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Integ > Debridement > Flashcards

Debridement Flashcards

1
Q

Removal of necrotic and/or infected tissues that interfere with wound healing; Decreases risk of infection; Enhances wound healing

A

debridement

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2
Q

What are the purposes for debridement?

A
  1. decreases bacterial concentration within the wound bed and the risk of infection
  2. Increase the effectiveness of topical antimicrobials
  3. improve the bactericidal activity of leukocytes
  4. shorten the inflammatory phase of wound healing
  5. decrease the energy required by the body for wound healing
  6. eliminate the physical barrier to wound healing
  7. decrease wound odor
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3
Q

What are indications to debridement?

A
  1. Necrotic tissue, foreign material, debris
  2. Possibly blisters and calluses
  • Red–yellow–black system
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4
Q 
system to describe wound bed
- pale pink to beefy red, granulation tissue
tx goals:
- protect wound
- maintain warm, moist environment
- protect periwound
A

red

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5
Q 
system to describe wound bed
- moist, yellow slough; may vary in adherence
tx goals:
- debride necrotic tissue
- absorb drainage
- protect periwound
A

yellow

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6
Q

system to describe wound bed
- thick, black, adherent eschar
tx goals:
- debride necrotic tissue

A

black

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7
Q

should you pop or not pop blisters?

A

Newest research suggests that all blisters open and closed be debrided
- blister fluid increases inflammatory response and provides ideal environment for bacterial proliferation

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8
Q

What are the contraindications to debridement?

A
  1. Red, granular tissue
  2. Stable intact heel pressure ulcer
  3. Urgent need for surgical debridement - Gangrene, Osteomyelitis
  4. Electrical burns
  5. Deeper tissue
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9
Q

What are the types of selective debridement?

A
  1. Sharp
  2. Autolytic
  3. Chemical/Enzymatic
  4. Biological
  5. Surgical
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10
Q

What are the types of nonselective debridement?

A

Mechanical

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11
Q

Endogenous enzymes digest necrotic tissue with moisture-retentive dressing

A

Autolytic debridement

- hydrocolloid; transparent

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12
Q

What are the advantages of autolytic debridement?

A
  1. Least invasive, least painful method
  2. Doesn’t disrupt healthy tissue
  3. May be used in conjunction with other methods
  4. Easy to perform
  5. Selective
  6. Requires minimal professional expertise/monitoring
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13
Q

What are the indications of autolytic debridement?

A
  1. All wounds with necrotic tissue
  2. Patients who cannot tolerate other forms of debridement
  3. Commonly used in home or long-term care settings
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14
Q

What are the contraindications of autolytic debridement

A
  1. Infected or deep cavity wounds

2. Wounds that require sharp or surgical debridement

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15
Q

What are the disadvantages of autolytic debridement?

A
  1. Time for debridement to occur
  2. Maceration possible
  3. Potential for bacterial growth
  4. Sensitivity to adhesives
  5. Does not allow for frequent wound visualization
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16
Q

Use of exogenous enzymes to remove devitalized tissue; Form of selective debridement; Requires physician’s prescription

A

Enzymatic debridement

  • Collagenase - only enzyme currently FDA approved
  • Santyl
17
Q

What are the advantages of enzymatic debridement?

A
  1. Less skill required

2. Less painful

18
Q

What are the disadvantages of enzymatic debridement?

A
  1. Maceration
  2. Skin sensitivity
  3. Pain, erythema, dermatitis, burning/stinging
  4. Expensive
19
Q

What are the indications of enzymatic debridement?

A
  1. Infected and uninfected wounds with necrotic tissue

2. Pt. unable to tolerate sharp debridement

20
Q

What are the contraindications of enzymatic debridement?

A
  1. Wounds with exposed deep tissues
  2. Facial burns
  3. Over calluses
  4. Wounds free of necrotic tissue
  5. Should not be applied to wounds being autolytically debrided
21
Q

Use of force to remove devitalized tissue, foreign material, and debris; Nonselective

A

mechanical debridement

  • Wet-to-dry dressings
  • Pulsatile lavage
  • Scrubbing
  • Whirlpool
  • Wound cleansing
  • Wound irrigation
22
Q

Use of scalpels, scissors, or lasers in a sterile environment to remove necrotic tissue, foreign material, and debris; Performed by physician or podiatrist

A

surgical debridement

23
Q

Who can perform sharp debridement?

A

PTs, Nurses, PAs

  • Standard of care for open wounds
  • need order from physician
  • most PTAs cannot perform
24
Q

Use of scissors or scalpel to cut and remove necrotic tissue; Fastest, most aggressive form of debridement

A

Sharp debridement

- Hemostatic agents and topical pain medications may be needed

25
Q

What are indications for sharp debridement?

A

Large amount of necrotic tissue, callus, advancing cellulitis, sepsis; May be used on wounds with any amount of necrotic tissue; Chronic wounds

26
Q

What are contraindications for sharp debridement?

A
  1. Clotting disorders
  2. Systemic infection
  3. Ischemic leg/foot ulcers
  4. Medically unstable patient
  5. When area cannot be adequately visualized
  6. Material to be debrided is unidentified
  7. Lack of clinician competency – needs more training to feel confident
    - Caution: anticoagulants
27
Q

When should you terminate sharp debridement?

A
  1. Clinician fatigues
  2. Pain is not adequately controlled for patient
  3. Decline in patient status or tolerance to technique
  4. Extensive bleeding
  5. Nothing remaining to debride
28
Q

How do you stop bleeding?

A 
Pressure with gauze for 5 min
Do not check wound
Add gauze if blood soaks through
Elevate body part above heart
Use silver nitrate if needed

Integ (11 decks)

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