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Wound Care > Exam 4: Management of Necrotic Tissue > Flashcards

Exam 4: Management of Necrotic Tissue Flashcards

1
Q

What are the five Bates-Jensen Rules for Wound Therapy

A 
If the wound is dirty, clean it.
If there is leakage, manage it.
If there's a hole, fill it
If it's flat, protect it.
If it's healed, prevent it from recurring
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2
Q

Why do we debride wounds?

A

Prevent infection
Reduce inflammatory cells caused from chronic inflammation
Promote DNA synthesis and keratinocyte growth
Convert chronic would physiology to that of an acute wound

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3
Q

What are the three types of debridement frequencies

A

Initial, maintenance, and continuous

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4
Q

____ debridement is done to remove obvious necrotic tissue

A

initial

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5
Q

_____ debridement is done to keep the wound clean and ready for healing

A

maintenance

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6
Q

_____ debridement is not done by a tool, but rather is done by putting enzymes or chemical on the wound bed to break down necrotic tissue

A

continuous

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7
Q

When debriding wounds, what type of patients should we be extra careful with because of their prior comorbidities?

A

diabetic patients and patients taking blood thinners

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8
Q

What are 4 types of nonviable tissue

A

Necrotic tissue
cellular debris
senescent nonfunctional cells
bacterial biofilms

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9
Q

True or False:

Bacterial biofilms cannot be seen by the naked eye

A

True

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10
Q

____ debridement can be good for cleaning bacterial biofilm

A

ultrasonic

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11
Q

You would expect to see bacterial biofilm on a (acute/chronic) wound

A

chronic

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12
Q

True or False:

Bacterial biofilm can cause infection when it reaches a stage of critical colonization since it is nonviable tissue

A

false, it never reaches that stage and doesn’t cause infections

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13
Q

Bacterial biofilm is a type of necrotic tissue, but does not cause infection. Why do we remove biofilm if it doesn’t cause an infection?

A

Because it blocks topical agents and antimicrobial treatments used on wounds

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14
Q

initially, what color would necrotic tissue in a wound be?

A

white or gray

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15
Q

In devitalized tissue, what color would the skin and necrotic tissue be?

A

gray or blue skin with white tissue

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16
Q

As the severity of necrotic tissue increases, what color does it start to turn?

A

tan/yellow to brown/black

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17
Q

What are the general characteristics of necrotic tissue

A

color, consistency, slough, eschar

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18
Q

What determines whether necrotic tissue becomes thin and stringy

A

moisture

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19
Q

Why would necrotic tissue become thin and stringy

A

Because it is exposed to air and becomes dry and hard

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20
Q

What type of tissue typically will be hard and stringy if it dies

A

subcutaneous fat tissue

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21
Q

If muscle or tendinous tissue becomes necrotic, it will be (thin/thick)

A

thick

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22
Q

(slough/eschar) has a moderate to high water content

A

slough

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23
Q

When eschar is present in a wound, it is an indication of damage of a ___ ______ wound

A

full thickness

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24
Q

List all of the characteristic of a necrotic arterial/ischemic wound

A

dry gangrene
thick, desiccated black/gray appearance
firmly adherent to the wound bed
surrounded by erythematous halo

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25
Q

Diabetic wounds are also called ____ wounds

A

nuerotrophic

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26
Q

Neurotrophic wounds are another way to describe ____ wounds

A

diabetic

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27
Q

List all of the characteristics of a necrotic neurotrophic/diabetic wound

A

Usually does not have necrosis

Hyperkeratosis surrounding the wound which resembles a callus formation

28
Q

In a neurotrophic/diabetic wound, hyperkeratosis resembles a _____ formation at the wound edges

A

callus

29
Q

In regards to a neurotrophic wound, what characteristic should a PT look at to determine the wound type

A

the hyperkeratosis surrounding the wound

30
Q

Where is a common location for a neurotrophic ulcer

A

on the metatarsal heads and on the side of the foot

31
Q

True or False:

If a neurotrophic callus is shaved off by a specialist or pediatrist, it will permanently be gone, but frequently foot care should be done

A

False, even though shaving a callus should be done by a specialist followed by frequent footcare, it WILL return

32
Q

List all of the characteristics of a necrotic tissue of venous disease/wounds

A

May have slough or eschar

yellow fibrinous material covering the wound

33
Q

If there is eschar on a venous wound, it may be attributed to ____ of the wound

A

desiccation (hardening)

34
Q

A venous wound could have slough or eschar. Describe when each characteristic would occur

