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Higher nurse education

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BUKOVINIAN STATE Medical university




on the methodical conference of department

of patients’ care and higher

nurse education

“ ” ________ 200_ protocol N __

Chief of department, associate professor I.A. Plesh






nursing in surgery

for 3nd year students

of medical faculty №4,

specialty "nurse business''

Methodical instruction was prepared by:

Assistant Riabyi S.I.

Chernivtsi - 2010


(The purpose and problems of nurse during applying bandages. The main kinds of bandages. The main dressing means and materials. The basic types of gauze bandages. Rules of applying gauze bandages. Applying gauze bandages on head, neck, upper and lower extremities. Applying gauze bandages on chest, abdomen and pelvis. Using of elastic and net bandages).

^ 2. Duration of the class: 2 academic hour.

3. Study aim:

3.1. The student should know:

  • definition of bandage, dressing;

  • the main kinds of dressing material;

  • classification of bandages;

  • rules of applying gauze bandages;

  • nurse’s assistance during dressing of patients;

  • complication during and after applying bandages;

  • nurse’s tactics in cases of early and late complication;

  • kinds of bandages on head and neck;

  • kinds of bandages on chest and upper extremities;

  • kinds of bandages on abdomen;

  • kinds of bandages on pelvis and lower extremities;

  • peculiarities of using of elastic and net bandages.

^ 3.2. The student should be able:

  • to prepare and use modern kinds of dressing material;

  • to apply gauze bandages on different parts of human body;

  • to apply elastic and net bandages on different parts of human body;

  • to take care of surgical patients during and after dressing;

  • to assist to doctor during dressing.

^ 3.3. The student should master practical skills:

  • preparation of dressing material;

  • making of gauze towels, balls, pads etc;

  • applying gauze bandages on head;

  • applying gauze bandages on neck;

  • applying gauze bandages on chest;

  • applying gauze bandages on abdomen;

  • applying gauze bandages on pelvis;

  • applying gauze bandages on upper extremities;

  • applying gauze bandages on lower extremities;

  • applying elastic and net bandages;

  • nurse‘ assistance during dressing.

  1. Advice for students:

Requirements and principles of dressings for patients.

The original dressing applied at the time of operation should provide as sufficient absorptive material to take care of the wound secretions for at least 24 - 48 hours, and it should be applied well enough to remain in place for that period of time. It should provide sufficient pressure to aid in producing haemostasis. Experience in the cave of operative wounds in ambulatory patients permits the surgeon to gauge very well the amount of absorptive dressing necessary in a given wound. Following incisions of infected areas in which packing has been inserted, gauze dressings or the commercial type of gauze dressing containing a film of cotton should be applied over the wound. Pressure is obtained by placing one or two strips of adhesive on the skin across the dressing and applying a firm bandage. In the application of a simple dry dressing, as in the application of all dressings to ambulatory patients, it should be remembered that the dressing need be no larger than the wound to be covered. It is therefore, quite permissible, and even recommended, that the sterile gauze be cut with sterile scissors, to fit the wound rather than that a large dressing be applied to a small wound. The gauze may be held in place by either adhesive or bandage, depending on the situation of the wound.

^ Types of Bandages.

Gauze - the bandages most commonly used are of 32 x 28 mesh gauze.

Elastic Cotton-webbed bandages, which have a marked degree of elasticity and are sold by several manufacturers. They are used in 2 and 3 and occasionally in 4 in. widths when it is desired to apply elastic pressure, and they far surpass the flannel bandage for this purpose. They may easily be applied in an overlapping spiral, even though the part is conical. These bandages may be used over and over again because washing almost completely restores the original elasticity.

^ Elastic Adhesive Tapes. Several manufacturers have placed in the market cotton-webbed bandages which are overlaid on one side with adhesive. They are most often used in 2, 3 and 4 in. widths. These bandages are excellent for use when the fixation of a non-adhesive bandage is somewhat difficult. Thus they may be used in the treatment of contusions, sprains, varicose veins, ulcers and so forth.


