TYPES OF DRESSINGS

transparent film (description)adhesive plastic, semipermeable, nonabsorbent dressings allow exchange of oxygen between atmosphere and wound bed, impermeable to water and bacteriatransparent film (purpose)provide protection against contamination and friction; to maintain a clean, moist surface that facilitates cellular migration; to provide insulation by preventing fluid evaporation; facilitate wound assessmenttransparent film (indications)IV dressing, central line dressing, superficial wounds, pressure ulcers stage Itransparent film (examples)bioclusive, Op-site, polyskin, tegadermimpregnated nonadherent (description)woven or nonwoven cotton or synthetic materials are impregnated

with petrolatum, saline, zinc-saline, antimicrobials, or other agents; require secondary dressings to secure in place, retain moisture, and provide wound protectionimpregnated nonadherent (purpose)to cover, soothe, and protect partial and full-thickness wounds without exudateimpregnated nonadherent (indications)postoperative dressing over staples/sutures, superficial burnsimpregnated nonadherent (examples)adaptic, aquaphor gauze, carrasyn, xeroform dressingshydrocolloids (description)waterproof adhesive wafers, pastes, or powders; wafers designed to be worn 7 days, consists of 2 layers, inner adhesive layer has particles that absorb exudates and form hydrated gel over the wound; outer layer provides an occlusive seal

hydrocolloids (purpose)absorb exudate; to produce a moist environment that facilitates healing but does not cause maceration of surrounding skin; protect the wound from bacterial contamination, foreign debris, and urine or feces; prevent shearinghydrocolloids (indications)pressure ulcers stage II-IV, autolytic debridement of eschar, partial-thickness woundshydrocolloids (examples)comfeel, duoDERM, replicare, restore, tegasorbclear absorbent acrylic (description)transparent, absorbent wafer designed to be worn 5-7 days; acrylic layer absorbs exudates and evaporates the excess off the transparent membraneclear absorbent acrylic (purpose)maintains a transparent membrane for easy wound bed assessment, provides bacterial and shearing protection, maintains moist wound

healing; can be used with alignates to provide packing for deeper wound bedsclear absorbent acrylic (indications)pressure ulcers, skin tears, venous stasis ulcers, surgical wounds, wounds undergoing chemical debridement agentsclear absorbent acrylic (examples)tegaderm absorbenthydrogels (description)glycerin or water-based, nonadhesive, jelly-like sheets, granules, or gels; oxygen permeable unless covered by a plastic film; requires secondary occlusive dressinghydrogels (purpose)to liquefy necrotic tissue or slough, rehydrate wound bed and fill in dead spacehydrogels (indications)pressure ulcers, skin tears, partial-thickness woundshydrogels (examples)

carrasyn, elasto-gel, NU-gel, purilon, tegaderm, vigilonpolyurethane foams (description)nonadherent hydrocolloid dressing, edges need to be taped down or sealed, require secondary dressings to obtain occlusive environment, surrounding skin must be protected from maceration, easy to cut and fit to wound bedpolyurethane foams (purpose)absorb up to heavy amounts of exudate, provide and maintain moist healing, provide thermal insulationpolyurethane foams (indications)light to highly exudating wounds, pressure ulcers, skins tears, venous stasis ulcers, surgical wounds, wounds undergoing chemical debridement agentspolyurethane foams (examples)allevyn, curafoam, flexzan, lyofoam, vigiFOAMalignates/exudate absorbers (description)

nonadherent dressings of powder, beads or granules, ropes, sheets, or paste; conform to wound surface and absorb up to 20 times their weight in exudate; require secondary dressingalignates/exudate absorbers (purpose)provide moist wound surface by interacting with exudate to form gelatinous mass; absorb exudate; eliminate dead space or packs wounds; support debridementalignates/exudate absorbers (indications)pressure ulcers, skin tears, venous stasis ulcers, surgical wounds, wounds undergoing chemical debridement agentsalignates/exudate absorbers (examples)algiderm, curasorb, debrisan, kaltostat, sorbsancollagen (description)gels, pastes, powders, granules, sheets, sponges derived from animal sources (usually cow or pig)

collagen (purpose)assists with stopping bleeding, helps recruit cells into the wound and stimulates their proliferation to facilitate healingcollagen (indications)clean, moist woundscollagen (examples)biostep, cellerate RX, NU-gel, promogran

