Assistance with dressing

Types of injuries

 * intentional injuries – they occur during treatment (surgery, venipuncture, radiation burns),
 * unintentional injuries – they are accidental, e.g. in a car accident.

Types of wounds

 * open wound (a wound where the surface of the skin is impaired),
 * closed wound (tissues are traumatized without skin impairment).

According to the mechanism of formation

 * contusion – is a closed wound that occurs as a result of a blow from a blunt object,
 * abrasion – is an open wound that occurs as a result of friction, e.g. after falling on the road surface, this injury affects only the skin,
 * stab wound – is an open wound caused by a sharp instrument that penetrates through the skin and underlying tissues (this also includes venipuncture and intramuscular injection),
 * laceration – occurs when tissues tear apart and create irregular edge ,
 * penetrating wound – occurs when the tool penetrates deep into the tissues through the skin, often accidental, e.g. wounds caused by projectiles or metal fragments,
 * cut wound (incision) – caused by a sharp instrument, e.g. a scalpel or accidentally a sharp knife.

According to the degree of contamination (Garner, 1986)

 * clean wounds - they are not infected, there is no inflammation and they do not affect the respiratory, digestive, reproductive or urinary system,
 * clean contaminated wounds - these are surgical wounds in which the respiratory, digestive, reproductive or urinary system is affected, we do not find any evidence of infection in these wounds,
 * contaminated wounds - they include open, fresh, accidental wounds and surgical wounds where there has been a major violation of sterile technique or large amounts of contents are leaking from the gastrointestinal tract, signs of infection are also often visible,
 * unclean or infected wounds – they are old, accidental wounds that contain dead tissue and wounds with evidence of clinical infection such as purulent discharge.

General principles in wound care

 * caring for the patient's psychological well-being,
 * instructing the patient about the procedure, its course and about necessary patient's behavior after the treatment,
 * ensuring a suitable position for the patient, a suitable environment and privacy during dressing,
 * keeping the affected area in a physiological position,
 * applying bandages suitable for the type of indication, always sterilely and with gloves,
 * ensuring correct application of the bandage (the bandage should embrace the affected area mildly but firmly, from all sides),
 * monitoring the patient's condition throughout the dressing,
 * checking the surroundings of the bandaged area (surrounded area must remain visible, sufficiently perfused, without swelling),
 * if the patient reports pain, regularly evaluate the source of the pain and keep checking the wound.

Non-adhesive dressings

 * they are made of cotton or viscose fibers or nylon material,
 * they are porous (airy), impregnated with an indifferent ointment that prevents the bandage from sticking to the wound,
 * these dressings protect the granulation tissue but do not create a bacterial barrier,
 * do not need secondary coverage,
 * they are not left on the wound for more than 24 hours,
 * are used to cover surface wounds, sutures or burns,
 * these are for example ATRAUMAN ®, SILICONE ®, MELOLIN ®.

Antiseptic dressings

 * these are bandages made of non-woven porous material impregnated with an antimicrobial substance,
 * they protect granulation tissue, allow free passage of exudate, require secondary coverage,
 * they can cause an allergic reaction so we must carefully consider who we apply them to,
 * they may remain on the wound for several days,
 * these materials are widely used for various types of wounds including infected ones,
 * these are for example INADINE ®, IODOFLEX ®.

Activated charcoal dressings

 * they are composed of fabric that contains activated carbon,
 * clean the wound very well, reduces odor and excess exudate,
 * suitable use is for strongly infected wounds, strongly odoured wounds, pressure ulcers, fistulas, also for wounds where the presence of yeast has been detected ,
 * these are for example ACTISORB ®, VLIWAKTIV ®, CARBONET ®.

Alginate dressings

 * basis of these bandages is brown seaweed which contains sodium and calcium alginate,
 * these bandages create a non-adhesive gel and thus keep the wound in a moist environment,
 * the gel must then be removed from the wound with physiological saline solution before evaluating the effect of the dressing.

Hydrogel dressings

 * they are made of hydrogel polymers that contain up to 96% water,
 * they shape well, cool the wound, reduce pain,
 * the bandage is transparent so it is easy to check the defect.

Internal factors

 * vascularization – good blood supply supports healing,
 * immune status – infection, diabetes mellitus or radiotherapy increases the requirements for the healing process,
 * nutritional status - healing is prolonged in patients with poor nutritional status,
 * obesity - fatty tissue limits blood supply and wounds are therefore difficult to suture,
 * medicines - immunosuppressants may prolong healing,
 * smoking - reduces functional hemoglobin in the bloodstream and therefore body tissues are less oxygenated,
 * stress - places additional demands of the organism and thus adversely affects healing.

External factors include

 * preoperative status,
 * preoperative preparation,
 * surgical performance.

Bleeding

 * persistent bleeding (hemorrhage) after surgery is abnormal, it can be caused by a blood clot, a loose ligature, visceral vessel erosion.

Infection

 * it can appear 2-10 days after surgery, if infection is suspected, the exudate should be examined.

Dehiscence with possible evisceration

 * it is a partial or complete rupture of the wound, often occurs after abdominal surgeries when the layers under the skin are also separated,
 * evisceration is the extrusion of internal organs through an incision.