Integ: Lecture 3 - Dressings

Question 1

Dressings should fill in any voids to promote _______ healing

prevent maceration of periwound

decrease bioburden

manage edema

Answer 1

bottom up healing

Question 2

Primary vs secondary wound dressing

Answer 2

Primary dressing - comes in direct contact with the wound

Secondary dressing- placed over primary dressing to increase protection

Question 3

Gauze advantages and disadvantages

Answer 3

advantage: cheap, easy, used with lots of material

disadvantages: can dry and rip out tissue

Question 4

when should you use gauze

Answer 4

scrubbing/prepping
absorption
protection
filling space
delivery mechanism for solutions

Question 5

nonadherent petroleum impregnanted gauze advantages and disadvantages

Answer 5

advantage: not adherent
-if dont want primary layer stuck on it
-reduces pain and tissue damage during dressing changes
-keep moist semi occulusive and comforming

disadvantage:
-poor absorb not for heavy exudate
-lack antiseptic –> choose silver or iodine instead
-can be messy

Question 6

Semipermeable film advantages and disadvantage:

Answer 6

Advantages: Allows wound visualization: impermeable to fluids/bacteria, lasts longer (up to 7 days)

Disadvantage: no absorption, adherent to dry skin, may cause maceration

When to use: Stage 1 or stage 2 pressure ulcer

Question 7

which is a polyurethane or copolymer with porous adhesive layer that allows transmission of O2 and mositure vapor

Answer 7

semipermeable/semiocculsive film

Question 8

amorphous Hydrogels advantages and disadvantages

Answer 8

(may contain silver or alginate)

Advantages: hydration of wound, autolytic debridement, easily cleaned

disadvantages: may macerate, minimal absorption, requires secondary dressing, daily changes requires

Question 9

when should you use a semipermeable/semi occlusive film

Answer 9

stage I or II PU
primary or secondary dressing
low exudating wounds

Question 10

When to use amorphous hydrogels or hydrogel sheets?

Answer 10

Stage 2 or 3 pressure ulcers, skin tear/abrasion

Question 11

non cross linked polymers plus water and or glycerin (can contain silver or alginate)

Answer 11

hydrogels-amorphous

Question 12

cross linked polymer with central mesh to hold together made from water and glycerin

Answer 12

hydrogel sheets

Question 13

Hydrogel sheets vs amorphous hydrogels

Answer 13

sheets have self adherant border

Question 14

advantages and disadvantage of hydrogel-sheets

Answer 14

advantage:
-hydration of wound bed
-autolytic debridment
-some absorption
-non-adherent
-may have self adherent border may stay in place 2-3 days
-can reduce pain

disadvantage
-potential for maceration
-min absorption
-requires secondary dressing (if not bordered)
-only min fill empty space

Question 15

Advantage and disadvantages of foam

Answer 15

advantages: Higher absorbant, can be used when infected
can be used in tunnels and undermining

Disadvantages: may require additional tape, may macerate, not recommended for dry eschar (will dry it out more)

Question 16

polyurethane open cells sheets, single or multilayered, multiple varieties

Answer 16

foam

Question 17

when to use hydrogel -sheets

Answer 17

stage II, III, IV PU
abrasions
skin tears

Question 18

When to use foam?

Answer 18

Stage 2,3,4, Pressure ulcer w/ heavy drainage, tunnels, cavities

Question 19

What is hydrocolloid?

Answer 19

Hydrophillic (absorbant) colloid particles bound to foam or film, forms gel on contact with wound fluid; it’s impermeable to bacteria

Question 20

Hydrocolloids advantages and disadvantages

Answer 20

Advantages: creates moist enviroment, impermiable to bacterial, autolytic debridement, Can wear up to 7 days, min to mod absorption, thermal insulation , self adhering, avaliable with silver

Disadvantages: contraindicated for infection, will not handle a lot of drainage, difficult to remove from fragile skin, requires second product to fill space

-some are opage
-cant handle max exudate,

Question 20

What are the most impermiable dressings?

Answer 20

1. Latex
2. Hydrocolloid
3. Hydrogel (sheet)

Question 21

What is a biological skin substitute

Answer 21

Combines novel materials with living cells

dermagraft and apligraft most common, are derived from neonatal forskin

APPLIED BY PHYSICIAN

Question 21

when to use hydrocolloids

Answer 21

stage I or II PU, shallow stage III or IV PU
primary or secondary dressing

Question 22

What are alginates

Answer 22

Composite fibers derived from seaweed, cause exchange of sodium calcium ions

Question 22

What does biological skin substitute look like

Answer 22

may look like yellow crust on these wounds (this is growth factor) dont debride this!

