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
