Question

Jeffy fell off his bicycle and skinned his knee. He has cleaned the wound with soap and water.

1. Why is it important to wash the area, other than to remove bacteria?

2. If his physician wanted to order a medication to into deeper crevices of the abrasion, would you expect the medication to be an ointment or cream? Explain why that would be the medication of choice.

3. Why is it important to obtain a health history of possible allergies even when applying a topical medication?

4. What should you tell Jeffy about keeping the bandages dry?

5. If his physician orders an occlusive dressing, what would you expect to place on the abrasion?

Answer 1

1. Purpose of washing the wound area with soap and water

                       It is equally important to keep wounds clean in order to prevent an infection developing from contamination and subsequent colonization. It’s important to clean the wound properly right away to prevent infection.

· Wash the wound with a large amount of water to remove all the dirt, debris, and bacteria from the wound.

• Rinse the wound in clear water to loosen and remove dirt and debris.
• Use a soft washcloth and mild soap to clean around the wound. Don’t place soap in the wound. That can hurt and cause irritation.
• Use tweezers to remove any dirt or debris that still appears after washing.

2. Cream or Ointment

A cream is generally water based. It is the preparation of oil in water whereas Ointment is oil based. It is the preparation of water in oil.

· Both have a different concentration too. Ointment is 80%oil and 20% water while Cream is 50% of oil and 50% of water (means balanced).Higher the oil concentration, greasier and stickier the product is. Skin absorbs cream more quickly and works better on larger areas due to their spread ability factor.

· Ointments have a higher concentration of oil. They take longer time to absorb and remain for longer on the skin.

                    Generally people prefer creams over ointments since they are less sticky and very light on skin. Given their higher water content and evaporation process that occurs after application they are considered as moisturizing. They are better than ointments in treating oozing or wet skin conditions.

                   Ointments are best used for a dry skin. They are known to keep skin moist for a longer period of time. Complete absorption of medication and less likely to cause an allergic reaction.

3. Importance of Obtaining allergic history in Topical application

                      Before administering the topical application, it is necessary to obtain the health history of the patient for possible allergies also. Some patients have allergy to ointment or cream also. Without knowing it, by applying the ointment to treat the condition, it will adversely affect the patient.

                    A topical medication is made up of an active ingredient and base which may contain preservatives and fragrances. Allergens found in topical medications may be the active drug ingredient or a component of the vehicle or base that carries the drug.

                      Allergy to a topical medication is diagnosed by performing special allergy tests, called patch tests. Diagnosis may involve testing against the active drug ingredient or a component of the base.

Without obtaining a health history regarding the allergies on topical application,it will leads to :

· Contact urticaria results in a local burning sensation, tingling, itching may occur within minutes to about 1 hour after contact with the skin.

· Swelling and redness ,intense itching may be seen.

· Rash usually resolves by itself within 24 hours of onset.

· A photosensitivity rash is caused by the interaction of sunlight with an ingredient in the product.

4. Keeping the bandages dry

· A dressing that is allowed to get wet and then left to dry out could lower the temperature of the wound, dry out the wound bed and delay healing.

· By discouraging patients from social cleansing, may be increasing their risk of developing wound infection as the increased number of bacteria on the surrounding skin could be transferred into the wound.

· Wash around the wound with the dressing in place, then to change it immediately after the bath or shower.

· A temporary dressing could be applied after the bath until the dressing can be replaced.

· Patients have to adapt their bathing techniques in order to protect dressings on other areas of the body.

5. Occlussive dressing

                              Occlusive dressings are used for sealing particular types of wounds and their surrounding tissue off from air, fluids and harmful contaminants, such as viruses and bacteria, in a trauma or first aid situation. They are often utilized as an immediate means of controlling the cleanliness of a wound.

· Pressure and bleeding are two of the major concerns when managing any wound; they can often be immediately addressed with the application of an occlusive dressing.

· Atopical ointments benefit from the application of an occlusive dressing.

· The dressing allows for ointments to thoroughly penetrate wounds by preventing evaporation.

· Minor wounds and skin conditions can also benefit from an occlusive dressing, which provide protection from contaminants, can help to expedite the healing process and reduce scar tissue.