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Physical Agents--Debridement > Debridment Lecture > Flashcards

Debridment Lecture Flashcards

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1
Q

Why would you chose to do debridement on a patient?

A

To increase the rate of wound healing.

  • Non-viable tissue impairs healthy granulation tissue and migration of keratinocytes
  • Necrotic tissue serves as a medium for bacterial growth
  • Pockets of space are visualized after debridment
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2
Q

If you see exposed bone on your patient, what should you do?

A

Referral to a physician to rule out osteomyelitis

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3
Q

Describe the debridement method of Autolytic

A

Endogenous enzymes interact with moist dressing to soften, re-hydrate and remove tissue/ liquefy hard eschar and slough

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4
Q

Positives about autolytic debridement

A

Simple, pain-free, doesn’t induce bleeding and uses body’s own mechanisms for debridement, selective (no damage to surrounding tissue)

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5
Q

Negatives about autolytic debridement

A
  • Slow, not as rapid as surgical debridemnt
  • Excessive moisture can cause maceration
  • Requires careful monitoring for infection
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6
Q

Autolytic is best used for what types of wounds?

A

Stage III or IV wounds with light to moderate exudate

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6
Q

This type of debridement involves the use of removal of non-viable and viable tissue through the use of sterile, sharp instruments. Causes significant pain and bleeding. Performed by physicians, podiatrists, PA-C

A

Surgical

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6
Q

Positivies about surgical debidement

A
  • Highly selective

- Rapid Results

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6
Q

Negatives about surgical debridement

A
  • Can cause pain
  • Risk of bleeding
  • Requires training
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6
Q

Contraindications for surgical method

A
  • Clotting/bleeding abnormalities
  • Ischemic tissue
  • Impaired arterial flow
  • Immunocompromised
  • Hands/face
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6
Q

What do you call a force on a body immersed in a fluid equal to the wight of the fluid displaced by the object? (Reduces the force of gravity)

A

Buoyancy

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6
Q

Surgical method is best to use on what types of wounds?

A
  • Wounds with large amount of necrotic tissue

- Wounds in conjunction with infected tissue

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7
Q

How do you do Mechanical Debridement?

A

Wet to dry method-allowing a dresing to proceed from moist to wet, then manually removing the dressing causes a form of non-selective debridemnt
*Dr. Lorello hates this method

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8
Q

Disadvantages of Mechanical Debridement

A
  • NON-SELECTIVE and may traumatize healhty or healing tissue
  • Time consuming
  • Painful
  • Macerate wound margins
  • Frequent dressing changes are required
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9
Q

Define hemodynamic effects

A

Local changes in circulation due to the warmth or cooling effects by water

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10
Q

What is hydrotherapy?

A

NOT aquatic therapy

  • Whirlpools-Stainless steel or acrylic tanks of various sizes used to provide therapeutic effects
  • Ex: Hubbard tank=large whirlpool designed for full body immersion, can allow patient’s to exercise in the tank, requires a lift
  • Ex: Highboy or lowboy tanks
11
Q

What is this a list of?
-Tx patients in private room/ventilated w/doors that close
-Items in room must be covered
-Tubes, ports, etc must be covered
-Consider masking pt
No family during tx
-Used standard precautions plus hand hygiene
-All disposable must be disposed properly
-After tx disinfect all environmental surfaces

A

Pulsatile lavage with suction

12
Q

Advantages of Mechanical effects of Hydrotherapy

A
  • Occurs as the result of agitation
  • Force of water can debride loose necrotic tissue
  • Cleanse wound of dirt
  • Improve circulation to area to increase healing
  • Softening effect on tissue
13
Q

Disadvantages of Mechanical effects of Hydrotherapy

A
  • May cause damage to granulation tissue

- Can macerate the periwound area

14
Q

List what you should do to protect yourself when doing hydrotherapy

A

*Protective gear: cap, mask, gown, gloves, goggles or face mask

Personnel are exposed to airborne water vapor, inhalation or contract dermatitis of water droplets containing bacteria presents health risk

15
Q

Why is pulsatile lavage with suction used?

A
  • Reduces bacterial count
  • Promotes granulation tissue formation through negative pressure

*Use the gentle setting for wound cleaning and the stronger setting for debridement

16
Q

How often do you pulsatile lavage?

A
  • Typically 1 time/day
  • Wounds >50% necrotic tissue w/ purulent drainage/foul odor do 2 times/day
  • Full granulation base with no odor and no purulent drainage can be treated 2-3 times/week
17
Q

Name the types of pulsatile lavage with suction

A
  • Small splash shield tips for debridement and irrigation
  • Long flexible tips for tunnels and undermining
  • Use normal saline for irrigation fluid, antibiotics can be used per physician
18
Q

What are some advantages of larva therapy? (Maggots consume necrotic tissue)

A
  • Selective
  • Rapid
  • May be painless’
  • Can be used for various wounds
19
Q

Disadvantages of larva therapy

A
  • Psychological distress

- Deep, tunneled wounds

20
Q

Advantages of using enzymatic cream (enzymes degrade and remove necrotic tissue)

A
  • Cost effective
  • Selective
  • Decreased wound trauma
  • Patient on anticoagulants
  • Infected Wounds
21
Q

Disadvantages of using enzymatic cream

A
  • Twice a day dressing
  • May sting
  • May need to cross hatch eschar
  • Need physician prescription
22
Q

What type of tissues can you debride?

A
  • Necrotic
  • Foreign
  • Debris
  • Residual topical agents
  • Blisters
  • Callus
23
Q

What type of tissues can you NOT debride?

A
  • Granulation
  • Viable
  • Stable heel ulcers
  • Gangrene, osteomyelitis
  • Electrical burns
  • Deep tissue
24
Q

What are steps to do when preparing for debridement?

A
  1. ) Assemble equipment and supplies
  2. ) Position patient
  3. ) Use proper positioning and body mechanics
  4. ) Make sure you have good lighting
  5. ) Wash hand, put on gloves
  6. ) Remove old bandage
  7. ) Discard soiled gloves, put on clean ones
  8. ) Inspect wound, may need to debide
  9. ) Rinse wound
    10) Remove soiled gloves
  10. ) Explain procedure to pt
  11. ) Ensure adequate pain control
25
Q

Steps of Debridement

A
  1. ) Put on clean gloves
  2. ) ID tissue
  3. ) Remove as much of tissue
  4. ) Rinse wound
  5. ) Assess any changes in wound status and do wound measurements
26
Q

Steps after Debridment

A
  1. ) Dispose sharps
  2. ) Remove soiled gloves
  3. ) Put on clean gloves
  4. ) Apply appropriate dressing
  5. ) Remove gloves
  6. ) Wash hands
  7. ) Pt edu
  8. ) Documentation

Physical Agents--Debridement (3 decks)

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