Rough Road Ahead: Skin and Wound Care Products

3/31/2015
Rough Road Ahead: Skin and
Wound Care Products
Rita A. Rusenas BSN, RN, CWOCN
May 13, 2015
NIA Community Education day
Objectives
• Identify various wound dressings and
techniques for their application
• State the three primary classifications of
wound care products in maintaining the
wound bed for optimal healing
• Define the principles of skin and wound
management in the general practice setting
• Describe three products that can be used for
treatment of a pressure ulcer
Skin Care
• Skin ---Changes with age
• Bathing products
• Moisturizing products
• Protectants
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Wound Healing Physiology
• Two ways for soft tissue in the body to heal
– Regeneration –Epidermis and Dermis
– Granulation –Scar tissue formation• Subcutaneous tissue does not regenerate
• Muscle does not regenerate
• Bone –traumatic injuries regenerate
Wound Healing Physiology
Acute wounds-occur in a sudden manner
Trauma or Surgery
Chronic woundsNormal healing orderly cascade of events is
interrupted
Principles of Topical Therapy
– Debride Necrotic
Tissue
– Identify and treat
infection
– Pack/Fill/Wick dead
space
– Absorb excess
exudate
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Principles of Topical therapy
• Maintain moist
wound surface
• Open or excise
closed wound edges
• Protect from
infection/trauma
• Insulate
Wound Cleansing
Clean Granulating wounds
– Goal to minimize disruption of wound surface
– Cleanse gently
– Use Non cytotoxic solutions
Wound Cleansing
Necrotic/Dirty wounds
– Goal is to remove as much debris from wound
surface as possible without damaging underlying
tissue
Types of Necrotic tissue
Slough
Eschar
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Should this wound be debrided?
Necrotic tissue can be a major impediment to
healing
Debride Necrotic Tissue ----Types of Debridement
TYPES of
DEBRIDEMENT
Mechanical
Surgical
Enzymatic
Autolytic
Identify and treat infection--Infected Wounds
• Types of Antimicrobial dressings
• Wounds involving infection of soft tissue:
– Clinical S/S: erythema, peri-wound warmth,
edema, increased pain or tenderness, purulent
exudate
– Treatment: systemic antibiotics (culture based if
possible)
• Wounds involving osteomyelitis:
– Clinical S/S: exposed bone; nonhealing tunnel
– Treatment: systemic antibiotics
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Pack/Fill/Wick dead space—Filler dressings
• Types of dressings to pack/fill/wick
– Wounds with tunnels
– Wounds with undermining
– Wounds with depth to fill
Absorb excess exudate—Moisture balance
• Dressings to absorb exudate
– Categories of absorbent dressings
Maintain moist wound surface—Moisture
Moist wound healing
Old, outdated dressings
-wet to dry dressings
• Moisture lending dressings
• Moisture retentive dressings
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Final 3 Principles of Topical Therapy
• Open or excise closed wound edges
– What is a closed wound edge? Epibole?
• Protect from infection/trauma
• Insulate-How frequency of dressing changes
can help or impede healing
Advanced and Adjunct Wound
Therapies
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Negative pressure therapy
Whirlpool therapy
Compression therapy
Total Contact Casting
Hyperbaric oxygen therapy
--other modalities
Wounds- Managing Priorities
• Determine goal of wound management
– Maintenance vs. Healing
• When patient lacks ability to heal due to systemic
problems, i.e. malnutrition
Terminally ill
• When underlying etiology/pathology cannot be
corrected
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Guidelines for Dressing Selection
Deep WET Wounds
Need: Absorptive filler and cover
dressing
Deep Dry Wounds
Need: Hydrating Filler and cover dressing
Shallow Wet Wounds
Options:
Shallow Dry Wounds
Options:
Conclusion and Case Studies
Thank You!
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