The time for redressing depends upon the type of wound or more exactly, upon the amount of discharge from it.

^ Dressing of Clean Wounds. In clean-wounds, unless pain, swelling or other evidences of infection appear, redressing is not necessary until it is time to remove the sutures. In all clean wounds, therefore, the patient is instructed to return in 3 days or sooner. On the third day visit, the dressing is inspected. If it is not spoiled and there is no discomfort in the region of the wound, the patient is asked to return on the fifth to seventh day for removal of the sutures. When there is some spoiling of the superficial parts of the dressing, the gauze on top may be changed, care being taken not to disturb the underneath layers, where there is usually a brownish hard stain of dried blood which acts as an excellent splint for the wound. When the patient complains of some discomfort in the area of the wound and on inspection of the bandage, some oedema of the tissues is noted, the dressing is removed and the wound is inspected. This state of affairs is usually found in cases in which there has been considerable dissection in the subcutaneous fatty tissues' and a low grade localized cellulitis has resulted. In such cases it is rarely necessary to open the wound, although removal of one or two sutures to relieve tension may be helpful. Experience has shown that this type of wound reaction will subside in 24-48 hours by the application of 70% alcohol on the dressing and the patient is instructed to apply this three to four times a day. At the patient's second visit on the fifth to seventh day after operation, the sutures are removed. In cases in which the integrity of the wound may be affected by movement of the part, splints are included as a part of the dressing for a week or so after removal of the sutures. In other cases, adhesive strips may be applied across the wound at right angle to its long axis. These provide continued support to the wound edges and may be left in place for a week or 10 days if desired. They are especially valuable for wounds of the shoulder and back. Occasionally, it is necessary to continue the alcohol dressings for several days after the sutures are removed. When wet dressings of alcohol are used, the same precautions as to the application of adhesive should be followed as are recommended in the case of hot moist dressings. It will be noted that none of the commonly used antiseptics is applied in the care of clean wounds and when alcohol moist dressings are used, it is with the idea of providing an easily available evaporating lotion which will not cause maceration of the skin.

