3 Types of wounds: Intentional Open Closed Clean Clean-contaminated Infected/dirtyChronicPartial thicknessFull thickness
4 Pressure ulcers:Also known as decubitus ulcers, bedsores, pressure soresCauses: pressure, friction and shearing
5 Persons at risk: Confined to bed or chair Need some or total help to moveLoss of B/B controlPoor nutrition and fluid balanceAltered mental awarenessProblems with sensing pain/pressureObese or very thinOlderCirculatory problems
6 Sites: Usually occur over a bony spot Called pressure points In obese, can occur where there isskin to skin contactIn persons who are bedridden, sorescan develop on the earsepidermal stripping
16 Prevention of Circulatory Ulcers: Do not sit with legs crossedDo not dress in tight clothesKeep feet clean and dry, dry well between toesDo not scrub or rub skin during bathLinens dry and wrinkle freeAvoid injury to legs and feetMake sure shoes fit properlyKeep pressure off heels and other bony areasObserve legs and feet, report any skin breaks or color changes
17 Wound assessment: Location of each wound Size and depth (the nurse does this, you may assist)Appearance: area around it is red/warm to touch/swollen, sutures/staples intact, wound edges closed/separatedDrainage present COAWound photography
21 Factors that affect wound healing: Circulatory diseaseAgeSmokingDiabetesCertain medications (blood thinners)Nutrition (especially protein)Type of wound and treatmentAntibioticsWeakened immune system
22 Prevention of skin breakdown and injury: Heel and elbow protectorsBed cradleTurning and positioningWrinkle free linensBe careful when moving a personPrevent friction and shearing when turningMake sure skin is completely dry when bathingDo good perineal careApply lotion to dry skin as directed by care planDo not massage over pressure pointsKeep heels off the bedReposition frequently in chair, encourage patient to shift weightReport any skin conditions immediately
23 Other prevention techniques Special beds/mattressesSpecial chair cushionsProtective barrier cream
25 Treatment of wounds: Dressing changes: Dry dressing Wet to dry Packing DuodermGauze, non-adherent gauzeTegaderm (transparent)Sterile vs. cleanPurposes of dressings
26 Others: Montgomery ties Breast binder Single and double T binders Abdominal binderAce wrapTED Hose
27 Guidelines for applying: Binders: Make sure there is firm even pressure over the area, snug, but not impeding circulation or breathing. Secure any pins to point away from the wound.With Ace wraps, make sure they are snug, but not too tight and they are secured.See pages 575,576Always wash your hands, change any wraps/binders that become soiled.Anything with blood or body fluids (such as dressings) need to be put in biohazard.CNAS can apply a simple dry dressing (like basic first aide), but the nurse does all complicated dressing changes. You may assist. Be careful when removing tape (like after a blood draw).
28 Other treatments Ointments Irrigation Debridement Wound vac CNAS can apply NON-MEDICATED protective barrier cream in most facilities. Check with your facility. Do NOT apply any type of medicated ointment or powder!
29 A final word…..You will see some bad wounds during the course of your career. Some will have a very bad odor, lots of drainage, or be very deep (where you can see bone, muscle, etc).You have to keep your emotions in check. Do not talk about the wound negatively in front of the person. They need to feel accepted and not worry about what people think of their wounds. Also, don’t run down the facility they came from in front of the patient (it is the nursing home’s, surgeon’s or hospital’s fault).