Learnig Objectives:Theory-List the Stages of an infectious process-Identify 5 ways to decrease the occurrence of health care-associated infections (HAIs)-Explain how Transmission-Based Precautions are used with Standard Precautions-Describe how proceedures for Airborne Precautions differ from those for Droplet Precautions-Discuss the special requirements for airborne precautions when the patient has pulmonary tuberculosis-Compare infections prevention and control proceedures appropriate for the hospital with those used in the home-List techniques for handling specimens, disposing dirty linen, trash, & sharps; & cleaning the equipment in the isolation setting-Give 3 examples of nursing measures used for phychosocial care of a patient in isolation-State the 4 rules of surgical asepsisLearning Objectives:Clinical Practice

-Use Standard Precautions when caring for a patient-Utilize Transmission-Based Precautions when caring for patients-Properly bag & remove soiled linens & trash from an isolation room-Teach a patient or family member how to properly dispose of soiled items at home-Demonstrate performance of surgical scrubFour Stages in the infectious Process:-Stage 1: Incubation period^begins when organism first enters the body and lasts until the onset of symptoms; infection can be transmitted during this stage-Stage 2: prodromal period^short time from onset of vague symptoms to the onset of specific disease symptoms; THIS STAGE IS HIGHLY INFECTIOUS-Stage 3: the illness period^localized and systemic symptoms appear^fever, headache, malaise, & disease specific symptoms (e.g. leukocytosis, rash, swelling, wound drainage, diarrhea, & vomiting)^ severity & duration depend on virulence of pathogen & person's susceptibility-Stage 4: the convalescent stage^begins when symptoms begin to subside & continues until person returns to normalHealth Care-Associated Infections (HAIs)-Transmitted while recieving health care services- Health care workers can also contract an HAI-PATIENTS at GREATEST RISK include those with:^surgical incisions with or wothout drains^artificial airways^urinary catheters^intravenous (IV) lines^implanted prosthetic devices^repeated injections or vanipunctures^compromised immune systemsInfection Prevention & Control-Use medical & surgical asepsis, Standard Precautions, & Transmission-Based Precautions-Strict aseptic technique:^used in invasive diagnostic and therapeutic proceedures (IV/urinary catheters, surgical procedures)

-Isolation used to prevent contact between patient & others-Infection prevention and control involves:^monitoring diagnostic reports related to infection^observing patient for signs of infection^implementing proceduresto contain microorganisms^properly handling, sterilizing, or disposing of contaminated items^using approved sanitation methods^recognizing individuals at high risk for infection & implementing appropriate protectionCurrent Standards-Teir 1: Standard Precautions:^delineate methods for avoiding direct contact with body secretions except sweat-Teir 2: Transmission-Based Precautions:^interrupting mode of transmission by identifying specific secretions that might be infective^used alone or in combination but always in addition to Standard PrecautionsTransmission-Based Precautions-Standard Precautions = for all patients-Airborne Precautions = measles, varicella, TB (special mask) [my chicken hez TB]-Droplet Precautions = meningitis, pneumonia, diptheria [SPIDERMAN]-Contact Precautions = GI, skin, wound infection, RSV, herpes simplex [MRS WEE & VCHIPS]Guidelines for Patient Care Contact-Never touch anything with bare hands that comes from a body surface or cavity-Gloves are to be worn for contact with body fluids of any sort including: saliva, urine, feces, & blood-The only times gloves are not worn is for contact with intact skin or unsoiled articlesApplication of Nursing Process-Assessment (data collection):^assess for signs of infection that may require Transmission-Based Precautions^wounds should be assessed each shift for infection^monitor the patient's temperature^admission lab studies may indicate infection-Nursing diagnosis:

^risk for infection, r/t surgical wound, open wound, or weakened conditionPlanning-Expected outcomes would include "No health care-associated infection is evident"-When using Transmission-Based Precautions that require putting on personal proctective equipment (PPE), the nurse must prepare before each entry into the patient's roomImplementation:-Patient teaching is needed on disease process, modes of transmission, & precautions to prevent spread of infection-Standard Precautions used for each contact with patient-Hand hygiene:^MOST IMPORTANT in preventing infection transmission^before & after contact with patient, wound care, or invasive procedure^before donning gloves & after removing them-PPE:^disposable gloves^masks^gown^gloves^goggles/face shieldGeneral Guidlines for Isolation Precautions:-Specimen removal:^label specimen container before entering the room, collect specimen & place it in a leakproof container without contaminating the outside-Linens:^handel as little as possible, roll up & place inside linen hamper inside patient's room-Trash:^disposable soiled equipment should be placed in plastic bags lining the waste receptacle; a bihazard (red) bad may be needed-Sharps:^never recap a needle before disposal; all sharps are dropped into a sharps container, which are replaced when 2/3 full-Other equipment:^reusable equipment cleaned if visibly soiled, then sent to central supply to be disinfected-Natural defenses:^institute measures to enhance the patient's natural body

