Wound Care
Wounds include cuts, scrapes, scratches and punctured skin. They often occur as a result of an accident or injury, but surgical incisions, sutures, and stitches also cause wounds. Minor wounds usually aren’t serious, but even cuts and scrapes require care. To avoid infection and aid healing
- Apply pressure with a clean cloth to stop bleeding
- Clean the wound with water
- Use an antibiotic ointment to prevent infection
- Bandage the wound if it’s in an area that might get dirty
- Watch for swelling and redness
- Get a tetanus booster if you are due for one
Serious and infected wounds require medical attention. You should also seek attention if the wound is deep, if you cannot close it yourself, if you cannot stop the bleeding or get the dirt out, or if it does not heal.
Wet to Dry Dressing Changes
Your doctor or nurse may ask you to change your dressing at home. By placing a wet (or moist) gauze dressing on your wound and allowing it to dry, wound drainage and dead tissue can be removed when you take off the old dressing.
Your doctor or nurse will tell you how often you should change your dressing at home.
As the wound heals, you should not need as much gauze (or packing gauze).
Removing the Old Dressing
Follow these steps to remove your dressing:
- Wash your hands befor and after each wound dressing change.
- Put on a pair of non-sterile gloves.
- Carefully remove the tape.
- Remove the old dressing. If it is sticking to your skin, wet it with warm water to loosen it.
- Remove the gauze pads or packing tape from inside your wound.
- Put the old dressing, packing material, and your gloves in a plastic bag. Set the bag aside.
Cleaning Your Wound
Follow these steps to clean your wound:
- Put on a new pair of non-sterile gloves.
- Use a soft washcloth to gently clean your wound with warm water and soap. Your wound should not bleed much when you are cleaning it, but a small amount of blood is okay. Rinse your wound with water, and gently pat it dry with a clean towel. Do not rub it dry. In some cases, you can even rinse the wound while showering.
- Check the wound for
- Increased redness or swelling
- A bad odor
- Drainage that is darker or thicker
- Color of the drainage and amount
- After cleaning your wound, remove your gloves and put them in the plastic bag with the old dressing and gloves.
- Wash your hands again.
Changing Your Dressing
Follow these steps to put a new dressing on:
- Put on a new pair of non-sterile gloves.
- Pour saline into a clean bowl. Place gauze pads and any packing tape you will use in the bowl.
- Squeeze the saline from the gauze pads or packing tape until it is no longer dripping.
- Place the gauze pads or packing tape in your wound.
-
Carefully fill in the wound and any spaces under the skin.
- Do not let the wet gauze or packing tape touch any healed skin.
- Cover the wet gauze or packing tape with a large dry dressing pad. Use tape or rolled gauze to hold this dressing in place.
- Put all used supplies in the plastic bag. Close it securely, then put it in a second plastic bag, and close that bag securely. Put it in the trash.
- Wash your hands again when you are finished.
When to Call the Doctor
Call your doctor if you have any of these changes around your incision:
- Worsening or more redness
- More pain
- Swelling
- Bleeding
- The wound is larger or deeper
- The wound looks dried out or dark
- The drainage is increasing
- The drainage has a bad smell
Also call your doctor if:
- Your temperature is above 100 °F for more than 4 hours
- Drainage is coming from or around the incision or wound and it:
- Is not decreasing after 3 – 5 days
- Is increasing
- Becomes thick, tan, or yellow, or smells bad
Alternate Names
Dressing changes; Wound care – dressing change
Nasal CPAP
CPAP stands for “continuous positive airway pressure.” CPAP is a treatment that delivers slightly pressurized air during the breathing cycle.
This keeps the windpipe open during sleep and prevents the episodes of blocked breathing in persons with obstructive sleep apnea and other respiratory problems.
It is sometimes called nasal continuous positive airflow pressure (CPAP).
WHO SHOULD USE CPAP
Continuous positive airflow pressure (CPAP) is the best treatment for obstructive sleep apnea. It is safe and effective in patients of all ages, including children.
After using CPAP regularly, many patients report the following:
- Better concentration and memory
- Feeling more alert and less sleepy during the day
- Improved sleep for the person’s bed partners
- Improvements in work productivity
- Less anxiety and depression and a better mood
- Normal sleep patterns
A similar machine, called BiPAP (for bilevel positive airway pressure) is used as an alternative to CPAP. With this machine, the pressure changes while a person breathes in and out.
These devices are useful for children and adults with collapsible airways, small lung volumes, or muscle weakness that makes it difficult to breathe.
CPAP or BiPAP may also be used by people who have:
- Acute respiratory failure
- Central Sleep Apnea
- COPD
- Heart failure
HOW CPAP WORKS
CPAP works in the following way:
- The device is a machine weighing about 5 pounds that fits on a bedside table.
- A mask fits over the nose. A tube connects the mask to the CPAP device.
