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yr4s1: pm5 > workshop2- HRF dressings, compressions > Flashcards

workshop2- HRF dressings, compressions Flashcards

(59 cards)

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1
Q

what to consider for choice of dressing

A
  1. goal of dressing
    -moisture
    -absorb exudate
    -absorb odour
    -debridement
    - antimicrobial
  2. infection
  3. biofilm present
  4. exudate levels
  5. how long dressing is to stay in place/ ease of redressing?
  6. x ray required?- no silver.
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2
Q

foam dressings, how to apply

A

white to the wound, pink is plastic. border of 0.5-1cm aruond wound

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3
Q

what medical history do you need to ask when dealing with HRF

A
  1. BGL
    2.HBA1C
  2. renal disease
  3. any immunosuppression medications/conditions
    -chemotherapy
    -antiplatelets
    -anticoagulants
    -NSAIDs
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4
Q

if immunosuppressant medication is identiied in patient history what should you do

A

GP letter/specialists for discussion regarding potential change in medication regime

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5
Q

what questions to ask for infection status

A
  1. ask if they’re feeling well
  2. fatigue, fevers
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6
Q

what else is important patient history for HRF

A

-smoking
-alcohol
-nutrition
-exercise/activity
-footwear
-carers/ who does dressings

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7
Q

what do dressings do for a chronic wound

A
  1. allow macrophages and fibroblasts to enter wound
  2. promotes autolysis
  3. improves cell proliferation due to low pH and hypoxia
  4. enhances growth factors ad cytokines in the wound
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8
Q

types of occlusive dressing categories

A
  1. foams
  2. hydrofibre
  3. alginates
  4. hydrogels
  5. tulles
  6. semipermeable film
  7. hydrocolloid
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9
Q

types of foam dressings

A

mepilex, AMD, biatain, acquacel foam

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10
Q

benefits of foam dressings and what wound to use it on

A
  1. highly absorbent
  2. conforms to contours for cushioning
  3. may have an antimicrobial property like silver
  4. promotes desloughing
  5. moist environment for healing
    6.cost effective
  6. can be primary or secondary dressing

use when: neruopathic wound that is exudating/macerated, sloughy

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11
Q

types of hydrofibre dressings

A

acquacel

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12
Q

benefits of hydrofibre and what wound to use it on

A
  1. interacts with wound exudate to form gas-permeable gel
  2. highly absorbent mod-high
  3. promotes autolotic debridement
  4. provides moist environment
  5. conformable

wound: mod- high exudating wound

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13
Q

types of alginates

A

kaltostat, sorban

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14
Q

benefits of alginate dressings and what wound to use on

A

-gel is formed to maintain moist wound environment
-asorbed exudate
-debrides slough
-occlusive environment
-haemostatic

use on: wound with high exudating and sloughy properties.

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15
Q

types of hydrogels

A

intrasite

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16
Q

benefits of hydrogels

A

-water released slowly to keep wound moist
-rehydrates and debrides dead tissue
-not absorbant, can cause maceration

wound: dry, necrotic or sloughly wound beds to rehydrate and debride dead tissue
not for high exudating wounds.
IWGDF does not recommend for DFU.

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17
Q

types of tulles

A

jelonet, Inadine, urgostart, activon honey tulle

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18
Q

benefits of tulles

A

-non-adhereant: it does not stick to wound surface

use on flat shallow wounds with low exudation
only used as primary dressing, may need secondary dressing

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19
Q

types of hydrocolloid dressings

A

duoderm, allevyn thin, comfeel

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20
Q

benefits of hydrocolloids

A

-turns into gel when exudate is absorbed
-moist environment and promotes debridement

use on: light-heavy exudating wounds, sloughy or granulating
not to be used on infection
caution with HRF

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21
Q

what are the antimicrobial agents in dressings

A

honey
silver
PHMB- broad spectrum

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22
Q

evidence for antiseptics and antimicrobials and updates to IWGDF

A

low

-in neuroischaemic foot ulcers
-no change in ulcer with standard care
-no infection
can consider sucrose-octasulfate impregnanted dressing

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23
Q

AMD has what antimicrobial agent

A

PHBM
-board spectrum antimicrobial (gram positive and negative and some strains of MRSA)
-prevents bacterial colonisation

Wound- use on wound with biofilm, unknown infection

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24
Q

what types of antimicrobial dressings are there and what antimicrobial properties do they offer against organisms

