1
Q
What are the 4 main benefits of moist wound healing?
A
- Facilitates all 3 phases of wound healing
- Traps endogenous enzymes to facilitate autolytic debridement and preserves GFs
- Reduces pain
- More cosmetically appearing scars
2
Q
What happens when a wound is too moist?
A
- Maceration
- Additional skin damage/ulcer
- increased chance of infection
3
Q
What happens when a wound is too dry?
A
- Crust formation
2. Lacks enzymes/growth factors
4
Q
Optimal temperature enviornment for wound healing?
A
- 37-38 deg celicius (98.6-104–want closest to body temp)
5
Q
Wound dressing should be chosen how?
A
-minimize need for change, because wound temperature decreases with each change and can remain decreased up to 90 min.
6
Q
What is the main reason for abcess formation?
A
dead space
7
Q
What are the function of a secondary dressing?
A
- Protection
- Cushioning
- Absorption
- Occulsion
8
Q
What type of secondary dressing would you use when performing enzymatic debridement?
A
occulsive secondary dressing to help let enzyme work
9
Q
Moisture-Rententive Dressings have low moisture vapor transmission rate compared to gauze, what does that mean?
A
it means that thye can better trap wound fluid rish in enzymes/neutrophils/growth factors/macrophages.
10
Q
Moisture Rententive Dressings can facilitate what type of debridement?
A
Autolytic, usually within 72-96 hours.
11
Q
M-R dressings generally need to be applied with a ______border around intact skin
A
1-2 cm border
12
Q
Wrinkles or creases in a wound dressing provide a pathway for
A
- wound fluid to escape from under the dressing and for microbes from the environment to enter the wound bed.
Ex: put dressing on an elbow with the elbow flexed, that will allow it to accommodate when the elbow is straightened.
13
Q
List the Dressings From Most PERMEABLE/NON occlusive to IMPERMEABLE (Occlusive)
A
Air–>Loose-weave gauze–Fine weave gauze–>calcium algniates–>impregnated guaze–>semipermable film–>semipermeable foam–> hydrogels (sheet)–> hydrocolloids–>latex
14
Q
List MR dressings from least absorption to most absorption
A
Semipermeable film–>hydrogels–>hydrocolloids–>semipermeable foam–>alginates
15
Q
List gauze dressings from least absorptive to most absorptive
A
Woven–>Nonwoven–>gauze pad–>layers of gauze padding
16
Q
T/F finer woven gauze with smaller pores decrease wound bed trauma
A
T
17
Q
What type of gauze may allow granulation tissue to grow into it
A
Loose-woven
18
Q
What type of gauze should be used for tunneling?
A
strips
19
Q
Gauze is the dressing of choice when
A
Keep in mind Can be used on both infected and uninfected wounds
- When a wound requires frequent changes
- Most appropiate secondary dressing for patients with fragile skin due to non-adhesion properties
- Large wounds or wounds in irregularly shaped area
- Prevent premature closure and wick away exudate in tunneling and undermining wounds
20
Q
What type of gauze dressing are reserved for superficial, non-draining wounds, these are typically non-adherent with very little absorptive properties
A
Telfa dressings
21
Q
What are the main Precautions and Contraindication that practioners need to keep in mind for GAUZE DRESSINGS?
A
- may leave residue or lint
- Gauze can dehydrate and thus adhere to the wound bed
- roll gauze apply at an angle without tension
22
Q
This type of dressing is used as the wound contact layer and requires a secondary dressing, typically regular gauze. They are nonadherent and allow pain free and trauma free remvoal and increases occulsiveness of dressing in comparison to regular gauze.
A
Impregnated gauze
23
Q
What type of impregnated gauze is typically used in treating venous insufficiency ulcers and burns?
A
Petrolatum impreg.
24
Q
Petrlatum Impregnated gauzes may be used as a ____layer on______wound beds in combination with a _____dressing.
A
contact, granulating, secondary
25
Xeroform gauze is impregnated with a combination of
bismuth and petrolatum
26
Bismuth has mild antimicrobial properties and has been used prophylactically to prevent wound infection. However, bismuth is
cytotoxic to inflmmatory cells and may cause inflammatory response in patients with venous insufficiency ulcers
27
Iodine impregnanted gauze can also be
cytotoxic
28
Thin sheets of transparent polyurethane with adhesive backing, permeable to water vapor, allow visulaization of wound bed, little absorptive capabilities
Semipermeable film
29
How long can you leave a semipermeable film dressing in place?
5-7 days
30
What are semipermeable film dressing commonly used on?
superficial wounds such as skin tears, laceration, abrasion, partal thcikness wounds w and donor graft sites. May be used on red granular wounds and yellow covered wounds with minimal drainage. They are waterproof and sometimes used prior to ultrasound treatment.
31
What are percautions and contras to semipermeable films?
