Treatment Chronic wounds

Function of transparent film dressing

Not absorbent allows for wound visualization

Where is the common area for neuropathic Ulcer

Over weight bearing areas of foot

Risk factor of Neuropathic Ulcer

PVD neuropathy trauma diabetes

What caused Pressure ulcer

Pressure- Compress blood vessels=tissue death Shear- forces=stretching of sub q tissue when sliding causes occlusion of blood vessels Friction-damage epidermis Moisture

Pressure Ulcer treatment

Promote healing: moist not flooded environment Protect from infection Protect from trauma minimize scarring

What are principle of choosing dressing?

1. Wound drainage level (wet or dry) 2. wound location (anatomy) 3. Wound depth 4. Hydration required?

What is Sheet hydrogels

3D network of cross linked hydrophilic polymers. Up to 96% water yet insoluble in water. cool to wound

Wounds care Dressing definition

Absorb excess fluid Protect and maintain moisture environment Hydrate drug wound & faciliate autolytic debridgement

What is alginate dressing

Absord fluid -> become gel For heavy draining wound Many require secondary dressing

Function of Hyrdrocolloid

Adhesive Absorbent- not as much Protective 3-4 days before change has melting behavior

Important Risk factor for chronic wounds to Pharmacist

Advance Age Obesity Medication _ Sedative/ hypnotic _ Diuretics _ Anticholinergic _ Immunosuppressive/ Anti-neoplastic _ Corticosteroids

WHat is hydofiber dressing

CMC fiber, very absorptive, form gel in presence of water Can over-dry wound

Treatment for Chronic Wounds

Cleanse wound Determine if infection is present and treat Debride if necessary Dressing appropriately Monitor

Secondary dressing

Covers primary dressing

When to use Dressing to absorb Fluid?

Early inflammatory stage Venous leg ulcer Lymph edema

Risk factor for chronic wounds

Excessive pressure Immobility Diabetes Mellitus Poor circulation Immunodeficiency Infection Poor Nutrition

What is not appropriate for self treat

Foreign matter Diabetes Chronic wound Infection Deep acute wound Secondary to bite

Pressure ulcer Stage 3

Full thickness skin loss with damage to epidermis, dermis, dermal appendages, and may involve subcutaneous tissue

Pressure ulcer Stage 4

Full thickness skin loss with extensive tissue necrosis and damage to muscle tendon, joint capsule or bone

Example of Secondary Dressing

Gauze

Advantage of Foam dressing

Good for mod/heavy draining wounds such as venous ulcers. Good for cushioning

Not recommended cleanser

H2O2: inhibit skin growth ALcohol Dakin's full strength

Dakin solution

Hypochlorite solution bleach that has been diluted and treated to decrease irritation strong antiseptic that kills most forms of bacteria and viruses.

Treatment for Venous Stasis Ulcer

Improve venous return Compression and elevation Dressing to adsorb excess exudate

What is armorphous hydrogels

Like on ointment in a tube. Similar to sheet but not cross linked. Not as cooling as sheets. Good for dry escharic wound to facilitate autolytic debridement Need a secondary dressing often a film

Treatment for Neuropathic

Manage risk factors: DM Reduce pressure Maintain moist wound ( not wet)

Treatment for Arterial Ulcer

Modified Risk factor: Smoking, high cholesterol, pseudophed.. Vascular surgery Dressing to add moisture

What is Pressure ulcer

Most common type of wound Primarily in immobile patients and geriatrics Classified by stages Over boney prominences: sacrum, elbow, or heal

When to use dressing to Protect and maintain

New tissue filling in

Pressure ulcers Stage 1

Nonblanchable erythema of intact skin with discoloration, warmth or hardness

How to cleanse wound

Normal saline: best choice Cleanser Maggot therapy

Debridement of wouds definition

Removal necrotic tissue Helps formation of granulating tissue Consider as surgical procedure for Medicare billing

Pressure ulcer Stage 2

Superficial lesions with partial thickness skin loss involving epidermis, dermis, or both

What is transparent film dressin

Thin polymer sheets Coating on one side Adhesive Inactivated by moisture-will not stick to wound Gas permeable Impermeable to liquid

What is Arterial Ulcer

Too much drainage Little to exudate Due to ischemia / inadequate blood flow

What is venous stasis Ulcer

Wound by blockade-> swelling Irregularly shaped Big drainage Large and often on inner side of ankle Large amount of exudate

When would Medicare pay for dressing

Wound caused by / treat by surgical procedure medically necessary debridement wound

Exudate

a mass of cells and fluid that has seeped out of blood vessels or an organ, especially in inflammation

Primary dressing

dressing in physical contact with wound

When to use Hydrate Dressing

dry wound that need debridgement

Disadvantage of Foam dressing

is not as easy to shape over certain anatomical sites

What are characteristic of arterial ulcer

painful little to no exudate

Debridgement of wounds methods

sharp scalpel enzymatic hydration

Indication of Regranax Gel

the treatment of lower extremity diabetic neuropathic ulcers extending into the SQ tissue or beyond with adequate blood supply After initial sharp debridement