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Guest Lecture Pres

Wounds Guest Lectures

QuestionAnswer
What is Governor Brownback's new reform of Medicaid & when does it go into action? KanCare; 1/1/2013 SRS will be Dept for Children & Families Dept of Aging will be Dept for Aging & Human Services
3 MCOs under KanCare United HC Sunflower Amerigroup
Insurance Requirements for Wounds Physician's order with wound location, size of wound (LxWxD), wound type, exudate amount, type of debridement, freq. of dressing change, type(s) dressing used, description of wound care
When is a new wound assessment required? If still ordering same supplies after a month Expect wounds to change within 2 weeks
Medicare doesn't pay for what? Hospital-acquired pressure ulcers
Long-term care reimbursement for Medicare EBP for prevention & treatment of pressure ulcers & LE wounds are in place. Penalties for non-compliance are severe. Home care, CMS requires reporting on wound care published on a public website.
Preventing Pressure Ulcers- Pressure Regular re-positioning & pressure re-distribution (pillows or devices)
Preventing Pressure Ulcers- Sheer/Friction Apply skincare products to lubricate- such as Aloe Vesta Skin Conditioner or moisturizing body cream (not lotion); or Apply moisture-retentive dressings to reduce friction (hydrocolloid extra thin or transparent dressings)
Preventing Pressure Ulcers- Excess Moisture Protect with skin barrier products- ointments, desitin, zinc, InterDry Ag
Preventing Pressure Ulcers- Dryness Use moisturizing bathing- such as Aloe Vesta; AND Conditioning creams
Preventing Pressure Ulcers- Expected Outcome Skin stays intact without signs of hyperemia
Skin Care & Prevention- Protective Ointments Help treat & prevent rash associated with diaper use or continued exposure to feces, urine or both. Help treat skin tears & sheering, stage I ulcers
What to use protective ointments on Intact, clear skin; Red, dry skin; Mild dermatitis; Denuded skin; Adheres to macerated skin- be careful not to cause shear wounds Don't apply over deep or puncture wounds, infections or lacerations
Protective Ointment Properties Usu. petrolatum based; Vits A&E help sooth/condition skin; Some have clove oil (helps mask odor, slightly numbing); Karaya absorbs moisture, adheres to weepy/macerated skin; Doesn't wash away when exposed to urine/feces; Can see through some
Dimethicone Silicone oil that softens the skin without contributing to the lipids, or making the skin feel greasy
Anti-Fungal Cream Tx: Tinea cruris (jock itch), Tinea corporis (ringworm), Tinea pedis (athlete's foot) Water based, absorbs quickly Don't use in areas exposed to urine/feces Contains Vitamin E & skin conditioners
Guidelines Decide which type of wound you're treating Determine what you want tx to accomplish Create a plan & choose products to help If it's dry, wet it; If it's wet, dry it If wound has both characteristics, wet AND dry
What to do prior to treatment Assess for infection (increased/purulent exudate, inflammation, delayed healing, odor, discolored granulation tissue) Obtain measurements weekly Cleanse- wound cleanser/sterile water/saline
Moisture Balance- Dry Wounds Dry wounds-hydrate Need- moisture to help dissolve dead tissue. Reduce dead space in cavity wounds. Wound gel/gauze filled w/ wound gel/hydrogel wafer Transparent dressing if no exudate Thin hydrocolloid if none--slight exudate Soft silicone contact
Should you fill the wound bed? Line the wound, don't fill. If you fill, gel comes out & will macerate wound edges. With lining, it will seep back into wound bed & hydrate it.
Moisture Balance- Wet Wounds Manage exudate; Need- dressing that can keep moist environment, remove exudate, permit moisture vapor transmission, avoid wound trauma at dressing changes
Products to use in wet wounds Foam- thick/thin Alginate- hydrofiber (manmade), calcium alginate (seaweed) or collagen alginate (animal based) Composite- protect, absorb, adhere (3 layers) InterDry AG- skin to skin moisture
Secondary Dressings- Cover & Protect Bordered gauzes, Island dressings, Woven/non-woven gauze, Wraps, ABD dressings, Hydrocolloids, Foams, Composite Dressings
Dry Wound-- Hydrogel- 3 forms Tube Wafer Impregnated Gauze
Hydrogel Gently rehydrates necrotic tissue; Effectively de-sloughs; Creates moist environment; Non-adherent; Keeps gel in close contact with wound surface; Non-cytotoxic Change daily! Use 2ndary dressing
Wound Gel Application (Dry Wounds) Cleanse & pat wound dry. Measure. Apply by positioning pt so gel can go directly into wound. Line wound bed (don't fill); If necrotic, line edges of necrotic tissue. Cover with 2ndary dressing.
Wound Gel impregnated gauze application (Dry wounds) Clean, pat dry, measure. Cut or fold gauze to fit wound bed. Place over wound bed. Cover with 2ndary dressing.
Hydrogel Wafer application (dry wounds) Clean, pat dry, measure. Doesn't have to be cut to fit wound bed, cover wound & surrounding skin. Cover with 2ndary dressing.