1. make sure to use a skin sealant before applying
2. DO NOT use on infected wound
3. Fragile Skin
4. Wounds with moderate/heavy drainage.
32
These dressings are 80-90% water or glycerin based, donate moisture to dry wounds. less efffective bacterial barrier Permeable to gas and water, almost non-adhesive and require a secondary dressing.
Sheet Hydrogels
33
What are the contraindications for sheet hydrogels?
1. Minimal absorptive properties so don't use on wounds that are heavily draining.
2. Infected wounds
3. Need skin sealant to protect periwound
4. Not appropiate for bleeding wounds
34
What are indicated for minimally or moderately draining wounds. And are commonly used on superficial and partical thickness wounds such as abrasions,, skin tears, blisters, donor sites, radiation burns , thermal burns, pressure ulcers, diabetic ulcers, mastitis and sx sites.
Sheet hydrogels
35
What type of hydrogel may be used over wounds as a coupling agent for ultrasound?
amorphous hydrogels
36
This wound dressing is made of polyurethane foam with a hydrophilic wound side and a hydrophobic outside
Semipermeable foam
37
Semipermeable foams are permeable to_____but NOT _____
gas but not bacteria. (have high moisture vapor transmission rates)
38
Common uses for semipermeable foams
1. Can be used on wound with minimal to heavy exudate
2. Reserved for granulating or slough-covered partial and full thickness wounds.
3. May be used on donor sites, ostomysites, minor burns, diabetic ulcers, and venous insufficiency ulcers.
39
If semipermeable foam dressing is used on infected ulcer they should be
changed daily.
40
Contraindications for Semi-permeable FOAMS
1. NOT INDICATED FOR DRY/ESCHAR covered wounds
2. NOT FOR ATERIAL ULCERS
3. NOT FOR HEEL ULCERS
4. MAY NEED SKIN SEALANT ON PERIWOUND.
make sure to use a skin sealant.
41
This dressing contains hydrophilic collodial particles (gelatin, pectin, and carboxymethylcellulose) with a strong film/foam adhesive back
HYDROCOLLOIDS
42
How do hydrocolloids tend to absorb exudate?
absorb slowly by swelling into a gel-like mass. (after removal, leaves a foul odor smelling residue that can be mistaken as infection) can absorb, 75-674% of their weight in fluid.
43
Hydrocolloids are impermeable to
water
O2
Bacteria
44
What type of hydrocolloid is an effective barrier against urine, poo, MRSA, HBV, HIV and Pseudomonas.
Duoderm (will turn white when it is absorbed, the whiter it is the more moisture it has, will smell when removed.
45
T/F wounds with hydrocolloids have lower infection rates than those covered with gauze, semipermeable films, foams, and sheet hydrogels
TRUE
46
Hydrocolloids are most often used to treat
PRESSURE ULCERS, they are safe for both granular and necrotic wounds. Designed for use of more sacral and coccygeal pressure ulcers. but can be used to treat minor burns and venous insufficiencies.
47
What are the contras and precautions for hydrocolloids?
1. Bleeding wounds
2. Infection, unless changed daily
3. Dry wounds, arterial ulcers, 3rd degree burns , wound with minimal drainage
4. Wounds with exposed tendons or fascia
5. Patients with poor skin integ due to the strong adhesive backings
6. Occulusions may contribute to silent infections, so hydrocolloids should be used with caution on immunosupressed patients
48
This dressing is made from salts of alginic acid from brown seaweed, reacts with serum and wound exudate to form hydrophilic gel to provide a moist wound enviornemnt. Highly permeable and non-occulusive, typically requires a secondary dressing, comes in sheets and ropes for filling tunneling/undermining and applicators for swabing cultures.
ALGINATES
49
Common uses for Alginates
1. absorb 20x their weight in excudate thus indicated for moderately or highly draining wounds.
2. partial and full thickness draining wounds, such as venous ulcers, pressure, neuropathetic ulcers and burns
3. Ideal for infected wounds, when used should be changed daily.
3. Can be used on graular and slough covered wounds
50
Precautions and Contra for Algniates?
1. Not indicated for dry, minimally exudating wounds
2. full-thickness 3rd degree burns
3. wounds with exposed tendons, joint capsules, bone
51
Composite dressing must have how many layers?
3 layers
52
Describe the Inner, Middle and Outer layer for composite dressing
1. Non-adherent, prevents wound bed trauma
2. Absorbs moisture, wicks, maintains moist wound bed, can be hydrogel semipermeable foam, hydrocolloid, alignate
3. Outer layer: is considered the bacterial barrier; commonly semipermeable film
53
Antispectic Agents used on dressing are referred to as Antimicrobial dressings they are typically used to decrease wound bioburden however ....research suggest
little to no evidence to support their use. (especially silver)
54
What are the precautions and contraindications to silver antimicrobial dressings?
- cause the wound bed to turn blue or black
- use short term for infection control
- moniotr signs of hypersensitivity
```
DO NOT MOISTEN WITH SALINE! it deactivates silver, need to irrgate with water.
