wound care

1. New approach to understand wound care
By Khalid Remaly

2. Metaphors illuminate all kinds of
concepts.
Williams Harvey described the heart as a
pump and, as
we couldn’t know much about
how the heart worked until the water
pump was invented

6. Farming is a team activities devoted primarily

to the practice of producing and managing
crops.
Farmer job is to provide the best conditions

for the planting as natural process to take
place.
It is long with multiple phase process.


7. Understand your Patient and wound
 
challenges assessment.
Plan to overcome. Plan to manage.
 

9. Remove dead tissue and control

contamination

10. Why do We Want to Remove Necrotic Tissue?
Necrotic tissue inhibits healing

Necrotic tissue is a medium for infection.

Necrotic tissue in a wound stimulates the

inflammatory response.

12. Using of anti septic

should be limited to the
early stage of highly
contaminated wound.
For the further stage

you should switch to
modern antimicrobial
agent.

15. presence of exudate in a wound

will provide an environment that
stimulates healing.
WBC
ENZYMES
GROTH
FACTORS
Exudate contains various

components, including:
lysosomal enzymes, WBC's,
EXUDATE
lymphokines and growth factors.

17. Absorbent dressing in heavily exudation

wound.
Moist retentive dressing in dry wound.


20. Take the necessary procedures to keep the

wound warm.
Warm up saline before cleansing.

Use dressings of low frequency change.

Change secondary dressing before getting

wet.

22. Proper selection of the dressings.

Remove dressing gently.

Avoid fibrous dressing on wound bed.


24. Inspect skin

Moisture control

Proper positioning and transfer

techniques
Nutrition

Avoid pressure on heels and bony

prominences
Monitor and document


25. Alterations in mobility

Level of incontinence

Nutritional status

Alteration in sensation or response to

discomfort
Medications that delay healing

Decreased blood flow to lower

extremities when ulceration is present

26. Friction
Immobility
Shear
Pressure
Ulcers
Pressure Incontinence
Malnutrition

27. Location

Stage and Size

Periwound

Undermining

Tunneling

Exudate

Color of wound bed

Necrotic Tissue

Granulation Tissue

Effectiveness of Treatment


28. Wound and Risk Assessment every visit

Documentation on Wound Assessment Form every 7

days when 1 or more pressure ulcer exists
Physician assessment and documentation on

Physician Wounds Care Assessment tool

29. Stage I Stage II Stage III Stage IV

30. Overall strategy and scope of the
treatment plan depends on
patient’s condition, prognosis,
and reversibility of the wound.

31. Prevent complications or the deterioration

of an existing wound
Prevent additional skin breakdown

Promote wound healing


32. Dressing considerations should
include:
Patient’s condition and prognosis

Ease of use

Ability to maintain moisture

balance
Frequency of change


33. Cleanse Debris from the

Wound
Possible Debridement

Absorb Excess Exudate

Promote Granulation

and Epithelialization
When Appropriate
Possibly Treat Infections

Minimize Discomfort


34. Indicated for Mechanical Debridement ONLY
Causes Injury to New Tissue Growth

Is Painful

Predisposes Wound to Infection

Becomes a Foreign Body

Delays Healing Time


35. Goal is to minimize the Decrease Frequency

frequency of dressing of Dressing Changes
change
Daily dressing changes

increase chances of
infection and disrupts
the healing of tissue
Optimal wear time is

3-7 days

36. Assess “Risk for Breakdown”

Utilize skin creams and lotions for

dry skin
Utilize barrier products as needed

to minimize irritation from
incontinence
Reposition frequently

Use pillows in bed for positioning


37. Remove Wound Debris

Sustain Moist

Environment
Soften Necrotic Tissue

Debride the Wound

Reduce the Risk of

Bacterial Contamination
and Infection
Reduce Odor


38. Dry to Minimal

Exudate
Moderate Exudate

Copious Exudate


39. TREATMENTS:
GOALS:
Maintain skin integrity

Skin to remain clean and odor Preferred agents (dry skin)

free Aloe Vesta skin cream

Protect and moisturize skin Preferred agents (at risk for

breakdown due to
incontinence/pressure)
Aloe Vesta protective

ointment

40. Dry to Minimal Exudate
GOALS:
TREATMENTS:
Minimize dressing changes

Maintain moist

Preferred agents:
environment
Prevent infection

Hydrocolloid

Prevent additional skin

(DuoDERM )
breakdown

41. Moderate Exudate
GOALS: TREATMENTS:
Minimize dressing

changes Preferred Agents:
Maintain moist Hydrofiber (Aquacel)
 
environment Hydrocolloid (DuoDERM)

Prevent infection

Prevent additional skin

breakdown

42. Copious Exudate
GOALS: TREATMENTS:
Minimize dressing

changes Preferred Agents:
Manage Exudate Hydrofiber (Aquacel)
 
Prevent infection

Prevent additional skin

breakdown

43. Mechanical Debridement

Autolytic Debridement

Sharp or Surgical Debridement*


44. Treatments:
Goals:
 Removal of exudate
Preferred Agents
 Odor control
Non-Adherent Gauze

 Pain control Dressing .
Zinc Oxide Paste

(Viscopaste)
Non-Pharmacological
Activated Charcoal Dressing
measures to control odor 
(Carboflex)
include:
 Oil of Wintergreen
Atropine solution may be
 Charcoal briquettes or
used to control bleeding
Coffee grounds
 Dryer Sheets
Metrogel cream can be used
to control odor

45. Treatments:
Diagnosis of wound infection:
 Based on clinical signs
Preferred agents:
(fever, increased pain,
 Hydrofiber (Aquacel Ag)
friable granulation tissue,
foul odor)
DO NOT USE:
Providine Iodine

Iodophor

Dakin’s solution

Hydrogen peroxide

Acetic Acid


46. Comfort and Shear
Reduction Products:
Pillows

Heel/Elbow DO NOT USE DONUT TYPE

DEVICES IN WHEELCHAIRS
Protectors
Foot Cradles

Sheepskin Pads


47. Multiple Pressure Points (greater than 2 turning
surfaces)
 Standard Mattress
 3-4” Eggcrate Overlay on Standard Bed
 Gel Mattress Overlay
 Wheelchair Foam Pad
 Wheelchair Gel Pad
Multiple Pressure Points (fewer than 2 turning surfaces)
 Static Air Mattress
 Alternating Pressure Pad and Pump
 Low Air Loss Mattress (requires approval)

48. High quality crops.

High economical value

Happy customer


49. High quality healing

results.
Saving hospital costs.

Happy patients.