Question 23

What are advantages and disadvantages of alginates

Answer 23

Advantages: Highly **absorbant** (x20), **non-occlusive**, can be used in **infection**, has **hemostatic** properties, useful in tunneling, atraumatic removal, facilitates **autolysis** Disadvantages: requires secondary dressing, can dry out and adhere to woundbed, may **macerate** if hydrated too much

Question 23

What's the difference between between an Apligraf and a full skin graft

Answer 23

Apligraf doesnt have langerhan cells, melanocytes, endolthelial cells Apligraf is approved to treat venous ulcers

Question 24

When to use alginate?

Answer 24

Stage 2 ,3, 4 Pressure ulcers that have moderate to heavy drainage/exudate, sinus tract, undermined areas, infected wounds

Question 24

What is a dermagraft?

Answer 24

FDA approved to treat **full thickness wounds** contains **fibroblsts** (no lymphocytes or macrophages)

Question 25

T or F OTC antimicrobials can improve a wound

Answer 25

F OTC microbials like neosporin arent supported w/ research perscription topicals are more effective

Question 25

looks like a fruit strip

Answer 25

alginate

Question 26

What is hydrofiber?

Answer 26

Simular to alginate: Costs more, more absorbant -increase amt of drainage to 30x but costs a lot more -comes in square, rope, silver

Question 26

When and how should antiseptic agents be used

Answer 26

Should be diluted only used short term, and when there's no healthy tissue example: early after bite wound just after motorcycle accident

Question 27

__________ added to all other types of dressing make them antimicrobial

Answer 27

silver or cadexomer

Question 27

When you have multiple dressing options, what should you pick

Answer 27

Pick the one that allows the **fewest dressing changes** best cost and ease of application

Question 28

silver is a metal and long term use of dressings with high silver content can lead to ___

Answer 28

metal toxicity (rare tho)

Question 29

What are honey impregnanted dressing

Answer 29

Made from manuka plants to be more **anti-inflammatory** -can be a dressing or topical may decrease pain and healing time "tastes just like honey" -steven lim -sticky and messy

Question 30

what are Collagen dressings

Answer 30

these type of dressings allow you to add collagen to the woundbed Change weekly , only change secondary dressing during the week

Question 31

how often should you change a collagen dressing?

Answer 31

Change weekly , only change secondary dressing during the week

Question 32

collagen helps add scaffolding to help with?

Answer 32

wound healing

Question 33

what happens when collagen gets wet?

Answer 33

it shrinks so need dressing ontop of it

Question 34

barriers and sealants purpose

Answer 34

-protect wound edges and periwound from maceration and other irritaiton such as dermitis -can also cause irritations -but can protect from adhesives

Question 35

What are the top 3 most permeable dressing?

Answer 35

1. Loose-weave gauze 2. Fine-weave gauze 3. Calcium alginate

Question 36

biological skin subsitutions

Answer 36

combine novel material with living cells -applied by physicain and often need multiple applications -need optimal wound bed preparation prior to application -dont debride yellow crust on these wounds (this is a growth factor) -watch for graft sticking to dressing with dressing changes

Question 37

should you debride the yellow crust on a biological skin subsitution?

Answer 37

NO! -dont debride yellow crust on these wounds (this is a growth factor)

Question 38

what is an apligraf

Answer 38

FDA approved to treat venous ulcers -bilayered skin product consisting of dermal equivalent composed of type I bovine collagen that contains living human dermal fibroblasts as an overlying cornified epidermal layer of living human keratinocytes

Question 39

what does apligraf not contain

Answer 39

langerhan cells melanocytes endothelial cells

Question 40

FDA approved for full thickness DFU

Answer 40

dermagraft

Question 41

cryoperserved human fibroblast derived dermal subsitute indicated for use in txt of full thickness diabetic foot ulcers

Answer 41

dermagraft

Question 42

what is dermagraft composed of?

Answer 42

fibroblasts ECM bioadbsorable scaffold (no macrophages, lymphocytes, blood vessels, hair follicles)

Question 43

what is the effect of dermagraft

Answer 43

fibroblasts proliferate to fill the inersitices of the scaffold with human dermal collagen, matrix proteins, growth factors and cytokines

Question 44

does topical antimicrobials help wound bed stay moist?

Answer 44

yes

Question 45

antiseptic agents should always be?

Answer 45

-should always be diluted

Question 46

when should antiseptic agents be used?

Answer 46

-used short term and only when there is no healthy tissue in the wound or massive infection -early after bite wound -after accident motor