A

A venous wound will typically have more slough, but the dryer it becomes, the more eschar will develop

35
Q

True or False

compression therapy can be used on venous wounds

A

true

36
Q

List all of the characteristics of a necrotic pressure injury

A

The necrotic debris relates to how much damage is done
Tissue can be be hard with purple/black discoloration on intact skin
eschar appears at the wound demarcates

37
Q

What does demarcates mean

A

a line that is formed between the good tissue and bad tissue

38
Q

If a pressure injury is still completely intact but has purple or black discoloration, we would stage it as a ______ pressure injury

A

suspected deep tissue

39
Q

What are the 6 different types of interventions of removing necrotic tissue

A 
Mechanical debridement
Wound irrigation
Enzymatic/chemical
Sharp debridement
Autolytic debridement
Biosurgical debridement
40
Q

What are the 4 different types of mechanical debridement

A

Wet to dry
wound irrigation
whirlpool
nonthermal ultrasound

41
Q

Which type of mechanical debridement has a lot of disadvantages

A

wet to dry

42
Q

What is the advantage of mechanical debridement

A

Most healthcare workers are familiar with that treatment form

43
Q

What is the advantage of using wound irrigation

A

it effectively decreases the bacterial burden on the wound

44
Q

What is the advantage of using whirlpool to debride a wound

A

it may soften necrotic debris for ease of removal by other methods

45
Q

What is the advantage of non-thermal ultrasound to debride a wound

A

it may decrease bacterial burden

46
Q

What are the disadvantages of wet-to-dry dressings

A

They are nonselective, rarely applied correctly, may cause pain when removed, more costly overtime, may cause maceration

47
Q

How does wound irrigation remove necrotic debris

A

By using pressurized fluids

48
Q

What are the two types of wound irrigation

A

pulsatile lavage and high pressure irrigation

49
Q

What type of wound intervention are pulsatile lavage and high pressure irrigation?

A

wound irrigation

50
Q

High pressure irrigation delivers fluid at a pressure between ___ and ___ psi

A

8 and 12

51
Q

What type of wound debridement intervention is the application of commercially prepared enzyme to the surface of necrotic tissue

A

enzymatic/chemical treatment

52
Q

Explain how you would use an enzymatic/chemical intervention to debride a wound

A

It is intended to use with a moist wound bed so it needs to be cross-hatched. After applying this intervention, a secondary dressing is necessary after the chemicals

53
Q

Enzymatic/chemical interventions are (inexpensive/expensive)

A

expensive

54
Q

What are the advantages of using enzymatic/chemical debridement interventions

A

It is selective and only works on necrotic tissue so it won’t harm good tissue and it works really well in combination of other debridement methods

55
Q

What are the disadvantages of using enzymatic/chemical debridement interventions

A

It takes 3 to 30 days to achieve a clean wound bed so it is not cost efficient

56
Q

What type of wound debridement intervention is performed using a scalpel, scissors or other sharp instrument

A

sharp debridement

57
Q

Explain the how sharp debridement works

A

It is a selective intervention that can be one time or sequential debridement that converts a necrotic wound into an acute clean wound quickly

58
Q

What are the disadvantages of sharp debridement

A

requires a skilled clinician
reimbursement is questionable
can be painful and require analgesia
potential for blood loss and infection, especially in diabetic patients

59
Q

What type of wound debridement intervention uses the body’s own mechanisms to remove nonviable tissue

A

autolytic debridement

60
Q

Explain how autolytic debridement works

A

maintaining a moist environment allows collection of fluid at the wound site and it can be performed alone or with other interventions

61
Q

What three dressings does autolysis usually use

A

transparent film dressing, hydrocolloids, or hydrogels

62
Q

What are the advantages of autolytic debridement

A

its selective, relatively cheap, can be used with other interventions, safe for diabetic patients

63
Q

What are the disadvantages of autolytic debridement

A

caregiver education is required

64
Q

Which type of wound debridement intervention is the application of disinfected maggots to the wound to remove nonviable tissue

A

biosurgical debridement

65
Q

What are the advantages of biosurgical debridement

A

reduces bacterial burden and possible grow stimulating effects

66
Q

What are the disadvantages of biosurgical debridement

A

availability, slower rate of debridement, and the removal and disposal of larvae

67
Q

Give examples of when to refer a patient with necrotic tissue

A

If they have elevated temperature or those on a downhill course
patients that don’t improve in weeks
Patients with cellulitis or gross infection
Patients with exposed bone, tendon, vital structures
Patients with evidence of abscess

Wound Care (8 decks)

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