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 1 3/31/2015 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 2 3/31/2015 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 3 3/31/2015 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 4 3/31/2015 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 5 3/31/2015 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 • • • • • • 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 6 3/31/2015 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! 7
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