Equipment
■ Clean nonsterile gloves.
■ Hydrating dressing 3 to 4 cm (1.5 in.) larger than the wound.
■ Moisture-proof bag.
■ Obtain the following items only if needed:
■ Sterile normal saline solution for irrigation, warmed to body temperature.
■ Emesis basin.
■ Sterile gauze for cleansing.
■ Disposable clippers or scissors.
■ Skin prep.
■ Measuring device.
■ Tape.
Assessment
■ Assess the area to determine whether a hydrating dressing is appropriate.
■ Determine the size of the wound.
Post-Procedure Reassessment
■ Note whether the dressing adheres comfortably to the skin.
■ Ensure the patient verbalizes understanding of treatment.
■ Inspect the dressing daily.
■ Change it if it becomes dislodged, leaks, or wrinkles or if it develops an odor.
■ Verify that a hydrocolloid dressing is still appropriate for the wound.
Key Points
■ Place the patient in a comfortable position.
■ Remove the soiled dressing, if necessary.
■ Cleanse the wound, if necessary.
■ Assess the wound, or other area where hydrocolloid dressing will be applied, for size, location, appearance, exudate, odor, and signs and symptoms of infection.
■ Be Smart! Clip the hair around the wound if necessary.
■ Apply the hydrating dressing.
Documentation
■ Document:
■ Appearance and location of the wound, type and amount of exudate, and odor, after cleansing.
■ Wound measurements, if taken, and condition of surrounding skin.
■ Method of cleansing the wound and surrounding skin.
■ Type of dressing applied to the wound.
■ Use of skin prep.
■ Education provided to the patient.
■ Assess the patient’s pain level before the procedure.
■ If the patient was medicated for pain, document the drug and dose used, time given, and patient response.
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| Removing the back of the hydrocolloid dressing |
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| A hydrocolloid dressing after application to the skin |
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