1.21 Ulcers and debridement Flashcards
Why do you get tunneling in a wound?
infection follows the easiest course of tissue destruction
What is the only instance you’ll leave eschar in place? How do you deal with this?
dry black heel
- monitor daily
- don’t want the wound open to environment
- it’s the body’s last ditch effort for a bandage in the area
For venous ulcers, you don’t want the leg in this position
dependent
When should you not elevate a patient’s leg with a venous ulcer?
if they have CHF
arterial ulcer debridement
- no sharp instruments
- often just slowing down tissue death
Why should you not use sharps to debride an arterial ulcer?
- might cut wound bed
- no vascularity, may further the process
What is the first thing you need to consider when treating a pressure ulcer?
- How healthy can you make the wound bed?
- get rid of dead tissue and slough
Why would you need to debride a pressure ulcer?
- to see the basement tissue
- help the healing process
- limit infection
best type of debridement
autolytic
how to facilitate autolytic debridement for pressure ulcers. Why is this the best way?
occlusive transparent dressing
- oxygen gets in, moisture stays out
- selective autolytic debridement
- keeps body’s fluid in the wound (WBCs, neutrophils, etc.)
types of mechanical debridement
- sharp
- pulsed lavage
- whirlpool
- wet to dry
- forceps
- gauze
types of debridement
- mechanical
- enzymatic
- biological
Why would you do sharp debridement?
- need it to bleed to get the healing process started again
- get dead tissue out
- remove a wound if it’s completely covered in eschar
**surgical
sharp debridement for a wound covered in eschar
- wound is rock hard and difficult to peel off
- do crosshatching, add moisture, then peel off
pulsed lavage
sprays saline over necrotic area, has suction
What does pulsed lavage work well with?
slough
con to pulsed lavage and whirlpool
spread of infection
how does whirlpool work?
agitation
Aside from infection, what is another con to using whirlpool?
nonselective: can damage good tissue as well as bad
wet to dry debridement
- take gauze, moisten, add to wound bed, dry it out, rip it off
- antiquated treatment, not a good idea
- MAYBE if there’s a lot of slough or necrotic tissue
forceps debridement
tweezers, grab dead tissue, pull it out
repeat
enzymatic debridement
- chemicals added to a wound that eat eschar/necrotic tissue
- some selective, some nonselective
biological debridement
- maggots
- medical grade honey
Why use medical grade honey for debridement?
- occlusive
- keeps moisture in
