Lecture 5 Wound Treatment Interventions Pt 1

what is the normal pH for skin

acidic (4.0-6.5)

what is the pH for vulnerable skin

basic (higher than 7.5)

what will increase the pH of the skin

urine and feces

what is the purpose of moisture barriers (creams)

protects the skin from excessive moisture

when are moisture barriers used

stage 1PI

peri wound to prevent maceration

pressure points

bony prominences

at risk skin

areas of incontinence

what is the purpose of skin sealants

protects against mechanical or chemical injury and excessive moisture

make a more adhesive environment

moisturizers are used to…

prevent dry skin and help restore the skin’s normal level of hydration

sunblock should be applied…

to wounds and scars after healed

what minimum SPF level does sunblock need to be

30 SPF

what is always the long term goal for wound management

wound healing (complete closure + approximation)

what is always the related STG for wound management

maintain clean, moist, warm, granular wound bed while protecting the peri wound and intact skin

what are the general treatment goals for a red wound bed

protect the wound

maintain warm, moist environment

protect periwound

what are the general treatment goals for a yellow wound bed

debride necrotic tissue

absorb drainage

protect periwound

what are the general treatment goals for a black wound bed

debride necrotic tissue

what is the treatment goal for granulating/epithelializing wound

protect and keep moist

what is the treatment goal for a necrotic wound

debride

what is the treatment goal for an infected wound

antiseptic/antibiotics

what is the treatment goal for a heavily draining wound

absorb

what is the treatment goal for a dessicated wound

moisten

what is the treatment goal for an odorous wound

charcoal based antiseptics

what is the treatment goal for undermining/tunneling

lightly pack wound

what is the treatment goal for bone/tendon exposure, flap/graft exposure, and organ/mesh exposure

protect and keep moist

how are wound treatment goals achieved

debridement

microorganism control

exudate management

skin/wound protection

what is debridement

removal of necrotic tissue, foreign material, and debris from the wound bed

what are the 2 categories of debridement

selective

nonselective

what is selective debridement

only removing devitalized tissue (sharp, enzymatic, or autolytic)

what is nonselective debridement

removal or nonspecific areas of devitalized tissue and may include mechanical and surgical debridement

what are the indications for debridement

necrotic tissue

foreign material

debris

residual topical agents

blisters

callus

what are the contraindications for debridement

granular/viable tissue

stable, hard, dry eschar in ischemic limbs (low ABI)

urgent need for surgical debridement (gangrene or osteomyelitis)

electrical burns

deeper tissue muscle, tendon, ligament, capsule, fascia, bone, nerves, and blood vessels

sharp debridement

use of scalpel, scissors and/or forceps to selectively remove devitalized tissue, foreign material, or debris

when is sharp debridement contraindicated

ABI <0.5

gangrene

stable heel ulcers (black eschar)

unidentifiable structure

terminally ill

why should calluses be sharp debrided

to eliminate localized areas of increased pressure

what is autolytic debridement

the body’s own mechanisms to remove nonviable tissue

establish moist wound environment that facilitates enzymatic digestion of nonviable tissue

enzymatic debridement sequence

eschar scoring/cross hatching

add enzymes

add dressing

what are the 2 types of nonselective debridement

surgical

mechanical

wet to dry dressings

nonselective debridement

douse gauze with saline, pack the wound, wait for it to dry, rip out dry gauze

what are the 2 treatments for infection we can do

debridement

antimicrobial therapy

what is the goal of antimicrobial therapy

destroy organisms while minimizing adverse reactions (infections)

what is systemic antimocrobial therapy

antibiotics

when is is systemic antimocrobial therapy used

sepsis

signs of advancing infection

deep space infections

why do you need to keep a wound moist

moist wound heal 3-5 times faster than a dry wound

if a wound is too dry…

crust formation

lack of endogenously produced enzymes and growth factors that facilitate wound healing

if a wound is too wet…

signs of maceration

more prone to injury, permeable, friable/ripping, infection

how do we create the optimal wound healing environment

create moist environment (dressings or moisturizer)

thermal insulation

barrier to microorganisms

protect exposed nerve endings

promote edema control

eliminate dead space by packing with dressing (tunneling/undermining)

provide adequate gas exchange

occlusion

ability of a dressing to transmit moisture between a wound bed and the atmosphere

moisture retention

ability to maintain a most wound environment

what is a primary dressing

contact layer

comes into direct contact with the wound

what is a secondary dressing

placed over the primary dressing to provide increased protection, cushioning, absorption, or occlusion

what is composite dressing

combination of primary and secondary dressing in 1 (ex: bandaid)

gauze dressings

primary or secondary

made of cotton or thread

highly permeable and relatively nonocclusive

when is gauze commonly used

infected wounds

wounds requiring packing

requiring frequent dressing changes

highly exudating wound

impregnated gauze

mesh gauze with materials liek hydrogel, saline, bismuth, or zinc incorporated

when are impregnated dressings commonly used

burn wounds

granulating wounds

epithelializing wounds

exposed deep tissue

wounds that bleed easily

painful wounds

semipermeable (transparent films)

thin flexible sheets of transparent plyurethane with adhesive backing

what is semipermable film permeable to

water vapor

oxygen

carbon dioxide

what is semipermable film impermeable to

bacteria

water

when is a semipermeable film commonly used

minimal to no drainage

skin tears

scalds

abrasion/lacerations

over intravenous catheters

over wounds for US treatment

hydrogels

water or glycerin based wound dressings that are available in sheets, gels, or impregnated gauzes

when is a hydrogel commonly used

min to mod exudating wounds

pressure ulcers

blisters

abrasion

skin tears

burns

donor sites

ca be used to soften eschar

hydrocolloid

hydrophilic gel-forming polymers with a strong film or foam adhesive backing

what are hydrocolloids commonly used for

partial and full thickness wounds

granular or necrotic wounds

pressure ulcers

skin graft donor sites

venous insufficiency ulcers

semipermeable foams

particularly marketed for pressure injuries

hydrophilic polyurethane base that contacts the owund surface and a hydrophibic outer layer

when are semipermeable foams commonly used

minor burns

skin grafts

donor sites

ostomy sites

pressure ulcers

venous insufficiency ulcers

neuropathic ulcers

ABD pad is short for

abdominal pad

when are ABD pads commonly used

wounds with heavy drainage

large wounds

post surgical

pressure ulcers

trauma

venous insufficiency ulcers

hydrofibers

provides moist wound environment while absorbing excess fluid from the wound bed

when are hydrofibers commonly used

heavy drainage

irregular shaoe

post surgical

pressure ulcers

abrasion/lacerations

partial thickness

venous insufficiency ulcers

alginates

seaweed

soft cotton like appearance

woven or non woven

when are alginates commonly used

high exidate

venous insufficiency ulcers

tunneling

pressure ulcers

infected

what dressings are most commonly used for high drainage wounds

gauze

ABD pads

hydrofibers

alginate

silver impregnated antimicrobial dressings used to

reduce bioburden

gauze, semipermeable films and foams, hydrocollloids, and alginates

charcoal impregnated antimicrobial dressings mainly used to

reduce odor

silver impregnated antimicrobial dressing can be in what types of dressing

gauze, semipermeable films and foams, hydrocollloids, and alginates

honey impregnated antimicrobial dressings have what effects

antibacterial