defense, such as protect intact skin; promote a balanced diet; provide opportunity for sleep; decrease stressPatient placement:^patients who need Transmission-Based Precautions should be placed in a private room or with another patient infected with the same organism-Transporting the patient:^avoid unless absolutely neccessary; patient is given standard mask to wear outside the roomInfection Prevention & Control at Home-Keep clothing and linens away from others until washed-Teach patient & family proper hand hygiene techniques-Disinfect bathroom with 1:10 bleach/water solution-Wash dishes in scalding water & let air dry-Use heavy plastic jug with secure top to hold needles-Use clean gloves for wound care or dressing changes, & teach family how to remove soiled gloves-clean patient's room frequentlyProtective Isolation-Patient in special room with own ventilation system-No one with active infection allowed in patient's room-Remain aware of your facility's policies and procedures regarding protective isolation, & follow them at all timesPsychological Aspects of Isolation-The patient in Transmission-Based isolation Precautions is at risk for decrease in self-esteem & sensory deprivation-Signs:^boredome^slow thought^disorganized thoughts^excessive sleeping during the day^anxiety^hallucinations^panic attacksInfection Prevention & Control for the Nurse-OSHA regulations protect health care workers from exposure to bloodborne pathogens in the workplace-3 main modes of occupational exposure to bloodborne pathogens are:1) Puncture wounds from contaminated needles or other sharps2) Skin contact, allowing blood, body fluids, & other

potentially infectious materials to enter through damaged or broken skin3) Mucuous membrane contact, allowing infectious materials to enter through the mucuous membrane of the eyes, mouth, & noseSurgical Asepsis-4 rules for surgical asepsis:1) Know what is sterile2) Know what is NOT sterile3) Separate sterile from unsterile4) Remedy contamination immediately-Goal: keep an area free from microorganismsSurgical Scrub-More lengthy & vigorous that regular hand hygiene-Remove as many microorganisms as possible without damaging the skin-Timing based on actual time spent scrubing, not including rinse time-Usually 2-4 minutes-Brushless technique with antimicrobial agent may be usedOpening Sterile Packages:-Perform hand hygiene-Open sterile package away from body-Touch only the outside wrapper-Do NOT reach across a sterile field-Always face the sterile field-Allow at least 6 inches between the body & the sterile fieldEvaluation-Patient recovering without additional instances of infection from other organisms or infection of other body areas-Assessing whether the patient's infection has been transmitted to any health care worker or any other patient on the unit or in the hospitalQuestion 1:During which stage of infection would a patient be irritable, fatigued, experience malaise, have an elevated temperature, & be considered highly infectious?a) Incubation periodb) Prodromal periodc) Ilness periodd) Convalescent period

Answer:b) Prodromal period(Stage 2)Question 2:Mary is taking care of a patient with tuberculosis. What specific type of precautions should Mary take?a) Standard Precautionsb) Airborne Precautionsc) Droplet Precautionsd) Contact PrecautionsAnswer:b) Airborne Precautions(remember My Chicken Hez TB)Question 3:When taking care of a known tuberculosis patient, the nurse must wear:a) Sterile glovesb) Sterile gownc) Particulate filter maskd) Shoes coversAnswer:c) Particulate filter maskQuestion 4:When opening a sterile package, a nurse should do all of the following EXCEPT:a) Select a moist tabletop at eye level.b) Wash hands and obtain equipment.c) Open packages away from the body, opening the distal flap first.d) Lift the front flap up and toward the body, handling only the outside of the wrapper.Answer:a) Select a moist tabletop at eye level(Open-Book Quiz)Question 1:Name & describe the stages of the infectious process.(pg 234)Answer:-Stage 1: Incubation Period:^begins when the organism first enters the body, & lasts until onset of symptoms; period where organism multiplies; period duration varies depending on type of organism; may

