Case Scenarios: Putting Your Dressing Knowledge Into Practice

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Wound Dressing Selection

by the WoundSource Editors

Selecting advanced wound care dressings is most effective when looking at the “whole” patient. If you are focusing only on the “hole” in the patient, you may not be enhancing the wound healing process as much as you had anticipated. In fact, you may be causing more harm to the wound without realizing it. Remember to always involve your patients in their treatment care plan, if possible. Your patients do not always share what is going on at home or economically. Let’s walk through a couple of case scenarios that may help you think outside the box when choosing a treatment plan for your patient.

Case Scenario #1: Chronic Pressure Ulcer – Stage 4

Your patient is a 47-year-old woman who has had a history of diabetes for the past 25 years, is a stroke survivor, and has congestive heart failure. She developed a stage 4 pressure ulcer following an above the knee amputation six months ago during her hospital stay. She lives at home with her daughter, who is a nurse, and also has home health care three days a week for dressing changes. Home health care is planned to last for only three weeks.

Wound etiology: Pressure ulcer, stage 4
Wound location: Coccyx
Thickness: Full
Size: 6×4×1.4cm
Undermining: 2–10 o’clock, 0.7cm
Wound tissue: 80% red granulation, 20% yellow fibrinous slough
Exudate: Heavy
Bioburden: Yes

What dressing order would you choose to benefit your patient most?

a. Cleanse wound with normal saline. Pat dry. Pack wound and undermining with calcium alginate. Cover with bordered foam three times a week.
b. Cleanse wound with normal saline. Pat dry. Pack wound with wet-to-dry dressing twice daily. Cover with abdominal pads. Secure with paper tape.
c. Cleanse wound with normal saline. Pat dry. Pack wound and undermining with silver alginate. Cover with bordered foam daily.

Answer: C. Due to date of onset, wound depth, exudate amount, and bioburden, an antimicrobial absorptive dressing is the best choice. The frequency is based on the exudate amount and the knowledge that the daughter can change the dressings on the days home health care is not available.

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Case Scenario #2: Chronic Diabetic Neuropathic Foot Ulcer

Your patient is 85 years-old, lives alone and has no family. He has poor vision and limited mobility due to arthritis. He was diagnosed with type 2 diabetes two years ago. He is compliant with monthly diabetic checkups with his physician, and it was discovered that he had an ulcer at the plantar aspect of the right foot. Your patient has been treating the wound himself for three months by soaking his foot in Dreft laundry detergent. The patient has now been referred to the wound care center, where he will be seen weekly.

Wound etiology: Neuropathic ulcer, diabetic type 2
Wound location: Right foot, plantar
Thickness: Full
Size: 4.2×2.3×0.2cm
Wound tissue: Pink/red granulation 100%
Periwound: Hyperkeratotic
Exudate: Minimal to moderate
Bioburden: Yes

As the wound physician/nurse, what dressing order would you choose to benefit your patient most with his situation?

a. Cleanse foot wound with normal saline. Apply collagen particles to wound bed. Cover with bordered foam three times a week.
b. Use silver hydrogel gauze dressing, foam, and a total contact cast once a week.
c. Cleanse foot wound with normal saline. Apply silver foam dressing. Secure with gauze roll, tape, and one layer of retention dressing (above toes to 1 inch below knee). Change once a week.

Answer: C. The patient has arthritis and has no help at home. Selecting an advanced wound care dressing that has longer wear time is most beneficial for the patient and the wound healing process. Following up with the wound physician once a week will help with monitoring.

In conclusion, not all patient scenarios are the same. Many factors play into developing a treatment care plan for your patients. Ask questions, educate, and tailor the plan of care. With thousands of dressings available, there are many options to make a better dressing selection that works for a patient’s specific needs. Educate yourself on dressing categories, indications, and wear time use. This way you can help your patients with wound healing to the best of your ability.

Note: The information provided herein is for informational purposes. Always refer to manufacturer information for Indications, Warnings and Precautions for a specific product.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

Comments

Newly FDA approved bioglass based product is FAR less expensive at around 90 a square inch and has a 98 percent healing rate on wounds with only needing to debride on the initial visit. Can be placed directly on bone and tendons including infected wound beds. Mimics the fibrin clotting and forms an extra cellular matrix Absorbs 400 percent it's own weight in exudate and does not require packing. Mirragen is a stand alone product and is typically used 3 times the first week, 2 times the second week and once thereafter until complete closure.

Hi Mark,
While I'm sure Mirragen is an excellent product, we as clinicians must first look at the whole patient when selecting dressings. Insurance coverage is the common hurdle. If Mirragen was covered 100% by every insurance, that would be the perfect scenario. ;)

Great content!

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