Student Nurse's Guide to Care of the Incision

It is important for the nurse to understand how to properly care for their patients wound, being able to properly care for your patients wound means understanding all types of wound care, types of dressings, and proper removal of dressing to name a few things.

Types of dressing covers include gauze which permits air to reach the wound, while a semi occlusive dressing permits oxygen to reach the wound but not air and an occlusive dressing does not permit air or oxygen to reach the wound.

When the primary physician or surgeon initially places a dressing on the patients the nurse should not remove this dressing but reinforce the dressing by placing an ABD pad on top of the primary dressing, the initial dressing is often only removed by the primary physician or surgeon.

When removing your patients dressing it is very important to avoid accidental removal or displacement of any drains that may be in place. If the physician has ordered an analgesic it will be most beneficial to medicate your patient 30 minutes prior to dressing a wound so your patient can be comfortable during the process. Whenever the wound or dressing is handled sterile technique should be used. If you expect soiling or splashing of a wound during care you should wear a gown, mask or protective goggles depending on your needs to protect yourself.

Dry dressings are used when little or no exudates/drainage is expected this type of dressing is used to protect the wound from introduction of bacteria, reducing discomfort, protect from injury and to speed healing. This type of dressing is used commonly for abrasions and non-draining postoperative incisions.

Wet to dry dressings are used primarily to mechanically debride the wound. How this works is by applying a moist dressing to collect exudates and wound debris as this dressing dries it will adhere to the wound and debrides it when the dressing is removed. Solutions that are commonly used on these types of dressings are normal saline, acetic acid, povidone-iodine, lactated ringers solution, sodium hypochlorite solution and antibiotic solutions.

A transparent dressing consists of a self adhesive film that is a synthetic permeable membrane that acts sort of like a temporary second skin. There are many advantages to a transparent dressing including that it adheres to undamaged healthy skin and will keep the exudates contained and will minimize wound contamination. It will also serve as a barrier to external fluids and bacteria yet still allow the wound to breathe so that it can heal faster while keeping infection rates minimized. Transparent dressings promote a healthy moist environment that will speed up epithelial cell growth and finally it permits visualization of the wound without having to remove the dressing.

Make sure to follow up with Student Nurses Guide to Care of the Incision with part 2 in our series on care of the incision.