AFTER 3 HOURS OF VARIED TEACHING-

LEARNING ACTIVITY, THE BSN STUDENTS

WILL BE ABLE TO ACQUIRE BASIC
KNOWLEDGE, DEVELOP BEGINNING
SKILLS ANS POSITIVE ATTITUDE RELATED TO
THE CONCEPT OF BAG TECHNIQUE AND
WOUND DRESSING.
SPECIFICALLY, THE STUDENTS WILL BE ABLE
TO:
 DEFINE THE FOLLOWING TERMS:
› PUBLIC HEALTH BAG
› BAG TECHNIQUE
› WOUND DRESSING
SPECIIFICALLY, THE STUDENTS WILL BE ABLE
TO:
 ENUMERATE THE PURPOSE OF BAG
TECHNIQUE, URINE TESTING, AND WOUND
DRESSING.
 IDENTIFY THE PRINCIPLES IN BAG
TECHNIQUE.
 RECOGNIZE THE SPECIAL
CONSIDERATIONS IN THE USE OF THE
BAG.
SPECIIFICALLY, THE STUDENTS WILL BE ABLE
TO:

 ENUMERATE AND DEMONSTRATE BAG

CONTENTS AND ITS ARRANGEMENT.
SPECIIFICALLY, THE STUDENTS WILL BE ABLE
TO:

 DISCUSSTHE 3 PHASES OF WOUND

HEALING
SPECIIFICALLY, THE STUDENTS WILL BE ABLE
TO:
 CLASSIFY WOUND ACCORDING TO:
› CAUSE
› CLEANLINESS
› DEPTH
› RYB CLASSIFICATION SYSTEM
SPECIIFICALLY, THE STUDENTS WILL BE ABLE TO:
 IDENTIFY THE DIFFERENT TYPES OF WOUND
› BRUISE
› ABRASION
› LACERATION
› AVULSION
› PUNCTURE
 APPRECIATE THE PURPOSE OF WOUND
CARE.
SPECIIFICALLY, THE STUDENTS WILL BE ABLE TO:
 RECOGNIZE THE MAJOR PRINCIPLES IN
CLEANING A WOUND.
 ENUMERATE THE MATERIALS NEEDED IN
PERFORMING THE FOLLOWING
COMPETENCIES:
› BAG TECHNIQUE
› WOUND DRESSING
 RETURN DEMONSTRATE THE FOLLOWING
PROCEDURES SATISFACTORILY.
 a tool making use of the public health
bag through which the nurse, during his
home visit, can perform nursing
procedures with ease and deftness, save
time and effort with the end view of
rendering effective nursing care.
 an essential and indispensible
equipment of the public health nurse
which she has to carry along with her
when she goes out home visiting. It
contains basic medications and articles
which are necessary for giving care.
 The use of bag technique should minimize if not totally
prevent the spread of infection from individuals to
families, hence, to the community.
 Bag technique should save time and effort on the part
of the nurse in performance of nursing procedures.
 Bag technique should not overshadow concern for the
patient rather should show the effectiveness of total
care given to an individual or family.
 Bag technique can be performed in a variety of ways
depending upon agency policies, actual home
situation, etc., as long as principles of avoiding transfer
of infection is carried out.
 The bag should contain all necessary
articles, supplies, and equipment which
may be used to answer emergency needs.
 The bag and its contents should be
cleaned as often as possible, supplies
replaced and ready for use any time.
 The bag and its contents should be well
protected from contact with any article in
the home of the client. Consider the bag
and its contents clean and/or sterile while
any article belonging to the client as dirty
and contaminated.
 The arrangement of the contents of the
bag should be the one most convenient to
the user to facilitate efficiency and avoid
confusion.
 Hand washing is done frequently as the
situation calls for, helps in minimizing or
avoiding contamination of the bag and its
contents.
 The bag when used for a communicable
case should be thoroughly cleaned and
disinfected before keeping and re-using.
 To minimize if not to prevent the spread
of infection.
 To work efficiently and rapidly during
techniques as means to save energy so
that work with the family may be more
effective thus saves time and effort.
 FRONT OF THE BAG LEFT TO RIGHT
› Oral thermometer
› Rectal thermometer
› Digital thermometer
 ON THE RIGHT REAR OF THE BAG
› Test tube and holder
› Medicine dropper
 ON THE LEFT REAR END
› Medicine glass
› Baby scale
› Bandage scissor
 BACK OF THE BAG (LEFT TO RIGHT)
› 70% isopropyl alcohol
› PNSS
› Povidone iodine cleanser
› Povidone iodine solution
› 5% acetic acid
› Benedict’s solution
› Denatured alcohol
 CENTER OF THE BAG
› Kelly forceps ( curve and straight) in
container
› Surgical and bandage scissors in container
› Roller bandage and cotton pledgets
› Empty Alcohol lamp wrapped in plastic
› Match
› Tape measure
› 4 cotton ball container
› Extra cotton balls
› Drinking glass (test tube rack)
 TOP PILE IN THE CENTER
› Hand towel
› Soap in a soap dish/ liquid soap
› Apron
 FLAP OF THE BAG OR ON THE SIDES OF THE BAG
OUTSIDE THE LINING
› Sterile OS
› Waste receptacle with plastic lining (minimum of 3)
› Clean gloves folded in paper pockets(minimum of 3
pairs)
› Colored chart (urine testing)
› Eye chart (physical assessment
› Muslin case/ extra pouch
 WOUND
› a break in structure of an organ or tissue
caused by an external agent. Wound may
be a bruise, abrasion, laceration, avulsion,
and puncture.
When an injury is sustained, a complex set
of responses is set into motion and the
body begins a three phase process of
wound healing.
 DEFENSIVE (INFLAMMATORY) PHASE
 RECONSTRUCTIVE (PROLIFERATIVE) PHASE
 MATURATION PHASE
› Page 99-100 Seeley’s Principles of Anatomy
and Physiology
› A. immediate to 2-5 days.
› B. inflammation
 Vasodilation
 Phagocytosis
› C. Hemostasis
 Vasoconstriction
 Platelet aggregation
 Thromboplastin makes clot
 Inflammatory Phase
 Blood vessels are disrupted, resulting in
bleeding. Hemostasis is achieved by
formation of platelet plug & activation of
extrinsic & intrinsic clotting pathways.
 Formation of a provisional fibrin matrix.
 Recruitment of inflammatory cells into the
wound by potent chemoattractants.
Early Events in Inflammation
 Fibrin and fibronectin form a lattice that provides
scaffold for migration of inflammatory,
endothelial, and mesenchymal cells.
 Neutrophilic infiltrate appears: removes dead
tissue & prevent infection.
 Monocytes/macrophages follow neutrophils:
orchestrated production of growth factors &
phagocytosis.
› 2 days to 3 weeks
› A. Granulation
 FIbroblast lay bed of collagen
 Fills defect and produces new capillaries
› B. Contraction
 Wound edges pull together to reduce defect
› C. Epithelialization
 Crosses moist surface
 Cell travel about 3cm from point of origin in all
direction.
Proliferative Phase
 Granulation tissue formation (composed of
fibroblasts, macrophages and emdothelial
cells).
 Contraction.
 Re-epithelialization (begins immediately
after injury)
Mesenchymal cell proliferation
 Fibroblasts are the major mesenchymal
cells involved in wound healing, although
smooth muscle cells are also involved.
 Macrophage products are chemotactic for
fibroblasts.
 Replacement of provisional fibrin matrix
with type III collagen.
Angiogenesis
 The formation & differentiation of blood
vessels reconstructs vasculature in areas
damaged by wounding, stimulated by high
lactate levels, acidic pH, decreased O2
tension in tissues.
Epithelialization
 Basal cell layer (deepest layer)thickening,
elongation, detachment & migration