- The machine delivers a steady stream of air under slight pressure through this tube into the mask.
The doctor, nurse, or therapist will help choose the mask that fits you best. They will also help adjust the settings on the machine. The settings on the CPAP machine depend on the severity of your sleep apnea.
If you are using the CPAP machine but your sleep apnea symptoms do not improve, the settings on the machine may need to be changed. Some patients can be taught to adjust the CPAP at home. Otherwise, you will need to make trips to the sleep center.
GETTING USED TO THE DEVICE
It can take time to become used to a CPAP device. The first few nights of CPAP therapy are often the most difficult. Some patients may actually sleep less or not sleep well at the start of treatment.
Patients who are having problems may tend not to use CPAP for the whole night, or even stop using the device. However, it is important to use the machine for the entire night.
Common complaints include:
- A feeling of being closed in (claustrophobia)
- Chest muscle discomfort, which usually goes away after a while
- Eye irritation
- Irritation and sores over the bridge of the nose
- Nasal congestion and sore or dry mouth
- Noise that interferes with sleep (although most machines are quiet)
- Nosebleeds
- Upper respiratory infections
Many of these problems can be helped or eliminated by the following methods:
- Ask your doctor or therapist about using a mask that is lightweight and cushioned. Some masks are used only around the nostrils.
- Make sure the mask fits correctly. It should not be too tight or too loose, and it should not leak any air.
- Try nasal salt water sprays for a stuffed nose.
- Use a humidifier to help with dry skin or nasal passages.
- Keep your CPAP equipment clean.
- Place your CPAP machine underneath your bed.
Your doctor or therapist can lower the pressure on the CPAP machine and then increase it again at a slow pace. Some new machines can automatically adjust to the pressure that is needed.
Alternative Names
Continuous positive airway pressure; CPAP; Bilevel positive airway pressure; BiPAP
Pediatric Bed Wetting
Children develop complete control over their bladder at different ages. Nighttime dryness is usually the last stage of toilet learning.
Most children who haven’t achieved bladder control have at least one parent or first-degree relative who also had a problem with bed wetting. Knowing this often helps the child feel less stressed about the situation.
Around 7% of children still wet their beds at age 5, only 3% do so by age 10, and 2% by age 15. Only 1 out of 100 children who wet their bed continue to have a problem in adulthood.
Causes:
Children who were dry for at least 6 months and then started wetting again have secondary enuresis. There are many reasons why children wet the bed after being fully toilet trained. These include:
- Diabetes
- Psychological problems or medical disorders, such as a urinary tract infection
- Urinary tract abnormalities
Home Care:
Do not worry about bed wetting in children before age 6, unless they were previously well toilet trained and the wetting is a new problem.
Do not punish a child who wets. Bed wetting is NOT caused by laziness or rebelliousness. Shaming a child for wetting the bed can lead to poor self-esteem and feelings of low self-worth.
Reassure your child that bedwetting is common and can be helped. You can also have your child take an active part in cleaning up from the bed wetting (such as helping to strip the bed and put the sheets in the laundry).
Start by making sure that your child goes to the bathroom at normal times during the day and evening and does not hold urine for long periods of time. Be sure that the child goes to the bathroom before going to sleep.
You can reduce the amount of fluid the child drinks a few hours before bedtime, but this alone is not a treatment for bedwetting. You should not restrict fluids too much. Avoiding drinks that contain caffeine can also help.
Reward your child for dry nights. Some families use a chart or diary that the child can mark each morning. Although this is unlikely to completely solve the problem, it can help. Try it before you use medicines. It is most useful in children 5 – 8 years old.
See your health care provider to consider the use of alarm systems (such as Wet-stop or Enuretone), or drugs like DDAVP nasal spray or pills. These drugs stop bed wetting in 60 – 75% of children who take them, but they are not a permanent cure (once the medication is stopped, the bed wetting tends to come back).
When to Contact a Medical Professional
Call your doctor if:
- Your child has had repeated episodes after age 6
- Your child complains that it hurts to urinate
- Your child has been drinking excess amounts of fluids
- Your child has been showing strange behavior changes (becoming unusually withdrawn or shy, or suddenly behaving in a sexually suggestive way)
What to Expect at Your Office Visit:
The health care provider will take a medical history from the patient and his or her parents (if the patient is a child).
Medical history questions documenting the bed wetting in detail may include:
- Time pattern
- When did bed wetting begin?
- How often does bed wetting occur?
- Have there ever been “dry” periods before?
- Quality
- How often does the child urinate during the daytime?
- Does the child have a problem controlling urine while awake?
- Does bed wetting cause the child to wake up?
- How is the bed wetting treated within the family?
- Is the bed wetting punished?
- Are other family members aware of the problem?
- Does the bed wetting cause shame?
- Aggravating factors
- What makes the problem worse?
