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UNIT 4 Supporting Physiological Function
Disposal of Dressings ■ Carefully dispose of contaminated dressings in biohazard waste receptacles. ■ Discard unused dressings if they become contaminated. Storage of Dressings ■ Store patient dressing supplies in a clean and dry area. ■ Do not share supplies among patients. ■ Access only the number of supplies you need for the dressing change. Protection of Dressings ■ Do not touch the supply of dressings with gloves that have touched the wound. ■ Discard unused dressings if they have become contaminated. Think Like a Nurse 32-6: Clinical Judgment in Action What would be the best method to secure dressings for Mr. Harmon (Meet Your Patient)? Supporting and Immobilizing Wounds Binders and bandages are used to hold a dressing in place, apply pressure to a wound to impede hemor- rhage, and support and immobilize an injured area, thereby promoting healing and comfort. Before apply- ing a bandage or binder, determine the purpose of the application and assess the part being bandaged. Binders Binders may be used to keep a wound closed when there is a danger of dehiscence or to immobilize a body part to aid in the healing process. They are typically used on large areas of the body and are designed for a specific body part. They may be made of cloth or elas- ticized material and fasten with straps, pins, or Velcro. The most common binders are the following: ■ A triangular arm binder or sling is used to support the upper extremities. Because commercial slings are readily available, you will rarely use a triangular sling. ■ A T-binder is used to secure dressings or pads in the perineal area. ■ An abdominal binder is used to provide support to the abdomen, for example, when there is an abdomi- nal incision or an open abdominal wound healing by secondary intention. The binder decreases the risk of dehiscence. To see the complete procedure, Go to Chapter 32, Procedure 32-10: Applying Binders, in Volume 2. Bandages A bandage is a cloth, gauze, or elastic covering that is wrapped in place. Except for slings, most bandages
Adhesive portion
Nonadhesive portion
FIGURE 32-16 Montgomery straps with ties may be used to secure a dressing that requires frequent changing.
Two: Contact Level Precautions in addition to Standard Precautions. See Chapter 20 and Chapter 20, Clinical Insight 20-4: Following Transmission-Based Precautions, in Volume 2. Several nursing activities also aid in preventing and controlling wound infections. Asepsis Measures If the patient has an infection, place them in a private room or in a room with a patient who has an active infection caused by the same organ- ism and no other infections. Follow any additional spe- cific precautions for the microorganism identified. Most importantly, wash your hands frequently and thor- oughly with soap and warm water. ■ Use clean gloves when caring for the patient with a wound. ■ Remove gloves and wash your hands before physical contact with another patient. ■ Change your gloves after removing a soiled dressing and before applying a clean dressing. ■ If a patient has multiple wounds, treat the least con- taminated wound first, and then progress to the most contaminated. Wash your hands and change gloves between each wound. Sterile Technique for Sharp Débridement To prevent infection, use sterile instruments for sharp débridement. Monitor the patient for signs and symp- toms of sepsis (e.g., fever, tachycardia, hypotension, and altered level of consciousness) after sharp débridement. Remember, only specially trained providers can do sharp débridement. See the content under the heading Sharp Débridement if you need to review. Dressings and Supplies Acute wounds may require sterile dressings. Chronic wounds require clean dressings. However, even a chronic wound may require sterile dress- ings if the patient is immunocompromised.
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