OPEN WET DRESSINGS

Indications

Bacterial infections that require drainage.

Inflammatory and pruritic conditions.

Oozing and crusting conditions.

Nursing and Patient Care Considerations

Apply dressing to affected area or teach patient to apply and moisten to the point of slight
dripping; remoisten as necessary.

Use warm tap water if warming is desired.

Apply for 5 minutes three to four times per day, unless otherwise indicated.

Keep the patient warm and do not treat more than one-third of body at a time because
open wet dressings can cause chilling and hypothermia.

Teach patients to prevent burns by measuring temperature of solution with a bath

thermometer or by testing tap water on wrist before applying compress. Advise them not
use microwave ovens to warm dressings because uneven heating can occur.

DRESSINGS FOR SKIN CONDITIONS

Occlusive Dressing
An occlusive dressing is formed by an airtight plastic or vinyl film applied over medicated areas
of skin (usually with corticosteroids) to enhance absorption of medication and to promote
moisture retention.
Indications
Skin conditions with thick scaling, such as psoriasis (on feet) and lichen simplex chronicus
Nursing and Patient Care Considerations

Wash area and pat dry.

Apply medication while skin is still moist.

Cover with plastic wrap, vinyl gloves, plastic bag.

Seal with paper tape at edges or cover with other dressing to hold in place.
P.1099

Do not apply to ulcerated or abraded skin, remove within 12 to 24 hours, or apply with
high-potency corticosteroids.

DRUG ALERT
Excessive use of occlusive dressings that contain corticosteroids may cause skin atrophy,
striae, telangiectasia, folliculitis, nonhealing ulceration, erythema, and systemic absorption of
corticosteroids.
Other dressings
Other dressing materials may be used as dry dressings to protect the skin, keep affected areas
clean, absorb drainage, or to cover medication or to hold occlusive dressings in place.
Nursing and Patient Care Considerations

Apply dry gauze dressing using clean technique (unless sterile technique is indicated by
open wounds).

Wrap extremities with elastic or cotton-rolled bandages, or apply tape.

Alternative dressing materials can be used for home care, such as disposable gloves for
the hands, cotton socks for the feet, sheets or towels for large areas, disposable diapers or
towels folded in diaper fashion for the groin, washcloths for the axilla, cotton T-shirt or
cotton pajamas for the trunk, turban or plastic shower cap for the scalp, or mask made
from gauze for the face, with holes cut for the eyes, mouth, and nose.

SKIN BIOPSY

Removal of a piece of skin by shave, punch, or excision technique to detect malignancy

or other characteristics of skin disorders.

Types of biopsy.
o Shave biopsyscalpel used to remove raised lesions, leaving lower layers of
dermis intact.
o Punch biopsyspecial instrument used to remove round core of lesion,
containing all layers of skin. Core is usually closed with sutures.
o Excisional biopsyscalpel and scissors used to remove entire lesion; suturing
required.

Nursing and Patient Care Considerations

Position the patient comfortably with the site exposed; explain that a local anesthetic will
be given. Check if the patient has any known allergies to local anesthetics. Ask the patient
what current medication he or she is taking. Aspirin or blood thinners may cause
increased postoperative bleeding.

Explain the procedure.

Obtain written consent.

After the biopsy, apply pressure to the site to stop bleeding if required and apply an
appropriate dressing. Pressure dressing may be required for larger wounds or wounds that
are bleeding.

Place the biopsy specimen in a clearly labeled container with 10% formaldehyde and
transport it to the lab.

Patient Education

Keep the bandage on surgery site for 24 to 48 hours. During this time, keep site clean and
dry.

After this time, remove the bandage and do the following daily:
o Wash the incision with soap and water.
o Dry the incision well.
o Apply antibiotic ointment as prescribed one to four times per day, keeping the
incision moist at all times.

After a few days, the dressing is no longer needed, but still apply antibiotic ointment one
to four times per day.

Do not apply makeup directly to the stitches.

Repeat wound care for 2 or 3 days after stitches have been removed, unless otherwise
instructed.