Dressings

Question 1

TIME prinicple

Answer 1

Tissue viable or deficient: debride wound and restore base.

Infection or inflammation: high microbial: antibiotics

Moisture imbalance

Epidermal margin: stimulate migration

Question 2

Primary vs Secondary Dressings

Answer 2

Primary: comes into contact with wound

Secondary: placed over primary for increased protection, cushioning, absorption, or occlusion

Question 3

Dressing Considerations

Answer 3

anatomical site
bacterial load
drainage amount
depth
edema
aggressive vs conservative

Question 4

Gauze advantages

Answer 4

Various shapes/sizes.
Can be used for packing.
Can be impregnated.
Nonadherent.
Primary or secondary
Non-selective debridement

Question 5

Gauze disadvantages

Answer 5

Pain with removal.
Can harm healthy tissue.
Can dessicate wound bed.
Little absorption.
No barrier to bacteria.

Not cost effective due to frequency of changes.

Question 6

Contact layers

Answer 6

Provide wound bed protection with fluid flow through.

May be able to be reused

Usually non-absorptive

Requires secondary dressing

May be impregnated

Question 7

Transparent films advantages

Answer 7

examples: tegaderm, op-site

Wound visible.
3-5 days.
Autolytic debridement
Semi-occlusive
Waterproof
Protect from friction/shear
Can be 1* or 2*

Question 8

Transparent films disadvantages

Answer 8

Minimal absoprtive.
Maceration.
Skin irritation.
Trauma upon removal.
Not to use on infection.

Question 9

Hydrocolloid advantages

Answer 9

“duoderm”, “second skin”

Occlusive
Autolytic debridement
Minimal-moderate absorbance
Can be used with compression
5-7 days
1* or 2*

Question 10

Hydrocolloid disadvantages

Answer 10

Odor
Hypergranulation
Maceration
Skin irritation
Edges roll/melt
Not to use with infection, undermining, or tunneling

Question 11

Hydrogel advantages

Answer 11

Waterbased gel

Moist wound environment
Pain management 
Autolytic debridement
Primary dressing
Can be used on viable and nonviable tissue.

Question 12

Hydrogel disadvantage

Answer 12

Variable viscosity
Maceration
Not for heavily draining wounds
Usually requires 2*

Question 13

Alginates and Hydrofibers advantage

Answer 13

Moderate-heavy draining wound
Viable or non-vaible tissue
Can assist with debridement
Can use compression
Can use on infected
Can pack wounds
Hemostatic

Question 14

Alginate disadvantages

Answer 14

Dessication

Alginate scab

Question 15

Foam advantages

Answer 15

Moderate to heavy drainage
Semi-occlusive
Adhesive or non-adhesive
Longer wear time
Wick away moisture
Protects/insulates
Retard hypergranulation

Question 16

Foam disadvantages

Answer 16

Maceration
Dessication
May require 2* dressing
Expensive

Question 17

Collagen Dressing advantages

Answer 17

Moderate to heavy drainage
Multiple forms
Reduces MMP

Question 18

Collagen disadvantages

Answer 18

Bovine ingredients (allergies)

Question 19

Composites

Answer 19

Two in one dressing: foam with other

Multiple features in one dressing

Various forms/sizes

Question 20

Combination

Answer 20

Two in one with antimicrobial

Multiple activities with one dressing

May be confusing for caregiver

Question 21

Silicone gel sheets

Answer 21

Used in maturation phase

Assists with scar management
May reduce hypertrophic scarring
Increase scar mobility
Reduce discoloration

Question 22

Antimicrobial dressings

Answer 22

Ointments
Silvadene
Silver dressings
Cadexamer
Wound cleanser
Dakin's
Acetic Acid
Betadine

Question 23

Antibiotic ointments

Answer 23

Bacitracin: water based, good for hands and face

Bactroban: effective against MRSA

Neosporin: allergies to neomycin

Question 24

Silvadene

Answer 24

Sulfa and silver

May look purulent when ready to remove

Can turn wounds dull/gray 2* silver

Question 25

Silver dressings

Answer 25

Effective against Pseudomonus, MRSA, staph, strep, eterococcus Can stain May require activation c sterile water Change twice for effectiveness against bacteria

Question 26

Hydrofera blue

Answer 26

Bacteriostatic against MRSA, VRE, staph, ecoli, more Methylene blue and crystal violet Requires rehydration Light/White when ready to be replaced Only antimicrobial that can be used in conjunction with enzymatic debriding

Question 27

Cadexamer

Answer 27

Iodoflex and iodosorb: pseudomous, MRSA, strep, staph ``` Time release Moderate to heavy drainage Assist with debridement Rust colored playdoh on application Yellow applesauce=ready to remove Indicated for sloughy, draining wounds ```

Question 28

Honey

Answer 28

``` Promotes moist wound environment Highly absorptive Cleanses and debrides Lowers pH Non-toxic, natural, safe ```

Question 29

Honey indications

Answer 29

``` DFU VLU ALU Pressure ulcer Superficial burns Donor sights Traumatic wounds ```

Question 30

Growth factors

Answer 30

Utilize platelet derived growth factor to stimulate proliferative phase. Regranex: recombinant. Indicated for DFU.

Question 31

Oasis

Answer 31

Biologic: from porcine small intestine Collagenous ECM c cytokines Temporary dressing for partial/full thickness loss. Hydrated on application

Question 32

Packing wounds

Answer 32

Fill, dont stuff, dead space Do not traumatize Use 1 piece if possible

Question 33

Changes if macerated

Answer 33

Increase dressing change freuqency Use skin barrier Use more absorbent dressing

Question 34

Hand bandaging

Answer 34

Keep bandaging minimal Each finger individually. Tubular if sterility not required Occlusive for small wounds

Question 35

When to change treatment

Answer 35

No sig change in 2-4 wks Wound worsening New odor or drainage Bleeding

Question 36

When to stop treatment

Answer 36

``` Osteomyelitis Recurrent, unresolved erythema Persistent purulent drainage New ulcers Necrosis of muscle, tendon, bone. ```