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Healing Skin Breakdown

What do you do First if you think A Pressure Ulcer is forming?

  1. The first thing to do if you think a pressure ulcer is forming is to determine what is causing the injury to the skin and relieve the pressure. If the person is spending a lot of time sitting or lying on one spot, get them to change positions at least every two hours. Using a cushion to relieve the pressure might also help.
  2. Check to see if any moisture might be getting to the area from excess sweating, leaky catheters, draining wounds, or soiled clothing. You can use a good barrier cream to help protect the skin from the moisture, especially if sweating is a problem.
  3. Put a dressing over the area to protect it from rubbing against sheets so the friction won’t further irritate the skin.

 

When Do I Need to Contact the Doctor About Skin Breakdown?

  1. Watch the area closely.  Measure the size of the area to make sure you can tell if it is getting bigger or smaller.
  2. If you see that it is getting bigger or if it begins to smell bad or has drainage that is yellowish/ashen/greenish, thick and sticky-like then it’s probably pus (an infection). If there are red streaks or a fever occurring, that’s another sign of an infection.  Be sure to call the doctor right away to get the area checked. 

YouTube Video Resources

Wound Irrigation

This video provides a demonstration of how to irrigate an open wound.

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Wound PACKING

The wound packing video continues from where the wound irrigation video left off and shows you how to pack the wound with gauze before dressing it to help absorb excess drainage. 

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Jackson-Pratt JP Drain Wound Care

 

Published on Nov 4, 2015
This video discusses how to care for (includes emptying & milking) a Jackson-Pratt drain (aka JP Drain) as a nurse and nursing student. It is great refresher for students and nurses. I discuss how a JP drain works, how to empty a JP drain, how to milk a JP drain, how to secure a JP drain, how to document about a JP drain, and potential complications from a JP drain.
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wound irrigation

  1. Perform wound irrigation when you need to clear out debris and drainage from a wound.  When you irrigate a wound, you direct a steady flow of irrigation solution (usually normal saline unless the doctor ordered something else) across the open wound.  You can request a wound irrigation kit that comes with everything you need in it or gather individual pieces.

    Supplies Needed:

    • a wound irrigation device (usually a 30-60 ml catheter-tip syringe),
    • the solution you will use to irrigate,
    • a container to hold the solution,
    • gloves and a gown to keep you dry,
    • chucks or bed protectors to keep the bed and patient dry,
    • something to collect the run-off irrigation solution
    • dressing, tape, and packing materials, if indicated to cover the wound afterward.   

    The procedure:

    • After gathering your supplies, drape all surfaces to keep the area around the wound dry and limit cross-contamination.
    • Remove the old dressing and discard it.
    • Assess the wound for any progress or changes.
    • Pull up the solution into the syringe. Gain the cooperation of your family member to start the process.
    • Gently depress the plunger of syringe spraying the wound.  Move from the cleanest point to dirtiest.  Do not move back over the rinsed area once you have cleaned it until you start a new sweep.
    • Repeat the irrigation process until the solution returns clear.
    • Dry off area by blotting with sterile gauze.
    • Pack wound if ordered or apply a dressing as directed.

    Lippincott Nursing Procedures (2019) 8th Ed. Philadelphia: Wolters Kluwer (836)

Wound Packing

  1. After cleaning the wound following the process noted above, pack the inside of the wound with sterile gauze.
  2. Open the gauze completely and dip it into saline or the other solution if ordered by the doctor.
  3. Spread it open so that it covers a large area. Gently insert the gauze into the wound so that it is covering most of the inside surface but not touching the outside. Using a cotton-tip applicator can help you push the gauze underneath the lip of skin folds that may be present. 
  4. Confirm that you covered all surfaces evenly.
  5. Wipe around the outside of the wound with clean gauze to remove liquid that may have seeped out.
  6. Cover the packing with dry gauze.
  7. Apply dressing over the top of the packing to hold it in place. 

YouTube Video Information Regarding Wound Treatment Product Options

Caregiver Marketplace Check out links to products recommended to help caregivers cope with the challenges of caregiving at home. Ideas are available on everything from positioning to self-help booksmobility devices, to skincare. 

Gauze Wound Dressings

Some of the areas covered in the video; sterile gauze, actcel hemostatic gauze, surgical gauze, fibers from gauze left in wound, removing gauze from healed wound, bandages, xeroform, tubular, mep, rolls, vaseline, pads, iodoform, quick clot combat, nu, invacare non adherent sterile gauze.

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Transparent Film Wound Dressings

The transparent dressings are see-through and allow you to see the fluid accumulate.  It looks nasty but the fluid actually helps the tissue to heal faster. 

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Hydrocolloid Wound Dressing 

Some topics covered are hydrocolloid bandages, adhesive pads, gel, exoderm, pros and cons, absorptive dressing, and tegaderm.

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Foam Wound Dressings

Topics covered; foam tape wound dressing complications, open cellular, kci, smith nephew, wound care foam ring, and wound vac foam.

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Alginate Wound Dressings 

Topics included; sodium alginate dressings, calcium alginate dressings.

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Hydrogel Wound Dressing

More information is available at http:woundeducators.com

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Composite Wound Dressing 

Composite dressings combine multiple components of wound protection into a single product to provide for a multi-funcional barrier such as one that has an anti-bacterial component, absorption and adhesion.