Study These Flashcards
A

1.AMD: broad spectrum postive and negative and some MRSA

  1. silver: broad spectrum, positive and negative, MRSA, VRE, psudomonoas
  2. iodine: broad spectrum
  3. honey/bee products: broad spectrum
25
why is broad specturm dressing choice desireable
wounds are typically polymicrobial with biofilm/colonisation of multiple organisms
26
which dressings have silver
acticoat : 3, 7- release ions into wound bed over certain amount of days hydrofibre: acquacel ag - absorb exudate and bacteria FOAM: mepilex ag - absorb exudate and release ions allevyn ag- " tulle: urgotul- release silver
27
povidine-iodine based dressings compared to betadine
iodine- slow release of iodine on contact and with wound exudate, it is in a water soluable base betadine is cytotoxic- high dose of iodine increasing tissue toxicity with no antimicrobial action
28
benefits of iodine and what wounds to use it on
-slow sustained release -decreases pain and odour -highly absorptive of slough and exudate -autolytic debridement wound: high exudating/sloughy wound, odouress wound
29
when is iodine contraindicated
iodine allergy thyroid disease dry wounds or deep wounds diabetes with advanced kidney disease (iodine excreted renally)
30
IWGDF recommends what dressing for hard to heal neuropathic ulcers without infection
sucrose octasulfate-impregnated dressings Urgostart
31
how does sucrose octasulfate impregnated dressings work
-forms gel that binds to damaged areas and limits affects of matrix metalloproteinases -created moist environment to promote healing
32
benefits of honey dressings
-antimicrobial -promotes autolytic debridement -anti inflammatory activity
33
types of honey dressings/products
dressing/paste- activon
34
what are VAC dressings used for
heal wounds prepare for surgery post surgery
35
benefits of VAC dressing
-improves blood flow -reduces wound bed oedema -reduces bacteria proliferation -encourages angiogenesis and granulation
36
how much of a dressing boarder around the wound do you want
0.5-1cm
37
how long do you stick with the same dressing regime
4-6 weeks unless wound deteriorates or infection develops
38
different ulcer types
1. neuropathic plantar/weightbearing areas callous 2. ischameic distal margins of foot (posterior heel, apex of toes) black dry necrosis 3. venous gaiter region of ankle signs of VI on legs 4. combination
39
SINBAD
Site: midfoot/hindfoot 1 Ischaemia: reduced 1 Neuropathy: LOPS 1 Bacteria: present 1 area: >1cm 1 depth: muscle, tendon, bone 1 /6
40
WIFI
W 0- no ulcer 1-small, shallow, no gangrene 2- exposed bone, joint, tendon, gangrene only in digits or a shallow heel ulcer 3- deep ulcer forefoot/midfoot or full thickness of heel ulcer with calc involvement, extensive gangrene I 0- ABI >0.8, TP >60 1- ABI 0.60- 0.79, TP 40-59 2- ABI 0.4-0.59, TP 30-39 3 ABI < 0.4, TP <30 FI 0-none 1-local involving skin 2-erythema >2cm or involving deeper structures 3- systemic infection (fever, tachycardia, hypotension, shivering)
41
ABI v TBI
TBI is more reliable in patients with diabetes as ABI can be falsely elevated due to arterial calcification
42
if PAD is identified what should you do
refer to GP for further investigations -colour flow doppler to assess a potential referral to vasuclar surgeon for revascularisation However, if is had been recently tested and was okay- doppler waveform before debridement is sufficient
43
why dont you want to debride ischamemic wounds
keep wound dry and sealed from bacteria use of iodine is appropriate
44
should you always probe a wound
no, only when you cant visualise the depth or suspect a sinus tract as it causes trauma and risk of infection
45
what is the gold standard for assessing offloading devices
PEDAR- Guidelines suggest plantar pressure to below 200kpa / reduction of 30% make sure not increasing pressure in other areas
46
if a DFU has been treated with debridement, offloading, dressings and no improvement over 6 weeks what should you do
refer to high risk foot service
47
offloading for HRFU
refer to flowchart
48
indications for compression therapy
1. excess fluid/leg symptoms 2. varicose veins/ surgical treatment 3. skin lesions caused by Chronic venous insufficiency 4. thrombosis/embolism 5. lymphoedema 6. lipoedema 7. pregnancy 8. POTS
49
What does compression do
reduces interstitial fluid reduces inflammatory process reduces risk of infection improves circulation
50
how often to replace compression garmets
3-6 months
51
how many pairs of garmets
2 to allow for washing for one pair
52
assessments required for compression prescription
1. ABI/TPI 2. functional assessment 3. skin integrity 4. neurological
53
what is contraindicated in compression therapy
1. sev PAD - ABI below 0.5, TP below 0.3 2. uncontrolled heart failure 3. severe neuropathy
54
ABI less than 0.5
no compression, refer to vascular
55
ABI 0.5-0.8
class 1- 3
56
ABI 0.8 or more
class 4
57
class 3 and 4 compression garmets should be prescribed by who
medical specialists
58
barriers to compression
-poor education/understanding the role -heat -mobility/strength -aesthetics -cost
59
local providers of OTC compression
1. morris medical 2. super pharmacy plus

yr4s1: pm5 (12 decks)

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