Dressings

Question 1

What are ideal topical treatment/dressing characteristics? (5)

Answer 1

1. moist environment
2. thermal insulation
3. removal w/o trauma
4. removes drainage/debris
5. maintain clean environment

Question 2

What does “TIME” stand for?

Answer 2

T = tissue non viable or deficient
I = infection or inflammation
M = moisture imbalance
E = epidermal margin

Question 3

What is the progression of the “T”

Answer 3

defective matrix/cellular debris – debridement – restore wound base and ECM

Question 4

What is the progression of “I”

Answer 4

high bacterial counts or prolonged inflammation – antimicrobials – low bacterial counts and controlled inflammation

Question 5

What is the progression of “M”

Answer 5

desiccation or excess fluid – dressings compression – restore cell migration, maceration avoided

Question 6

What is the progression of “E”

Answer 6

impairment of epidermal migration and ECM – biological agents cell therapy – stimulate keratinocyte migration

Question 7

what are the functions of the wound dressings?

Answer 7

1. primary (direct contact)

2. secondary (over primary - increase protection, cushioning, absorption or occlusion

Question 8

When choosing a dressing, what are some things you should consider?

Answer 8

anatomical site, drainage, bacterial load, periwound integrity, depth, edema, aggressive vs. conservative

Question 9

What are the advantages of gauze?

Answer 9

various shapes/sizes, used for packing, impregnated, nonadherent

Question 10

What can gauze be used for?

Answer 10

primary or secondary, and nonselective debridement (wet to dry)

Question 11

What are the disadvantages of gauze?

Answer 11

painful with removal, harm healthy tissue, dessicate wound bed, little absorption, no barrier to bacteria, frequent changes

Question 12

What type of dressing is “contact layer”

Answer 12

gauze

Question 13

what does “contact layer” do

Answer 13

provides wound bed protection with fluid flow-through

Question 14

is “contact layer” absorptive?

Answer 14

no, usually non-absorptive and requires secondary dressing

Question 15

can “contact layer” be impregnated?

Answer 15

yes

Question 16

what are the advantages of Transparent films?

Answer 16

wound visible, stays for 3-5 days, promotes autolytic debridement (semi-occlusive), waterproof

Question 17

what can transparent film be used for?

Answer 17

primary or secondary dressing

Question 18

What are the disadvantages of transparent film?

Answer 18

minimal absorptive capacity, maceration, promote skin irritation, traumatic on removal,

Question 19

when should transparent film not be used?

Answer 19

infected wounds (its trapping everything in)

Question 20

What is another term for hydrocolloid?

Answer 20

duoderm

Question 21

what does a hydrocolloid do?

Answer 21

interacts with wound fluid

Question 22

what are the advantages to a hydrocolloid

Answer 22

occlusive dressing - autolytic debridement, absorptive capacity, stays for 5-7 days

Question 23

what amount of absorptive capacity does a hydrocolloid have?

Answer 23

minimal to moderate absorbent capacity

Question 24

what can a hydrocolloid be used for?

Answer 24

primary or secondary dressing

Question 25

what are the disadvantages of a hydrocolloid?

Answer 25

wound odor (interact with infection), hypergranulation, macerate periwound, skin irritation, edges may roll,

Question 26

when should a hydrocolloid not be used?

Answer 26

infected wounds and wounds with undermining or tunneling

Question 27

what is a hydrogel?

Answer 27

water based gel

Question 28

what are the advantages for hydrogel?

Answer 28

moist environment, assists with pain management, autolytic debridement,

Question 29

when kind of tissue can a hydrogel be used on?

Answer 29

viable and nonviable tissue

Question 30

What is hydrogel used for?

Answer 30

primary dressing

Question 31

what kind of wounds are hydrogels "soothing" for?

Answer 31

dry wounds - arterial ulcers

Question 32

what are the disadvantages of hydrogel?

Answer 32

cause maceration, NOT for heavily draining wounds, requires secondary dressing

Question 33

what are "alginates"

Answer 33

seaweed derived dressing

Question 34

what are the advantages of alginates?

Answer 34

assist with debridement, used with compression, infected wounds and packing

Question 35

what type of wounds are alginates normally used on?

Answer 35

moderate to heavy draining wounds

Question 36

what type of tissue can alginates be used on?

Answer 36

viable or nonviable tissue

Question 37

alginates help stop _____.

Answer 37

bleeding

Question 38

what are the disadvantages to alginates?

Answer 38

dessicate the wound (similar to wet to dry), and cause alginate scab

Question 39

what type of wounds are foams used for? (drainage?)

Answer 39

moderate to heavily draining wounds

Question 40

what are foams good for?

Answer 40

wounds over bony prominences

Question 41

what are some advantages for foams?

Answer 41

semi-occlusive, longer wear time, wick away moisture, protects wound, insulator, retard hypergranulation, used with compression

Question 42

what kind of environment do foams promote?

Answer 42

warm, moist environment

Question 43

what are disadvantages of foam?

Answer 43

maceration, dessicate wound bed, secondary dressing

Question 44

what type of wounds is collagen used for? (drainage)

Answer 44

moderate to heavy draining wounds

Question 45

what are the advantages of collagen?

