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CHAPTER 32 Skin Integrity & Wound Healing
Primary dressings are those that are placed in the wound bed and physically touch the wound. A second- ary dressing is one that covers or holds a primary dress- ing in place. Many dressings can act as both, touching the wound bed and securing themselves to the wound with some type of adhesive. Figure 32-14 shows various sizes of gauze dressings. Figure 32-15 shows a transpar- ent film dressing over an IV site. There is no single “recipe” for healing a wound. Each wound must be treated and dressed individually based on the patient history and assessment. Many wound materials are available, and new products are contin- ually introduced. The “newest” type of dressing is not necessarily the best for the wound that you are treating. Choose the dressing based on what the wound needs and not the manufacturer’s brand name. Perform ongo- ing reassessment of your dressing choice every time you assess the wound, modifying dressings and treatments as the wound evolves. Knowledge Check 32-10 ■ What should you consider when choosing a dressing? ■ Describe the five types of wound débridement. ■ Identify the purposes of a wound dressing. ■ Differentiate between the different categories of dressings. ■ What types of dressings may be used for wounds with a large amount of exudate? ■ What form of dressing is appropriate for a wound with eschar that needs to be eliminated? Securing Dressings What you will use to secure a dressing depends on wound size, location, and amount of drainage; fre- quency of dressing changes; the patient’s activity level; and the type of dressings used. Tape, ties, bandages, sec- ondary dressings, and binders are among the choices. Tape is most often used. It is available in several forms: ■ Adhesive tape provides stability to a dressing. It is durable and can be used if you need to apply pressure
FIGURE 32-15 IV sites are commonly dressed with transparent film dressings.
to a wound. It leaves a residue on the skin and can cause trauma to the surrounding intact skin when it is removed. However, commercial adhesive removers can dissolve the residue and can be used to loosen the tape as it is removed. Adhesives in the tape can cause allergic skin reactions in some patients. Monitor for this complication. ■ Foam tape readily molds to the contours of the body and is ideal for dressings over joints. ■ Nonallergenic tape and paper tape are best for sensi- tive skin. Ask patients whether they have any history of tape allergies or irritation; use a tape that the patient has tolerated well in the past. To tape a dressing, place strips of tape at the ends of the dressing, and space them evenly over the remain- der of the dressing. For the fragile skin of older adults or infants, use porous tapes and avoid unnecessary tape use. Consider using thin hydrocolloids, low-adhesion foam dressings, or skin sealants under the tape to further help prevent skin tears. To see the complete procedure, Go to Chapter 32, Procedure 32-3: Taping a Dressing, in Volume 2. If a dressing requires frequent changes, you can use Montgomery straps with ties to secure the dressing (Fig. 32-16). Montgomery straps decrease the amount of pulling and irritation of the skin around a wound. Apply the adhesive part of the straps to the skin at the ends of the dressing and at evenly spaced intervals. Lace the cloth ties between the straps to secure the dressing. Change the ties whenever they become soiled. Keep the straps in place until they begin to loosen from the skin. Controlling Infection A wound provides a portal of entry or exit for micro- organisms. When caring for patients with closed wounds, follow CDC Standard Precautions. For patients with open or draining wounds, follow CDC Tier
FIGURE 32-14 Gauze dressings are available in a variety of shapes and forms.
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