Do not use with e-stim
Remove before MRI
NOT for neonates
cytotoxic
```
55
What are the percautions and contraindications for cadexomer iodine antimicrobial dressings?
1. Iodine sensitivity
2. Thyroid disease
3. Larger cavity wounds (too much iodine application can be cytotoxic)
56
What are the key functions for Charcoal and Honey impregnated dressings?
controls wound odor and may improve patient quality of life by reducing odor.
57
Which odor reducing dressing do not enhance would healing and is considered particularly important to use when wound debridemnt is not consistent with overall plan of care such as those with end-stage cancer and an infected pressure ulcers
CHARCOAL DRESSING
58
Leptospermum, alos known as manuka honey found in honey impregnanted dressing is considered to control what?
wound biorbuden and odor
59
Collagen dressings adhere to ____and are considered for what type of wound?
adhere to wound bed but not periwound, considered for non healing stage III and IV pressure ulcers. Needs more research.
60
Skin sealants and mostuire barriers are used to protect skin from masceration or adhesives. Skin Sealants are used on
on intact skin and make skin tacy to provide a better edge seal
61
Mositure barriers (creams or oitments) prevent____and can be applied to what type of skin?
prevent perineal rash/skin breakdown, can apply to macerated skin
62
T/F oitments are more occulsive than creams or lotions and petroleum moisturizer may penetrate best, helps restore barrier function of the epidermis
T
63
What are considered skin glues, and are used for by physicians for primary wound closure without the use of staples, usually used on ACUTE linear wounds without tissue loss
Tissue Adhesives (not used by PTs)
64
What are the contraindications and precautions for tissue adhesives?
1. contaminated wounds
2. puntured wounds
3. wounds more than 12 hours old
4. wounds that cross a joint
5. exposed deep tissue.
65
T/F a study found that wounds treated with certain growth factors improved significantly more than wounds treated with placebo
T
66
Growth Factors are limited to treating what type of wounds?
Chronic wounds that are non-responsive to traditional interventions
67
Becaplermin (GF) is used to treat what type of wound____
| Porcine small intestine sumucosa (OASIS, collagen, TGF-beta, FGF-2) are used to treat what type of wound_____
1. Diabetic foot ulcer
| 2. partial thickness chronic ulcer
68
Derived from natural tissues, retain skin's natural barrier properties, encourage autolytic debridement, help create healthy granular wound bed
Biosynthetic Dressings and Skin Subsitutes
69
What are the indications for biosynthetic dressings and skin sub.?
Non-healing, unifected partial or full thickness ulcers, usedd in highly specialized areas of wound care, such as burn clinics.
70
Skin grafts provide skin coverage for
1. wounds with extensive surface area
2. Full thickness burns
3. chronic wounds
71
Autograft
Allograft
Xenograft
```
individual's own skin
outside source (cadaver)
Graft donated from outside the patient's species (animal)
```
72
For a Draining wound what are 2 key components you want to keep in mind?
1. absorb moisture
| 2. protect surrounding wound from maceration
73
For a non-draining wound what 3 components do you want to keep in mind?
1. Provide moisture
2. Prevent evaporative fluid loss
3. Skin sealant should be used to protect periwound
74
For Granular non draining wound we want to obtain and maintain a moist enivornmnet and protect the surrounding tissue. List 4 dressing options we could use
1. Gauze
2. Impregnated gauze
3. Transparent film
4. hydrogel
75
For a Granular draining wound, we want to observe signs that may indicate infection, absorb exudate, protect the surrounding tissue. What 4 dressing options can be used
1. Gauze
2. Alginate
3. Semipermeable Foam
4. Hydrocolloid
76
For a wound that presents with necrotic tissue but is non draining. Our goals would be to soften the eschar, remove the eschar, obtain a moist enviornment, protect the surrounding tissue. List 5 dressing options
1. Gauze
2. Impregnated gauze
3. Transparent Film
4. Hydrogel
5. Hydrocolloid
Debridment is indicated
77
For a necrotic draining wound, we want to observe signs for infection, absorb exudate, remove eschar, protect surrounding tissue. List 4 dressing we could use
1. Gauze
2. Alginate
3. Semipermeable foam
4. Hydrocolloid
Debridement is indicated
78
What 2 issues should you keep in mind when treating an infected wound?
1. Never use an occulsive dressing
| 2. Change dressing daily
79
What 3 M-R dressings can be used on infected wound?
Gauze, Algniates, Semiperm. Foam
80
Dressings for Wound location: Fingers
-wrap individually, consider tubular
81
Dressings for Wound location: Hands
-figuer 8, if large or infected use roll gauze-
82
Dressings for Wound location: Legs/Arms
-Non-adherent due to hair or poor skin integ.
83
Ankle and foot wounds tend to
| Trunk
drain MORE, so need to consider absorptive dressing and possible need for AD.
Use short-stretch compression wraps with caution to allow for movement of chest wall and breathing
Integ Exam 2: Chapter 7
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