Transparent Dressing- Dry Wounds Breathable, high vapor permeability, allows moisture to pass from wound & surrounding skin. Barrier to bacteria. Waterproof (can't be submerged). Easy to apply. Conforms to body contours. Can view wound through dressing. Remove with LATERAL STRETCH!
Thin Hydrocolloid- Dry Wounds Activates enzymes through moisture; microbial barrier/waterproof; Adheres to slightly moist skin, not wound bed. Can be primary or secondary dressing. Facilitates autolytic debridement of fibrin & necrotic tissue. 1 hand application, self adhesive.
30 second rule Once applied, hold hand over it for 30 sceonds b/c it has to get to body temperature to adhere to the skin Hydrocolloids are often used for coccyx wounds
Applying Hydrocolloid Clean, pat dry, measure. Place dressing centering wound in middle of dressing. Spend 1-1.5 mins working dressing down after applying. Work from center out. Can use skin prep/tape for edges.
When should you change out a hydrocolloid? When exudate reaches within 1/2" dressing edge or leaking- usually lasts at least 3 days.
Contact Layers Prevents damage to new tissue Enables less frequent dressing changes Doesn't adhere to moist wound beds, only dry tissue Atraumatic to wound/surrounding skin, minimizing trauma & pain on dressing changes Transparent for inspection
Contact Layers continued Conforms to contours Designed for wide range of wounds, dry & wet, including 2nd deg burns, grafts Open mesh for application of topical tx Can line deep wound before application of packing materials
How long can contact layers be worn? Up to 10 days, just change secondary dressing
Foam Dressings Lite, Regular, Bordered- depends on exudate amount Hydrophilic Polyurethane Dressing sandwiched b/t nono-adherent wound contact layer & waterproof outer film S/sx infectoin- use only if proper infection tx initiated
More foam dressings Fast fluid uptake & absorption that xfers exudate away from wound- reduces maceration Can be cut to shape Bacteria & waterproof Breathable Don't use with oxidizing agents (Dakins, Hydrogen Peroxide, enzymatic)
Application of Foam Clean, dry, measure. Clip excess hair. Cut to fit awkward areas. Apply non-waterproof side to wound bed. Non-bordered, secure with tape/bandage. Remove by lifting dressing away from wound.
Alginates- Hydrofiber Dressings Alginates absorb 20x their weight Hydrofiber absorbe 5-6x more than gauze Insulate wound, fill dead space Non-adherent as exudate diminishes Controlled wicking Converts to clear gel/gel-fiber matrix Strong- simple application/removal
What would you use an alginate on? Deep or shallow wounds with or without undermining/tunneling-moist to wet wounds Only put alginate where there is moderate to heavy exudate. If it is put on good skin, you will just suck out moisture.
Thick Hydrocolloids Moist environment. Absorbs exudate, allows fluid to evaporate, avoiding maceration. Hydrophobic outer layer resists fluid penetration. Doesn't adhere to wound base. Primary or 2ndary dressing. 1-hand app 30 second rule & remove with lateral stretch!
Composite Dressings All in one Contact layer- exudate passes to absorbent pad Absorbent pad- absorbs exudate minimizing risk of maceration Protective film- semi-permeable, prevents fluids passing through dressing, protecting wound bed from contamination
InterDry AG Textile w/ Antimicrobial Silver Complex Treats intertrigo Wicks moisture from skin Reduces skin to skin friction 5-day therapy 5 cm interdry exposed to ensure skin folds remain dry
InterDry AG Candidiasis non-resolving in 5 days, antifungal powder (microguard) may be used Don't use creams, ointments, or pastes with interdry Refer if skin doesn't improve in 5 days Can use with compression bandages May be placed over wound dressings
Silver Dressings Wound gel; Foams; Alginates; Secondary dressings Wouldn't use silver on wounds changed daily or more b/c it's very expensive. Wound has to be infected for silver to work on it.
Silvery 2ndary Dressings Sustained release of Ag usually 3-7 days- purpose: kill bacteria Silver begins inactivating pathogens within 30 mins of applying Reduction of micro-organisms reduces odor Cost effective- 3x> other dressing- use Ag w/ cross infection/colonization
Prisma Collagen matrix that looks like styrofoam, can cut it & place in wond; reduces bacterial burdens; cut to fit wound bed, then cover with semi-occlusive dressing so moisture can exit Not for 3rd degree burns or patients sensitive to Ag
Prisma Sterile, freeze dried oxidized regenerated cellulose, collagen, & Ag. Transforms into soft, conformable gel. Reduction of bacterial burden = reduced risk of infection Collegen fibers- biodegradable matrix for cell invasion & capillary growth
Prisma Effective with- pseudomonas, staph, e coli, strep Cut to fit, cover with semi- or non-occlusive 2ndary dressing Used on dry wound-use saline to hydrate matrix
Prisma May be used under compression therapy Don't be concerned if any matrix residual left in wound, will be naturally absorbed into the body over time
Medihoney Resistant to degradation by wound fluid Sterilization doesn't decrease product effectiveness Debrides, lower wound pH moisture balance, natural & potential for extended wear times
Medihoney Uses: non-healing post-op, venous leg ulcers, Crohn's disease ulcerations, diabetic foot ulcers; Gel form, impregnated into calcium alginate dressing, Honeycolloid
Created by: 1190550002