Wound Dressings Module #6 Diane L. Krasner PhD, RN, FAAN & Lia van Rijswijk DNP, MSN, RN, CWCN   Module #6

Objectives To appraise the purposes of wound dressings To distinguish the relationship between wound characteristics and dressing choices To give examples of at least two types of dressings To correlate topical wound care to nursing concepts, nursing diagnoses and practice issues

Wound Dressings: General Purposes Protect the wound from contamination Optimize the local wound environment to facilitate healing Reduce pain Note: Topical care is only one of several components needed to help wounds heal. Other factors that may need to be addressed include pressure redistribution, nutritional support, wound bed preparation and patient adherence. Care should be safe, effective, cost-effective and patient-centered.

Wound Dressings: Protection against contamination Protect the wound from contamination All wounds are contaminated (colonized) with regular skin bacteria. However, too many bacteria, contamination with highly infectious bacteria or the presence of necrotic tissue (slough or eschar) should be addressed by using appropriate dressings and dressing change technique. © AAWC Used with permission

Wound Dressings: Optimize the local wound environment to facilitate healing Necrotic tissue should be debrided (e.g. surgical, enzymatic, or autolytic [by keeping the wound moist]). For healable wounds, tissues should be moist at all times. Note: Dressing selection is based on wound assessment observations. As the wound status changes, the type of dressing may need to change. © AAWC Used with permission A dry cell is a dead cell

Wound Dressings: Optimize the local wound environment to facilitate healing & reduce pain Use absorptive dressings (e.g., alginates, foams or hydrofibers) and cover with moisture-retentive dressings (e.g. hydrocolloids, films, foams) Dry Use moisture donating dressings (e.g., hydrogels) and cover with moisture-retentive dressings (e.g. hydrocolloids, films, foams) Moist Wet A wet wound can cause skin maceration and frequent dressing changes which can be painful A dry wound can be painful

Wound Dressings: Optimize the local wound environment to facilitate healing & reduce pain Use moisture-retentive dressings (e.g., hydrocolloids or films) Moist Dry Wet Optimal dressing choices reduce dressing change frequency and resultant pain.

Wound Dressings Optimal dressing choices are safe and effective: optimize the healing environment, reduce pain and suffering, and improve patient quality of life. Valid guidelines to help clinicians select optimal dressings are available. Krasner, D.L., Sibbald, R.G., & Woo, K.Y. (2014) Wound dressing product selection: A holistic, interprofessional, patient-centered approach. In: Krasner, D.L. (Ed). Chronic Wound Care: The Essentials. Malvern, PA., HMP Communications . Downloadable at www.WhyWoundCare.com/Resources Beitz, J.M., & van Rijswijk, L. (2010). A cross-sectional study to validate wound care algorithms for use by registered nurses. Ostomy Wound Management , 5694):46-59 Bolton, L.L., Girolami, S., Corbett, L. & van Rijswijk, L. (2014). The Association for the Advancement of Wound Care (AAWC) venous and pressure ulcer guidelines. Ostomy Wound Management, 60(11):24-66

Key Nursing Concepts Assessment Caring Comfort Ethics Evidence-based Practice Infection Infection Control Infection Prevention Pain Patient Education Perfusion Prevention Quality of Life Safety Self Care Deficit Thermoregulation Tissue Integrity

Key Nursing Diagnoses Potential for Alteration in Skin Integrity Potential for Alteration in Tissue Integrity Impaired Skin Integrity Impaired Tissue Integrity Oral Mucous Membranes, Altered Pain Knowledge Deficit r/t Self Care Deficit r/t

Key Nursing Practice Issues Patients who experience wound pain should be premedicated prior to dressing change (with enough time for the medication to take effect). Wound cleansing prior to new dressing application is the standard of care. Common solutions include normal saline, tap water and wound cleansers at body temperature to reduce pain. See Module 5 for more information on wound cleansing. Correct etiology is key to selecting the correct clinical practice guideline to follow for an individualized patient & wound plan of care

Websites for Further Information on Types of Wounds - Association for the Advancement of Wound Care www.aawc1.org - Canadian Association for Wound Care www.cawc.net - National Pressure Ulcer Advisory Panel www.npuap.org - World Union of Wound Healing Societies www.wuwhs.org - Wound Ostomy Continence Nurses Society www.wocn.org

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