Dressing of Infected Wounds. The patient with an infected lesion should be asked to return for dressing on the second day after operation. As a rule, it is unwise to change the dressing on the day following operation, since this usually sets up renewed bleeding and the secretions are usually not excessive enough to demand a change of the dressing. On the second day after operation, the superficial dressings are removed and the wound is inspected with the packing or the drainage still in place. The surgeon then decides as to the type of dressing to be applied and this must be done before the instruments and the dressing tray be spoiled. He should be provided with sufficient cotton balls soaked in hydrogen peroxide to wash away the dried secretions on the edge of the wound and to use as sponges in removing purulent secretions from the wound itself. A few alcohol sponges are useful for a final cleaning of the skin round the wound. If packing is to be replaced, he should reserve sterile instruments for removing packing from its sterile container and for cutting it with sterile scissors without contaminating the remainder. Unless the packing in the wound seems to be acting as a plug and preventing drainage of the wound secretion, it is usually wise to leave it in place or to remove it only in part at this dressing because, at this time, a sufficient amount of inflammatory induration has not developed in the walls of the wound to keep its lips from falling together. It should be mentioned in passing that, when gauze packing is adherent to the edges of the wound, considerable pain is experienced by pulling it away at this second day dressing, whereas it usually is easily removed without pain at later renewals of the dressing. After this initial dressing, the interval between future dressings depends to a great extent upon the amount of secretion. If it is profuse, daily dressings are necessary, whereas, if the breakdown of sloughing tissue is slow, dressings may be maintained for 2 or 3 days. Usually, at the second dressing all packing is removed from the wound, and by this time, if an adequate incision has been made, an opening of sufficient size remains. Unless the infected area is deep, there is no necessity for reinserting packing or other drainage material. The inflammatory induration in the walls of the wound will not permit its closure until all the purulent material has been discharged. When the wound is exposed, an effort should be made to remove all the liquid necrotic material and as much of the loosened area of necrosis as possible. Two methods are of particular value in the removal of liquid material. The easier and the more painless method is the irrigation of the wound with warm sterile saline solution. The glass syringes with rubber bulbs or the disposable sterile plastic bulb syringe have been found to be most useful in this connection; they may be handled with one hand and the force of the stream regulated so that the solution may be forced with good pressure into the deeper recesses of the wound cavity. This method of cleaning the wound is of particular value when the wound is deep and when there is considerable sloughing fascia and connective tissue. In surface infections, the liquid secretion and the slough may be removed by mopping the wound surface gently with a cotton sponge moistened in saline or hydrogen peroxide. Once the wound and the surrounding tissues have been cleaned of purulent material, areas of sloughing tissue which have not yet liquefied may be seen. Often these areas may be loosened gently by applying slight tension with forceps or they may be cut away carefully with the scissors from the surviving tissue adjacent to them. If the sloughs are nol loose, it is better to leave them alone until the next dressing rather than to run the risk of causing the patient pain and of setting up bleeding. When the wound and the surrounding tissues have been cleared of purulent secretions, it is often well to bathe the skin round the wound with 70% alcohol on a cotton sponge. This may prevent the infection of the hair follicles in the adjacent skin and the furunculosis, which not infrequently occurs. When the secretion is profuse, an excoriation of the surrounding skin may develop. This is treated by the application of a small amount of zinc oxide ointment after it has been thoroughly cleansed and bathed with 70% alcohol. Dressings are continued daily or every other day as long as there is much drainage from the wound. Moistening the dressings prevents crusting and permits the escape of the wound secretions. It should be borne in mind, however, that the best results are obtained and maceration of the skin is avoided by permitting the dressing to dry at frequent intervals, so that after the fourth or fifth day the dressings need to be moistened only once or twice a day. As soon as all the slough has disappeared and when the wound is covered with a base of granulation tissue, an effort may be made to hasten the closure of the wound by pulling its lips together with adhesive straps. Generally, this is necessary only in cases in which there has been considerable skin slough, as, for instance, following incision and drainage of a carbuncle. In few such cases, epithelization may be hastened by the application of pinch skin grafts.

^ Technique of dressing

The set up for dressings is relatively simple, but there are several points which experience has shown to be worth while. The dressing table should be fitted with a stainless steel, a glass, or an enameled top. If the table has a second shelf, the materials for dressings can be kept in glass jars, otherwise they may be stored in the drawers of the table. These include 1,2 and 3 in. bandages, the large-size (4x8 in.) dressings sterilized in packages and small size gauze compresses (3x3 in.). These dressings are now available sterilized in waxed-paper envelopes, which may be torn open, the dressings are removed with sterile forceps, and are placed on the tray. On the top of the table may be kept four 3 x 3 in. glass jars: the first containing cotton balls soaked in benzene for the removal of adhesive from the skin; the second containing cotton balls soaked in 70% alcohol; the third, cotton balls soaked in hydrogen peroxide; and the fourth, dry cotton balls. For each dressing there should be a sterile tray with the following sterile instruments: scissors, forceps, haemostat and probe. The trays which have been found to be most convenient are of enamel or of stainless steel 3 x 8 or 6 x 8 in. They may be made by placing the instruments between layers of gauze compresses and sterilizing them in the autoclave. When an autoclave is not available the instruments and the tray may be boiled in the sterilizer, except the scissors and other sharp instruments, which are sterilized in alcohol or sterilizing solution. When the tray is removed from the sterilizer with sterile lifting forceps, a sterile 4 x 8 in. gauze compress is placed in it. The instruments are then transferred from the sterilizer to the tray with the sterile lifting-forceps and may be covered with a lid or another sterile dressing. Two or three such trays may be kept in readiness, and, after use, the instruments and the trays may be resterilized. It is an advantage to keep on one tray, in addition to the above instruments, 2 Allis forceps, 2 towel clips and a toothed forceps. These are then at hand if needed in a hurry for a dressing or for some minor operation.