- Does the bed wetting increase in times of stress?
- Is there a urinary tract infection?
- Does the child drink beverages containing caffeine or alcohol?
- Relieving factors
- Is there anything that reduces the problem?
- What other symptoms are also present?
- Abdominal pain
- Back pain
- Fever
- Pain or burning when urinating
- What medications is the child taking?
- Have other family members had this problem?
- Is there a family history of diabetes?
- Is bowel control a problem?
- Can the child feel the need to urinate?
- What prevention methods have been tried?
- Alarm systems
- Diapers
- Periodic waking
- Restricting fluids
- Rewards
A complete examination will be performed, with emphasis on the abdomen, rectum, and urinary opening. The health care provider will discuss the available treatment options.
Diagnostic tests will not be done unless your health care provider believes there is a medical problem.
After seeing your health care provider: If your health care provider made a diagnosis related to bed wetting, you may want to note that diagnosis in your personal medical record.
Alternative Names
Enuresis – bedwetting
Urinary Incontinence – Choosing The Right Products
Urinary incontinence is loss of bladder control. Symptoms can range from mild leaking to uncontrollable wetting. It can happen to anyone, but it becomes more common with age.
Most bladder control problems happen when muscles are too weak or too active. If the muscles that keep your bladder closed are weak, you may have accidents when you sneeze, laugh or lift a heavy object. This is stress incontinence. If bladder muscles become too active, you may feel a strong urge to go to the bathroom when you have little urine in your bladder. This is urge incontinence or overactive bladder. There are other causes of incontinence, such as prostate problems and nerve damage.
f you have problems with urinary incontinence (leakage), wearing special products will keep you dry and help you avoid embarrassing situations.
Choosing the Right Product
First, talk with your doctor to make sure of the cause of your leakage cannot be treated.
If you have urine leakage, you can buy many types of urinary incontinence products. These products help keep your skin dry and prevent skin rashes and sores.
Ask your doctor which product might be best for you. It depends on how much leakage you have and when it happens. You might also be concerned about cost, odor control, comfort, and how easy the product is to use.
You can always try another product if the one you are using is uncomfortable or does not keep you dry enough.
Your doctor might ask you to drink less fluid throughout the day to cut down on leakage. Your doctor may also recommend using the bathroom at regular, set times to help avoid accidents. Keeping a journal about when you have leakage problems can help your doctor treat you.
Products for Men and Women
You can wear disposable pads in your underwear. They have a waterproof backing that keeps your clothes from getting wet. Common brands are:
- Attends
- Depends
- Poise
- Reassure
- Serenity
- Tena
- Tranquility
- Many different store brands
Always change your pad or underwear regularly, even if you are dry. Changing often will keep your skin healthy. Set aside time to change 2 to 4 times a day at the same times every day.
Adult Diapers and Underwear
You can use adult diapers if you are leaking large amounts of urine. You can buy the kind that you use once and throw away, or ones that you can wash and reuse. They come in different sizes. Wear a size that fits you snugly. Some have elastic around the legs to keep from leaking onto your clothes. Some come with a plastic cover for more protection.
Special, washable underwear are also available. These look more like regular underwear than adult diapers. Some have a waterproof crotch area and room for a pad or liner. Some are made out of a special waterproof fabric that keeps your skin dry. You do not need a pad with these.
Waterproof outer pants made of nylon, vinyl, or rubber are also available. They can be worn over your underwear.
Special Products for Men
Men can use a drip collector for small amounts of urine leakage. This is a small pocket that fits over the penis. Wear close-fitting underwear to keep it in place.
Men can also use a condom catheter device. It fits over the penis like a condom. A tube carries the urine that collects in it to a bag attached to the leg. This helps to prevent odor and skin problems.
Special Products for Women
Women can try foam pads. They are very small and fit between your labia. You take the pad out when you need to urinate, and then put a new one in. Common brands are Miniguard, UroMed, Impress, and Softpatch.
Women can also try a silicone cap, or shield. This fits in place over your urinary opening. It can be washed and used again. Common brands are CapSure, Bard Cap Sure, and FemAssist.
Products to Protect Your Furniture
You can buy special waterproof pads to put under your sheets and on your chairs. Sometimes these are called Chux. Some pads are washable and can be reused. Others you use once and throw away.
You can also create your own pad from a vinyl tablecloth or shower curtain lining.
Where to Buy Products
Many of these products are available over-the-counter (without a prescription) at your local drugstore or supermarket. You might have to check a medical supply store or search online for some products.
Remember, washable items may help save money.
When to Call the Doctor
Call your doctor or nurse if:
- You are not sure how to use your product.
- You are not staying dry.
- You develop a skin rash or sores.
- You have signs of infection (a burning sensation when you urinate, fever, or chills).
Alternate Names
Adult diapers; Disposable urinary collection devices