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Integ Midterm > Integument Debridement & Management > Flashcards

Integument Debridement & Management Flashcards

1
Q

Removal of necrotic tissue, foreign material, debris and decrease risk of infection and promote wound healing

Purpose:

A

● Decrease bacterial concentration within the wound bed and the risk of infection

● Increase the effectiveness of topical antimicrobials

● Improve the bactericidal activity of leukocytes

● Shorten the inflammatory phase of wound healing

● Decrease the energy required by the body for wound healing

● Decrease wound odor

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2
Q

debridement indicated:

A

● necrotic tissue
● foreign material
● debris
● residual topical agents
● blisters
● callus

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3
Q

debridement contraindications:

A

● granular tissue
● viable tissue
● urgent need for surgical debridement (gangrene, osteomyelitis)
● electrical burns
● grade IV pressure ulcers

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4
Q

red wound bed

A

pale pink to beefy red, granulation tissue

treatment goals:
● protect wound
● maintain warm, moist environment
● protect periwound

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5
Q

yellow wound bed

A

moist, yellow slough

treatment goals:
● debride necrotic tissue
● absorb drainage
● protect periwound

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6
Q

black wound bed

A

thick, black, adherent eschar

treatment goals:
● debride necrotic tissue

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7
Q

types of selective debridement:

A

Sharp
Autolytic
Enzymatic (Chemical)
Biological

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8
Q

Sharp overview:

A

● Serial Instrumental Debridement
○ Forceps, scissors to remove loosely adherent necrotic tissue
○ prior tissue preparation
○ (irrigation, whirlpool, suction)

● Selective Sharp Debridement
○ Scissors/scalpel to cut along the border of viable and nonviable issue
○ No tissue preparation

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9
Q

Sharp process:

A

● Fast and most aggressive

● Hold the scalpel & scissors parallel to the wound surface and debride in layers to keep from incising on healthy tissues

● Use forceps to apply gentle traction to the devitalized tissue

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10
Q

Sharp used for:

A

● Large amount of necrosis
● Callus
● Cellulitis or sepsis
● Thick, adherent eschar

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11
Q

Sharp poor for:

A

● Extensive tunneling/undermining (PT can’t see where to debride)

● Unidentified material to debride

● Uninfected ischemic ulcers (Ischemic ulcers less likely to heal without adequate blood flow)

● Low ABI
● Areas of hypergranulation tissue

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12
Q

Autolytic overview:

A

● Most conservative, least painful but slow process

● Allowing the body to produce enzymes to digest necrotic material

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13
Q

Autolytic process:

A

● Warm and moist wound
● Dressing to seal wound (hydrogel, foam, hydrocolloid)

● Wound releases endogenous enzymes
○ Liquefied necrotic tissue
○ Inflammatory & proliferative phase accelerated

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14
Q

Autolytic used for:

A

● Wound should present with necrotic tissue

● Pt cannot tolerate other forms of debridement

● Frequently used in LTC, home care settings

● Palliative treatment

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15
Q

Autolytic poor for:

A

● Infected wounds
● Deep cavity wounds
● When sharp or surgical debridement is mandated
● Gangrene, necrotic tendon…

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16
Q

Enzymatic (Chemical) overview:

A

● Exogenous enzymes to remove devitalized tissue

● Physician prescription required

● Less skill but long process

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17
Q

Enzymatic (Chemical) used for:

A

● Necrotic tissue (w/ or w/o infection)
● Autolytic doesn’t work
● Benefit from exogenously supplied
enzymes
● Combine antimicrobial
therapy if infection present

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18
Q

Enzymatic (Chemical) poor for:

A

● Exposed deep tissues, Ligament, tendon, capsule, blood vessels, nerves, or bones

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19
Q

Biological overview:

A

Maggot debridement

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20
Q

Biological process:

A

● Sterile maggots placed for ~ 3 days
● Maggots ingest/ destroy necrotic tissue/bacteria by releasing enzymes
● Viable tissue is spared

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21
Q

Biological used for:

A

● Necrotic tissue

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22
Q

Nonselective Debridement:
Removal of non-specific areas of devitalized tissue

A

Mechanical
Surgical

23
Q

Mechanical: Wet-to-dry dressings process:

A
  1. Apply moist gauze
  2. Cover with dry gauze
  3. Gauze adheres to wound
    bed
  4. Then tear away from
    wound bed
    ○ May remove both good
    and bad tissue
24
Q

Mechanical: Wet-to-dry dressings used for:

A

● ONLY if entire wound bed is necrotic

25
Q

Mechanical: Wet-to-dry dressings poor for:

A

● Dry wound
○ Delays granulation tissue forming
○ Dryness can damage tendons, fascia, and joint capsules

26
Q

Mechanical: Scrubbing process:

A

● Use of sponge, brush, or gauze to debride wound

27
Q

Mechanical: Scrubbing used for:

A

● Benefits? Cheap, larger area, fast and clean

28
Q

Mechanical: Scrubbing poor for:

A

● Risks? Take the good material too

29
Q

Mechanical: wound cleansing process:

A

● Use of commercial solution with force to remove lightly adhered necrotic tissue

30
Q

Mechanical: wound cleansing used for:

A

● Appropriate for superficial wounds

31
Q

Mechanical: wound cleansing poor for:

A

● Chronic/deep wounds
● Can be cytotoxic and
delay wound healing ○ Not FDA regulated

32
Q

Surgical:

A

● Performed by physician or podiatrist
● Use of surgical tools in sterile environment

33
Q

Management:

A

Irrigation
Whirlpool
Pulsed Lavage with Concurrent Suction
E-Stim
Ultrasound
Holistic

34
Q

Irrigation overview:

A

● Use of Saline

35
Q

Irrigation process:

A

Removes:
● Loose cellular debris
● Surface bacteria
● Wound exudate
● Dressing residue

36
Q

Irrigation used for:

A

● Only option for well healing granular tissue

37
Q

Irrigation poor for:

A

● Profuse bleeding from wound

38
Q

Whirlpool overview:

A

● NOT USED IN CLINIC ANYMORE

39
Q

Whirlpool process:

A

● Area of wound is submerged in pool with circulating water

40
Q

Whirlpool used for:

A

● Burn wounds
● Reduce bacterial load
● Non-draining wounds to help rehydrate
● Soften thick eschar tissue
● Gently remove loosely adherent necrotic tissue

41
Q

Whirlpool poor for:

A

● Venous insufficiency or lymphatic ulcers
○ Sensation, Low BF and swelling
● Bowel and Bladder incontinence
● Cross contamination between patients
● Non-selective
● Wound maceration risk

42
Q

Pulsed Lavage with Concurrent Suction process:

A

● Handheld device using pressurized saline

43
Q

Pulsed Lavage with Concurrent Suction used for:

A

● Used for most wounds
○ Tunneling & undermining wounds okay

44
Q

Pulsed Lavage with Concurrent Suction poor for:

A

● Deep wounds with vital structures visible

45
Q

E-Stim overview:

A

Wound healing facilitation:
1. Restoring the current of
injury

  1. Causes Galvanotaxis
  2. Stimulate Cells
  3. Increases blood flow
  4. Increases bactericidal
    abilities
  5. Reduces edema
  6. Facilitates Debridement
46
Q

E-Stim process:

A

● Technique
○ Direct Contact
○ Immersion technique
○ Periwound technique

47
Q

E-Stim used for:

A

● Adjunct to wound healing
● Canbeusedasaco treatment option for all wounds

48
Q

E-Stim poor for:

A

● Used in chronic non healing wounds or for patients at risk of delayed wound healing

● Wounds with osteomyelitis

49
Q

Ultrasound overview:

A

● Can enhance all 3 phases of wound healing

● Improves scar pliability

● Enhances wound contractility

50
Q

Ultrasound process:

A

● result from changes in cell membrane permeability

51
Q

Ultrasound used for:

A

● Adjunct for chronic wounds

52
Q

Ultrasound poor for:

A

● General US precautions
● Untreated osteomyelitis
● AI
● DVT

53
Q

Holistic overview:

A

Nutrition, Water (fluid environment), Protein (restructuring of cells), Fats (fuel the healing process), Vitamins/Minerals

Integ Midterm (9 decks)

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