For the ordinary dressing, our preference has been for the smaller size instruments. Scissors 5 in. long are adequate, and straight scissors last longer and are more useful than curved ones. Plain forceps with serrated tips 4 in. in length are cheaper and more convenient than are the usually used 6 in. instruments. The hemostats may be ordinary 4 or 6 in. ones, and the best probes are those with round ends and 6 in. long. Before changing a dressing, the hands should be washed thoroughly with soap and warm running water. Bandages and adhesive should never be cut with scissors from the sterile tray but with bandage scissors. After removal of the bandage and the top layer of dressing with the fingers, the wound is exposed. If any part of the gauze is adherent to the wound, it should be left in place and the remaining part of the dressing cut away with bandage scissors and discarded. All spoiled dressings should be placed immediately in a waste receptacle, not on the sterile tray or on the dressing table. The remaining part of the dressing should be performed entirely with instruments. With the forceps, a sufficient number of dry cotton balls or peroxide sponges should be transferred from the jar to the sterile tray, and then any portion of the dressing adherent to the wound should be removed gently with the forceps. Next comes the cleaning up process, which should be carried out as described above and performed entirely with instruments. It is well to try to keep one instrument, usually the haemostat, uncontaminated, so that, if necessary, it can be used to transfer additional sterile supplies to the sterile tray. When the dressing is complete, the wound is overlaid with sterile gauze, which are transferred from the freshly opened package to the wound with the forceps or a haemostat. The instruments are then laid aside, and the dressing is completed with bandage and adhesive. By this technique, secondary infection is avoided as much as possible, and dressings of even large wounds may be performed easily with an aseptic technique without the necessity for rubber gloves. Disposable suture removal and dressing trays for those physicians who change dressings or remove sutures rather infrequently in an office practice, there are now available commercially sterile disposable packages of suture removal sets and dressing trays. These sets are well prepared and are available at reasonable cost.

^ 5. Study questions:

  1. Definition of bandage, dressing.

  2. The main kinds of dressing material.

  3. Classification of bandages.

  4. Rules of applying gauze bandages.

  5. Nurse’s assistance during dressing of patients.

  6. Complication during and after applying bandages.

  7. Nurse’s tactics in cases of early and late complication.

  8. Kinds of bandages on head and neck.

  9. Kinds of bandages on chest and upper extremities.

  10. Kinds of bandages on abdomen.

  11. Kinds of bandages on pelvis and lower extremities.

  12. Peculiarities of using of elastic and net bandages.

6. The literature:

6.1. Basic :

  1. Textbook of basic nursing / Caroline Bunker Rosdahl. – J. B.Lippincott Company. Philadelphia. - 6th ed. –1995.– 1518 p.

  2. Fundamentals of nursing /Taylor Mary Carol, Mary Carol, Lillis Carol– J. B.Lippincott Company. Philadelphia. - 1989.– 1356 p.

6.2. Аdditional:

  1. Gostishev V.K. "Guidance to practical employments on general surgery". M., "Medicine" - 1987.

  2. P. of Brown. Operating block. Operating brigade. – Kharkov, 1997. – with. 1-32.

Methodical instruction was prepared by

Assistant Riabyi S.I.

A review is positive, associate professor Chomko O.J.


Higher nurse education iconHigher nurse education

Higher nurse education iconHigher nurse education

Higher nurse education iconHigher nurse education

Higher nurse education iconHigher nurse education

Higher nurse education iconHigher nurse education

Higher nurse education iconHigher nurse education

Higher nurse education iconHigher nurse education

Higher nurse education iconHigher nurse education

Higher nurse education iconHigher nurse education

Higher nurse education iconHigher nurse education

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