Answer 45

reduce MMPs which may attract components for healing

Question 46

what is collagen designed to do?

Answer 46

absorbed into the wound and "jump start" a stalled out wound

Question 47

what is the disadvantage of collagen?

Answer 47

sensitivities for bovine material

Question 48

What are advantages of composites? (foam that has adhesive around it)

Answer 48

multiple function in one dressing, easy to use, various forms and sizes

Question 49

what are advantages of combinations? (dressing plus antimicrobial)

Answer 49

provides multiple functions

Question 50

what is an example of a "combination?"

Answer 50

silver (antimicrobial) and alginate or foam

Question 51

when are silicone gel sheets used?

Answer 51

maturation phase

Question 52

what are advantages of silicone gel sheets?

Answer 52

scar management, increase scar mobility/elasticity to reduce contractures

Question 53

when should you use antimicrobial dressings?

Answer 53

wound that is infected (systemic) or critically colonized (local)

Question 54

what type of debridement is antimicrobial dressings?

Answer 54

enzymatic debridement

Question 55

what are some examples of antibiotic ointments?

Answer 55

TAO (triple antibiotic ointment), bacitracin, bactroban, polysporin, and neosporin

Question 56

what is bacitracin?

Answer 56

water based - used for hands and face

Question 57

what is bactroban effective against?

Answer 57

MRSA

Question 58

what are the primary ingredients in silvadene?

Answer 58

sulfa an silver

Question 59

why can silvadene look purulent when ready to remove?

Answer 59

reacts with drainage (serous drainage has absorbed into white cream)

Question 60

what kind of dressing cancels out silver?

Answer 60

collagenase (enzymatic debridement)

Question 61

what are silver dressings effective against?

Answer 61

psudomonus, MRSA, staph, strep, enterococcus

Question 62

What is hydrofera blue effective against?

Answer 62

MRSA, VRE, staph, seratia, e-coli, etc.

Question 63

what does hydrofera blue require daily?

Answer 63

rehydration - and moisture for removal

Question 64

hydrofera blue is the only antimicrobial dressing that?

Answer 64

can be used in conjunction with enzymatic debriding ointment

Question 65

what is cadexamer iodine?

Answer 65

time released iodine so not cytotoxic but antimicrobial

Question 66

what kind of wounds is cadexamer iodine used for? (drainage)

Answer 66

moderate to heavy draining wounds (iodine is a drying agent)

Question 67

can cadexamer iodine assist with debridement?

Answer 67

yes

Question 68

what is the use of cadexamer iodine indicated?

Answer 68

>50% slough, draining wounds

Question 69

what does honey promote?

Answer 69

moist wound environment, highly absorptive

Question 70

Due to its high osmolarity, honey _______ and ________ the wound

Answer 70

cleanses and debrides

Question 71

what does honey do the wound pH?

Answer 71

lowers it for optimal environment

Question 72

what are the indications for honey?

Answer 72

DFU, VLU, arterial leg ulcers, pressure ulcers, burns, mixed, donor sits, traumatic/surgical wounds

Question 73

regranex is an example of?

Answer 73

topical growth factors

Question 74

what is regranex indicated for?

Answer 74

LE diabetic neuropathic ulcers

Question 75

what is Oasis an example of?

Answer 75

biological or biosynthetics

Question 76

what is oasis derived from?

Answer 76

small intestinal submucosa (SIS)

Question 77

what kind of wounds is oasis indicated for?

Answer 77

partial or full thickness loss, pressure, vascular, diabetic, thermal, or surgical origins

Question 78

what can you pack wounds with?

Answer 78

calcium alginate, collage alginate, cadexamer iodine, gauze, foam, packing strips

Question 79

what are skin sealants used for?

Answer 79

additional protection for periwound

Question 80

what is an example of barrier ointments?

Answer 80

vaseline

Question 81

what are some periwound considersations?

Answer 81

maceration vs. dryness, irritation, incontinence, trauma, dermatitis, skin prep, moisturizer, antibiotic ointment, moisture barriers, protective dressings and steroid ointments

Question 82

what are tricks for the finger?

Answer 82

each digit wrapped individually, keep bandaging to minimum, "tubular dressings"

Question 83

what are tricks for the hand?

Answer 83

occlusive dressing for small wounds, figure 8 for large wounds to minimize bandage for use of extremity

Question 84

what are tricks for arms/legs?

Answer 84

occlusive dressing for uninfected wounds, nonadherent dressings

Question 85

what are tricks for the trunk?

Answer 85

short-stretch wraps applied with caution to allow respiratory capacity, "burn vest"

Question 86

what are the tricks for the abdomen?

Answer 86

Montgomery straps

Question 87

what are the tricks for ankle/foot

Answer 87

bandaged like hand wound (Figure 8), more absorptive dressings, thick gauze on plantar surface,

Question 88

when should you change treatment course?

Answer 88

no change in 2-4 weeks, wound getting worse, necrosis debrided with viable tissue present, new odor, new redness/pain, bleeding present, too dry/moist

Question 89

when should you terminate treatment?

Answer 89

osteomyelitis, recurrent erythema, persistent drainage, necrosis with muscle/tendon/bone involvement, unexplained pain, new ulcers