exam 2 - wound interventions Flashcards
TIME
- Tissue (debride?)
- Infection/inflammation (goal is to reduce)
- Moisture (need balance, too much is bad)
- Edge (watch for undermining)
What range of psi do you want with irrigation
4-15 psi
antibacterial
- destroy or stop bacterial growth
- discontinue once infection is resolved
antiseptic
- prevent infection by killing microorganisms
- broad spectrum antimicrobials
- cytotoxic
antifungals
-inhibit or kill fungi
Selective debridement strategies
- enzymatic/chemical
- autolytic
- sharp
- biological (maggots)
non-selective debridement strategies
- surgical
- mechanical (wet to dry, pulse lavage, whirlpool etc)
Mechanical Debridement (selective vs non, types, indications)
- non-selective
- irrigation, pulsed lavage, whirlpool, wet to dry, scrubbing
- indication: wounds with loose necrotic tissue
Enzymatic or chemical debridement (selective vs non, indications, disadvantage, contraindication)
- selective
- **requires physician prescription
- indication: infected and uninfected with necrotic tissue, cannot tolerate sharp or mechanical
- disadvantage: slow
- contra: wounds with exposed deep tissues
Sharp debridement (selective vs non, indications, contraindication)
- selective
- indication: large amount of necrotic tissue
- patient with dry gangrene, impaired arterial flow, clotting issues etc.
surgical debridement (selective vs non, types, indications, contraindication)
- non-selective
- ***fastest most effective way to remove debris and necrotic tissue
- **always done by physician
- indicated: removal of necrotic bone, muscle, tendon. Wounds with extensive undermining etc.
- contra: medically unstable. Lack vascular supply for adequate healing
Biological debridement (what is it?)
maggots = digest necrotic tissue
Gauze (what, advantage, disadvantage)
- used on pretty much any wound
- can be impregnated with stuff
- low cost, easy to use
- disadvantage: freq changes, can dry wound, can shed
Autolytic debridement (selective vs non, indication, contra)
- selective
- using bodies own enzymes in breakdown of necrotic tissue
- indication: dry or moist necrotic wounds and patient cannot tolerate more aggressive forms
- contra: infected wound.
Calcium alginates (goods, bads)
- from seaweed
- highly absorptive (up to 20x)
- can be left 3-5 days
- good for moderate to heavy exudates (infected or not)
-not recommended for wounds with light exudates or dry eschar
Transparent film dressings (goods, bads)
- thin membranes
- impermeable to bacteria and contaminates, yet permeable to o2, co2, and water
- can leave for 5-7 days
- not really absorptive
**not for infected, or wounds with moderate to heavy drainage.
Foam dressings (goods, bads)
- from polyurethane
- for min, mod, or heavy drainage
- primary or secondary dressing
- not effective for wounds with dry eschar
Hydrogels (goods, bads)
- water or glycerin based (80-99% water)
- permeable to gas and water
- min absorptive capacity
-not recommended with wounds with heavy exudates
Hydrocolloids (goods, bads)
- occlusive or semi occlusive
- most occlusive - impermeable to water, o2, and bacteria
- light to moderate exudates
-not recommended for wounds with heavy exudates or sinus tracts. Not for infected wound
Antimicrobial dressings
- silver
- intended for shot term use
compression dressings
- manage edema and promote return of blood
- unna’s boot = gauze bandage blah becomes rigid compression dressing as it dries