 Epithelial cells (surface layer) proliferation

contributes new cells to the monolayer.
Contact inhibition when edges come
together.
Remodeling Phase
 Programmed regression of blood vessels &
granulation tissue.
 Wound contraction.
 Collagen remodeling.
3 weeks to 2 years
› new collagen forms which increases strength
of tissues on wound.
› Scar tissue is only 80% as strong as original
tissue.
Wound Contraction
 Begins approximately 4-5 days after
wounding by action of myofibroblasts.
 Represents centripetal movement of the
wound edge towards the center of the
wound.
 Maximal contraction occurs for 12-15
days, although it will continue longer if
wound remains open.
Wound Contraction
 The wound edges move toward each other
at an average rate of 0.6 to .75 mm/day.
 Wound contraction depends on laxity of
tissues, so a buttock wound will contract
faster than a wound on the scalp or
pretibial area.
 Wound shape also a factor, square is faster
than circular.
Wound Contraction
 Contraction of a wound across a joint can
cause contracture.
 Can be limited by skin grafts, full better
than split thickness.
 The earlier the graft the less contraction.
 Splints temporarily slow contraction.
Remodeling
 After 21 days, net accumulation of collagen
becomes stable. Bursting strength is only
15% of normal at this point. Remodeling
dramatically increases this.
 3-6 weeks after wounding greatest rate of
increase, so at 6 weeks we are at 80% to
90% of eventual strength and at 6months
90% of skin breaking strength.
Remodeling
 The number of intra and intermolecular cross-
links between collagen fibers increases
dramatically.
 A major contributor to the increase in wound
breaking strength.
 Quantity of Type 3 collagen decreases replaced
by Type 1 collagen
 Remodeling continues for 12 mos, so scar
revision should not be done prematurely.
 CAUSE
› Intentional
 occurs during treatment or surgery.
 Usually made under aseptic technique such as
incision or venipuncture.
› Unintentional
 Unanticipated and often the result of trauma
or an accident.
 Created under an unsterile environment and
therefore poses a greater risk of infection.
 CLEANLINESS – ranks the wound
according to its contamination and risk
of infection.
› Clean
 Intentional wound created under conditions in
which no inflammation was encountered, and
the respiratory, alimentary, genitourinary and
oropharyngeal tracts were not encountered.
› Clean contaminated
 Intentional wounds that were created by entry into
the alimentary, respiratory, genitourinary and
oropharyngeal tracts under controlled conditions.

