Exam 4: Management of Necrotic Tissue

Question 1

What are the five Bates-Jensen Rules for Wound Therapy

Answer 1

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

Question 2

Why do we debride wounds?

Answer 2

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

Question 3

What are the three types of debridement frequencies

Answer 3

Initial, maintenance, and continuous

Question 4

____ debridement is done to remove obvious necrotic tissue

Answer 4

initial

Question 5

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

Answer 5

maintenance

Question 6

_____ 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

Answer 6

continuous

Question 7

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

Answer 7

diabetic patients and patients taking blood thinners

Question 8

What are 4 types of nonviable tissue

Answer 8

Necrotic tissue
cellular debris
senescent nonfunctional cells
bacterial biofilms

Question 9

True or False:

Bacterial biofilms cannot be seen by the naked eye

Answer 9

True

Question 10

____ debridement can be good for cleaning bacterial biofilm

Answer 10

ultrasonic

Question 11

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

Answer 11

chronic

Question 12

True or False:

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

Answer 12

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

Question 13

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?

Answer 13

Because it blocks topical agents and antimicrobial treatments used on wounds

Question 14

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

Answer 14

white or gray

Question 15

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

Answer 15

gray or blue skin with white tissue

Question 16

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

Answer 16

tan/yellow to brown/black

Question 17

What are the general characteristics of necrotic tissue

Answer 17

color, consistency, slough, eschar

Question 18

What determines whether necrotic tissue becomes thin and stringy

Answer 18

moisture

Question 19

Why would necrotic tissue become thin and stringy

Answer 19

Because it is exposed to air and becomes dry and hard

Question 20

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

Answer 20

subcutaneous fat tissue

Question 21

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

Answer 21

thick

Question 22

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

Answer 22

slough

Question 23

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

Answer 23

full thickness

Question 24

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

Answer 24

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

Question 25

Diabetic wounds are also called ____ wounds

Answer 25

nuerotrophic

Question 26

Neurotrophic wounds are another way to describe ____ wounds

Answer 26

diabetic

Question 27

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

Answer 27

Usually does not have necrosis | Hyperkeratosis surrounding the wound which resembles a callus formation

Question 28

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

Answer 28

callus

Question 29

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

Answer 29

the hyperkeratosis surrounding the wound

Question 30

Where is a common location for a neurotrophic ulcer

Answer 30

on the metatarsal heads and on the side of the foot

Question 31

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

Answer 31

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

Question 32

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

Answer 32

May have slough or eschar | yellow fibrinous material covering the wound

Question 33

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

Answer 33

desiccation (hardening)

Question 34

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

Answer 34

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

Question 35

True or False compression therapy can be used on venous wounds

Answer 35

true

Question 36

List all of the characteristics of a necrotic pressure injury

Answer 36

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

Question 37

What does demarcates mean

Answer 37

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

Question 38

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

Answer 38

suspected deep tissue

Question 39

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

Answer 39

``` Mechanical debridement Wound irrigation Enzymatic/chemical Sharp debridement Autolytic debridement Biosurgical debridement ```

Question 40

What are the 4 different types of mechanical debridement

Answer 40

Wet to dry wound irrigation whirlpool nonthermal ultrasound

Question 41

Which type of mechanical debridement has a lot of disadvantages

Answer 41

wet to dry

Question 42

What is the advantage of mechanical debridement

Answer 42

Most healthcare workers are familiar with that treatment form

Question 43

What is the advantage of using wound irrigation

Answer 43

it effectively decreases the bacterial burden on the wound

Question 44

What is the advantage of using whirlpool to debride a wound

Answer 44

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

Question 45

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

Answer 45

it may decrease bacterial burden

Question 46

What are the disadvantages of wet-to-dry dressings

Answer 46

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

Question 47

How does wound irrigation remove necrotic debris

Answer 47

By using pressurized fluids

Question 48

What are the two types of wound irrigation

Answer 48

pulsatile lavage and high pressure irrigation

Question 49

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

Answer 49

wound irrigation

Question 50

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

Answer 50

8 and 12

Question 51

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

Answer 51

enzymatic/chemical treatment

Question 52

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

Answer 52

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

Question 53

Enzymatic/chemical interventions are (inexpensive/expensive)

Answer 53

expensive

Question 54

What are the advantages of using enzymatic/chemical debridement interventions

Answer 54

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

Question 55

What are the disadvantages of using enzymatic/chemical debridement interventions

Answer 55

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

Question 56

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

Answer 56

sharp debridement

Question 57

Explain the how sharp debridement works

Answer 57

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

Question 58

What are the disadvantages of sharp debridement

Answer 58

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

Question 59

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

Answer 59

autolytic debridement

Question 60

Explain how autolytic debridement works

Answer 60

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

Question 61

What three dressings does autolysis usually use

Answer 61

transparent film dressing, hydrocolloids, or hydrogels

Question 62

What are the advantages of autolytic debridement

Answer 62

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

Question 63

What are the disadvantages of autolytic debridement

Answer 63

caregiver education is required

Question 64

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

Answer 64

biosurgical debridement

Question 65

What are the advantages of biosurgical debridement

Answer 65

reduces bacterial burden and possible grow stimulating effects

Question 66

What are the disadvantages of biosurgical debridement

Answer 66

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

Question 67

Give examples of when to refer a patient with necrotic tissue

Answer 67

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