OPEN WET DRESSINGSIndications 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 CONDITIONSOcclusive DressingAn 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.IndicationsSkin conditions with thick scaling, such as psoriasis (on feet) and lichen simplex chronicusNursing 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 ALERTExcessive use of occlusive dressings that contain corticosteroids may cause skin atrophy, striae, telangiectasia, folliculitis, nonhealing ulceration, erythema, and systemic absorption of corticosteroids.Other dressingsOther 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. Shave biopsyscalpel used to remove raised lesions, leaving lower layers of dermis intact. Punch biopsyspecial instrument used to remove round core of lesion, containing all layers of skin. Core is usually closed with sutures. 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: Wash the incision with soap and water. Dry the incision well. 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.