 Contaminated
 Open, traumatic or intentional wounds which there are
break in the aseptic technique, spillage from
gastrointestinal tract, or incision infected urinary or biliary
tracts. These wounds have acute non purulent
inflammation present.
 Dirty and infected
 Traumatic wounds with retained dead tissue or intentional
wounds created situations where purulent drainage was
present.
 DEPTH – takes into account layers
involved.
› Superficial
 confined to the epidermis, which comprises the
outermost layer of the skin.
› Partial- thickness
 involves the epidermis and part of the dermis.
› Full – thickness
 involves the entire epidermis and part of the
dermis. Deeper structures such as fascia, muscles,
and bone may be involved.
 RYB (red, yellow, black) Classification system
› Red
 color of normal granulation tissue and are in the proliferative
phase of wound repair. This wound needs to be protected
and kept moist and clean.
› Yellow
 has withered fibrous slough or purulent exudates from
bacteria. This wound needs to be cleansed of purulent
exudates and non-viable slough needs to be removed.
› Black
 contains necrotic tissues (eschar – may be black, gray, brown
or tan). This wound needs debridement, which is the removal
of necrotic tissue. Mix color wound often occur. The rule of
treatment is to treat the worst color first such as red and black
wound debrided first then moistened, and protection would
be provided for the red portion.
 BRUISE
› aka contusion.
 ABRASION
› Aka scrape or rug burn
 LACERATION
› A cut or incision
 AVULSION
› Result when skin tissue is torn away from the body,
either partially or completely.
 PUNCTURE
› Results when the skin is pierced by a sharp object
such pencil, nail, or bullet.
 To promote wound healing
 To prevent pathogens from entering the
wound.
 To remove blood, debris and harmful
microorganisms from the wound.
 To treat wound infections.
 To prevent further injury.
 Use standard precaution at all times.
 When using a swab or gauze to clean the
wound, work from the clean area toward
the dirtier area.
 When irrigating a wound, warm the solution
to room temperature to prevent lowering of
the tissue temperature. Be sure to allow the
irrigating solution to flow from the cleanest
area to the contaminated area avid
spreading the pathogens.
 Protect the wound.
 Provide pressure on the wound.
 Help immobilize and support the injured
area.
 Help keep the wound free of drainage
and debris
 Aesthetic purposes.
 25% acetic acid
 Povidone iodine
 Sodium hypochlorite
 Hydrogen peroxide
 Normal saline solution
- protective covering placed over a
wound.

TYPES OF DRESSING APPLICATION

 Sterile dressing application
 Wet-to-dry dressing
 Location
 Size
 General appearance and drainage
 Pain
 Laboratory data
 Document wound assessment, including
the appearance, color, and odor.
 Record the type of solution and type of
dressing used.
 Chart client’s tolerance to the
procedure.
 Promote wound healing
 Prevent infection
 Educate clients
 Initiate emergency measures
 Cleanse the wound
 Dress the wound
 Monitor drainage of the wound.
 Checking bandages, binders, and slings
› GLOMERULAR FILTRATION –
 water and solutes move from the blood to the
glomerular capsule. The fluid that enters the capsule is
glumerular filtrate.
› TUBULAR REABSORPTION
 the movement of the substances from the filtrate in the
kidney tubules into the blood in the peritubular
capillaries. Only 1% of the filtrate remains in the tubules
and become urine. Water and other substances useful
in the body are reabsorbed. Water is reabsorbed by
osmosis, while most solutes are reabsorbed by active
transport.
› TUBULAR SECRETION
 is the transport of substances from the blood insto the
renal tubules. Potassium and hydrogen are primarily
eliminated from the body. Ammonia, uric acid, and
some drug metabolites are likewise eliminated.
 Developmental considerations
 Toilet training
 Aging
 Food and fluids
 Lifestyle
 Psychological variables
 Muscular activity and muscle tone
 Pathologic conditions
 Medications
 COLOR – amber/ straw
 ODOR – aromatic (upon voiding)
 TRANSPARENCY – clear
 pH – slightly acidic (4.6-8; average of 6)
 SPECIFIC GRAVITY – 1.010-1.025
(urinometer)
 BACTERIA
 PROTEIN
 PUS
 GLUCOSE
 To check for presence of glucose, acetone,
bacteria and other urinary products
 To aid in diagnosis
 To determine the condition of the patient
 To determine the effectiveness of the therapy
 SPECIMEN
› a sample or small part of a substance or
a thing taken for the purpose of
determining the character of the whole.
Example: urine, sputum, blood, tissue,
semen, feces.
 Midstream clean catch urine (MSCC)
 24h urine specimen
 2nd voided urine specimen
 Benedict’s test
› test for presence of glucose in urine.
 5ml of Benedict’s
 8 drops of urine
 Heated once
 Acetic acid test
› test for the presence of glucose in urine.
 5ml of urine heated ‘til boiling point
 3 drops of acetic acid heated ‘til boiling point