be infectious especially if viral-Stage 2: Prodromal Period:^short time from onset of vague symptoms to onset of specific disease symptoms; patient may be irritable, fatigued, experience malaise, and have elevated temperature; HIGHLY INFECTIOUS STAGE; most people do not realize they are ill during this stage-Stage 3: Illness Period:^localized & systemic symptoms appear; fever, headache, malaise, & disease specific symptoms: rash, leukocytosis, swelling, wound drainage, diarrhea, & vomiting; severity & duration depend on virulence of pathogen & person's susceptibility; stage where most people perceive they are ill-Stage 4: Convalescent Period:^begins when symptoms begin to subside & continues until the person returns to normal; duration may be days or weeks depending on the type of organism & person's overall health(Open-Book Quiz)Question 2:What are the 2 premises underlying the current system of isolation?(pg 236)Answer:1) Infection may be present before the diagnosis is made2) The greatest risk of transmitting infection for most microorganisms comes from direct contact by the caregiver's hands or equipment & supplies that have been soiled by blood, body fluids, & other potentially infectious materials(Open-Book Quiz)Question 3:Why are the elderly at greater risk for infection?(pg 237)Answer:-The elderly are at greater risk for infection because their immune system is not as active as that of a younger person(Open-Book Quiz)Question 4:When treating patients, when do you implement Standard Precautions & Transmission-Based Precautions?(pg 236)

Answer:-Use Standard Precautions for the care of ALL patients-Use Transmission-Based Precautions for the care of patients with known or suspected serious illnesses that can be transmitted via airborne, droplet, or contact(Open-Book Quiz)Question 5:According to the CDC guidlines, in what order do you don personal protective equipment?(pg 239)Answer:1) gown2) mask/respirator3) goggles/face shield4) gloves(Open-Book Quiz)Question 6:Summarize the guidlines for specimen preparation & transportation.(pg 239)Answer:-Verify the physician's orders and fill out the correct lab requisition forms; label the side of specimen container with patients information; put on gloves; explain what is needed to patient; collect specimen without contaminating the outside of the container; secure the lid;disinfect visibly contaminated containers; place specimen in laboratory biohazard transport bag & seal it; place lab requistion forms in outside pocket of lab transport bag before leaving the patient's room; remove gloves; wash hands; send specimen to lab for processing(Open-Book Quiz)Question 7:When transporting the isolation patient, what precautions are recommended?(pg 240)Answer:-Avoid transporting unless absolutely necessary-Give patient standard mask to wear-Take measures to prevent soiling of the environment-Notify receiving department that patient is under the particular type of Transmission-Based Precautions & any additional precautions required ahead of time

(Open-Book Quiz)Question 8:While a patient is in Transmission-Based Isolation, how can you prevent sensory deprivation?(pg 243)Answer:-Listen to the patient's feelings-Make positive comments on grooming & activity efforts-Engage in meaningful conversation-Make visitors feel welcome, & help them understand that ther patient benefits greatly from their presence(Open-Book Quiz)Question 9:List the 3 main modes of occupational exposure to bloodborne pathogens(pg 243)Answer:1) Puncture wounds2) Skin contact3) Mucous membrane contact(Open-Book Quiz)Question 10:What must you do when it is apparent that a break in surgical asepsis has occured?(pg 252)Answer:-Point out and/or correct the error:^begin scrub again^discard & replace gloves & equipmentDroplet Precaution Mnemonic:SPIDERMAN-S= Sepsis, Scarlet fever, Streptococcal (group A) pharyngitis-P= Parvovirus B19, Pneumonia, Pertussis, Pneumonic plague-I= Influenza, Haemophilus Influenza (type B)-D= Diptheria (pharyngeal)-E= Epiglottitis-R= Rubella (Measles)-M= Mumps, Meningitis, Mycoplasma pneumonia, Meningeal pneumonia

-A= Adenovirus-N= Neisseria meningitidisAirborne Precaution Mnemonic:My Chicken Hez TB-My= Measles (rubella)-Chicken= Chicken Pox-Hez= Herpes Zoster (Shingles)-TB= TuberculosisContact Precautions Mnemonic:MRS WEE-M= Multidrug-Resistant Bacterial Infections (MRSA, VRE, ESBL, C. diff)-R= Respiratory Infections (RSV)-S= Skin Infections-W= Wound Infections-E= Enteric Infections (C. diff)-E= Eye Infections (conjunctivitis)Contact Precautions Mnemonic:VCHIPS-V= Varicella-C= Cutaneous Diptheria-H= Herpes Simplex-I= Impetigo-P= Pediculosis (lice)-S= Scabies