-retentive dressings