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

2. 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

3. 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.

4. 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

5. 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

6. 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

7. 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.

8. 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
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

9. 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

10. 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

11. 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

12. Websites for Further Information on Types of Wounds
- Association for the Advancement of Wound Care
- Canadian Association for Wound Care
- National Pressure Ulcer Advisory Panel
- World Union of Wound Healing Societies
- Wound Ostomy Continence Nurses Society