Exam 4: Management of Necrotic Tissue Flashcards
What are the five Bates-Jensen Rules for Wound Therapy
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
Why do we debride wounds?
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
What are the three types of debridement frequencies
Initial, maintenance, and continuous
____ debridement is done to remove obvious necrotic tissue
initial
_____ debridement is done to keep the wound clean and ready for healing
maintenance
_____ 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
continuous
When debriding wounds, what type of patients should we be extra careful with because of their prior comorbidities?
diabetic patients and patients taking blood thinners
What are 4 types of nonviable tissue
Necrotic tissue
cellular debris
senescent nonfunctional cells
bacterial biofilms
True or False:
Bacterial biofilms cannot be seen by the naked eye
True
____ debridement can be good for cleaning bacterial biofilm
ultrasonic
You would expect to see bacterial biofilm on a (acute/chronic) wound
chronic
True or False:
Bacterial biofilm can cause infection when it reaches a stage of critical colonization since it is nonviable tissue
false, it never reaches that stage and doesn’t cause infections
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?
Because it blocks topical agents and antimicrobial treatments used on wounds
initially, what color would necrotic tissue in a wound be?
white or gray
In devitalized tissue, what color would the skin and necrotic tissue be?
gray or blue skin with white tissue
As the severity of necrotic tissue increases, what color does it start to turn?
tan/yellow to brown/black
What are the general characteristics of necrotic tissue
color, consistency, slough, eschar
What determines whether necrotic tissue becomes thin and stringy
moisture
Why would necrotic tissue become thin and stringy
Because it is exposed to air and becomes dry and hard
What type of tissue typically will be hard and stringy if it dies
subcutaneous fat tissue
If muscle or tendinous tissue becomes necrotic, it will be (thin/thick)
thick
(slough/eschar) has a moderate to high water content
slough
When eschar is present in a wound, it is an indication of damage of a ___ ______ wound
full thickness
List all of the characteristic of a necrotic arterial/ischemic wound
dry gangrene
thick, desiccated black/gray appearance
firmly adherent to the wound bed
surrounded by erythematous halo
Diabetic wounds are also called ____ wounds
nuerotrophic
Neurotrophic wounds are another way to describe ____ wounds
diabetic
List all of the characteristics of a necrotic neurotrophic/diabetic wound
Usually does not have necrosis
Hyperkeratosis surrounding the wound which resembles a callus formation
In a neurotrophic/diabetic wound, hyperkeratosis resembles a _____ formation at the wound edges
callus
In regards to a neurotrophic wound, what characteristic should a PT look at to determine the wound type
the hyperkeratosis surrounding the wound
Where is a common location for a neurotrophic ulcer
on the metatarsal heads and on the side of the foot
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
False, even though shaving a callus should be done by a specialist followed by frequent footcare, it WILL return
List all of the characteristics of a necrotic tissue of venous disease/wounds
May have slough or eschar
yellow fibrinous material covering the wound
If there is eschar on a venous wound, it may be attributed to ____ of the wound
desiccation (hardening)
A venous wound could have slough or eschar. Describe when each characteristic would occur
A venous wound will typically have more slough, but the dryer it becomes, the more eschar will develop
True or False
compression therapy can be used on venous wounds
true
List all of the characteristics of a necrotic pressure injury
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
What does demarcates mean
a line that is formed between the good tissue and bad tissue
If a pressure injury is still completely intact but has purple or black discoloration, we would stage it as a ______ pressure injury
suspected deep tissue
What are the 6 different types of interventions of removing necrotic tissue
Mechanical debridement Wound irrigation Enzymatic/chemical Sharp debridement Autolytic debridement Biosurgical debridement
What are the 4 different types of mechanical debridement
Wet to dry
wound irrigation
whirlpool
nonthermal ultrasound
Which type of mechanical debridement has a lot of disadvantages
wet to dry
What is the advantage of mechanical debridement
Most healthcare workers are familiar with that treatment form
What is the advantage of using wound irrigation
it effectively decreases the bacterial burden on the wound
What is the advantage of using whirlpool to debride a wound
it may soften necrotic debris for ease of removal by other methods
What is the advantage of non-thermal ultrasound to debride a wound
it may decrease bacterial burden
What are the disadvantages of wet-to-dry dressings
They are nonselective, rarely applied correctly, may cause pain when removed, more costly overtime, may cause maceration
How does wound irrigation remove necrotic debris
By using pressurized fluids
What are the two types of wound irrigation
pulsatile lavage and high pressure irrigation
What type of wound intervention are pulsatile lavage and high pressure irrigation?
wound irrigation
High pressure irrigation delivers fluid at a pressure between ___ and ___ psi
8 and 12
What type of wound debridement intervention is the application of commercially prepared enzyme to the surface of necrotic tissue
enzymatic/chemical treatment
Explain how you would use an enzymatic/chemical intervention to debride a wound
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
Enzymatic/chemical interventions are (inexpensive/expensive)
expensive
What are the advantages of using enzymatic/chemical debridement interventions
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
What are the disadvantages of using enzymatic/chemical debridement interventions
It takes 3 to 30 days to achieve a clean wound bed so it is not cost efficient
What type of wound debridement intervention is performed using a scalpel, scissors or other sharp instrument
sharp debridement
Explain the how sharp debridement works
It is a selective intervention that can be one time or sequential debridement that converts a necrotic wound into an acute clean wound quickly
What are the disadvantages of sharp debridement
requires a skilled clinician
reimbursement is questionable
can be painful and require analgesia
potential for blood loss and infection, especially in diabetic patients
What type of wound debridement intervention uses the body’s own mechanisms to remove nonviable tissue
autolytic debridement
Explain how autolytic debridement works
maintaining a moist environment allows collection of fluid at the wound site and it can be performed alone or with other interventions
What three dressings does autolysis usually use
transparent film dressing, hydrocolloids, or hydrogels
What are the advantages of autolytic debridement
its selective, relatively cheap, can be used with other interventions, safe for diabetic patients
What are the disadvantages of autolytic debridement
caregiver education is required
Which type of wound debridement intervention is the application of disinfected maggots to the wound to remove nonviable tissue
biosurgical debridement
What are the advantages of biosurgical debridement
reduces bacterial burden and possible grow stimulating effects
What are the disadvantages of biosurgical debridement
availability, slower rate of debridement, and the removal and disposal of larvae
Give examples of when to refer a patient with necrotic tissue
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
