Lecture 5 Interventions Part 1 Flashcards
What is Wound Management Long term goal?
Wound healing
What is wound management short term goal
- maintain clean, moist, warm, granular wound bed
Treatment goal for red wound bed
- Protect wound
- Maintain warm, moist environment
- Protect periwound
Treatment goal for yellow wound bed
- Debride necrotic tissue
- Absorb drainage
- Protect periwound
Treatment goal for black wound bed
- Debride necrotic tissue
- Get rid of eschar
Wound treatment goals are achieved through a combination of?
- Debridement
- Microorganism control
- Exudate management
- Skin/wound protection
What is Debridement, and what is its general purpose?
- Debridement is the removal of necrotic tissue from the wound bed
- General purpose is to decrease infection risk and promote healing
What are the 2 types of Debridement?
- Selective: removal of only non-viable tissue and may include sharp, enzymatic, or autolytic debridement
- Nonselective: removal of nonspecific areas of devitalized tissue and may include mechanical and surgical debridement
Contraindications for Debridement
- Granular tissue
- Viable tissue
- Stable, hard, dry eschar in ischemic limbs
- Electrical burns
- Deeper tissue muscle, tendon, ligament
General purpose of debridement
- Decrease bacterial concentration
- Increase the effectiveness of topical antimicrobials
- Shorten the inflammatory phase of wound healing
- Decrease wound odor
Prior to debridement, clinician must consider?
- Patient current health, PMH, medications, nutritional status
- Treatment goals
- Personal skill level
What are the types of selective debridement?
- Sharp
- Autolytic
- Enzymatic
- Biologic (maggot)
What are sharp debridement used for?
- wounds with large amounts of thick, adherent, necrotic tissue
- Also indicated for callouses
Sharp Debridement is contraindicated for?
ABI < 0.5
Gangrene
Stable heel ulcers
unidentifiable structures
terminally ill
Sharp Debridement often requires?
- pain management
- one to a few treatment sessions to complete
Qualified providers for Sharp Debridement
- physician, podiatrist, PT
Why is it important to remove calluses on the plantar foot?
- Pressure points increase the risk of ulceration in people with diabetes (neuropathic ulcers)
- eliminate localized areas of increased pressure
- reduce infection
Autolytic Debridement
- body’s own mechanisms to remove nonviable tissue
- Most conservative treatment, pain free but takes a long time
- a moist wound environment that rehydrates necrotic tissue and eschar, facilitating enzymatic digestion of the nonviable tissue
what are common methods used with autolytic debridement?
- use of transparent films, hydrocolloids, hydrogels & alginates
- Eschar should be cross-hatched prior to application of dressing
Enzymatic Debridement
- can be used on infected and non-infected wounds with necrotic tissue
- Eschar should be crosshatched prior to application of the enzyme
What is the purpose of Cross-hatching?
- open up more surface area so that enzymes or other debriding agents can work
How can Maggot/BIologic debridement help?
- debridement
- disinfection
- promoting cellular activity
Types of non-selective debridement
- Surgical
- Wet to dry dressings
- Scrubbing
- Wound Cleansing
- Wound irrigation: palsatile lavage
- Hyrotherapy: Whirlpool
Surgical Debridement
- Fastest and most aggressive method of debridement
Wet to Dry dressings are only indicated for what type of wounds?
- contain 100% devitalized tissue
Importance of Wet to Dry Dressings
- allow the later to dry for 8-24 hours before being torn away from wound bed
-Removal of dry dressings from granulation tissue may cause bleeding and pain - Also promotes wound bed desiccation (drying out) and delay dealing of granulating wounds
Scrubbing are used for what type of wounds?
- superficial wounds that are highly contaminated and/or wounds with 100% devitalized tissue
Wound Cleansing
- delivery of a wound cleanser to the wound surface
- Cytotoxic, delay wound healing, rarely appropriate
Purpose of Wound irrigation: Basic Technique
- removal of loosely adhered cellular debris
- improves clinician’s visual wound inspection ability and provides wound hydration
Wound irrigation: Basic technique is indicated for?
- all wound types, including granulating wounds
Required pressure for Wound irrigation: Basic technique
4-15 psi; 35 mL
What is Pulsatile Lavage
- Delivery of a wound irrigant under pressure by an electrically powered device
- Indicated for wounds requiring thorough irrigation or debridement
- Can be used on infected wounds
Purposes and effects of Whirlpool
- Softens necrotic tissue and eschar, facilitating their removal
- Hydrates the wound bed and promotes moist wound healing
- Promotes circulation
- Decreased patient pain
- improves range of motion for patients with burn injuries
Whirlpool indications
- Burns
- Infected wounds
- Dry wounds
- Wounds with eschar
Whirlpool Contraindications
- Clean/granulating wounds
- draining or macerated wounds
- Actively bleeding wounds
- venous insufficiency
Considerations for Whirlpool
- Infection control
- Patient PMH
- Behaviors
- Safety
Treatment for infected wounds
- Debridement
- Antimicrobial Therapy: Topical vs Systemic
Antimicrobial agent
- substance able to destroy unicellular microorganisms
Antibacterial agent
- Type of antimicrobials that are effective against bacteria
Bactericidal
cause bacterial death
Bacteriostatic
Inhibit bacterial growth
Antifungal agent
- type of antimicrobials that act on yeast / molds
Antiseptic
- Antimicrobial that reduces bacterial contamination on intact skin
Goal of Topical Antimicrobial Therapy
- Destroy organisms while minimizing adverse reactions
- Shown to penetrate the wound bed to the site of infection
What are Systemic Antimicrobial Therapy?
- Antibiotics
Systemic Antimicrobial Therapy typically used for?
Patients with sepsis, signs of advancing infection, deep space infections
Decision considerations for Systemic Antimicrobial Therapy
- type of microorganisms causing the infection
- sensitivity of the microorganisms to different antimicrobial agents
Wound Healing Principles
- A moist wound heals 3 to 5 times faster than a dry wound
Why does Moist wound heal faster?
- Decreases the intensity and length of the inflammatory phase
- Increases fibroblast proliferation and collagen synthesis
- Promotes angiogenesis
- Reduces Patient pain complaints
if a wound is too dry
- crust formation occurs
- lack the enzymes and growth factors that facilitate wound healing
If a wound is too wet
- Fluid can pool and cause tissue maceration
Goals of Wound dressings
- Creating moist environment
- Provide thermal insulation
- reduce infection risk
- reduce pain
- edema control
- eliminate dead space
- allow adequate gas exchange
What is Occlusion defined as?
- ability of a dressing to transmit moisture, vapor, or gases between the wound bed and atmosphere
Full occlusive substance are?
- Cmpletely impermeable
Non-occlusive substance is?
Permeable
Least to Most Absorption
Semipeameable films > Hydrogels > Hydrocolloids > Semipermeable foam > alginates
What is Moisture Retention
- Ability to maintain moist wound environment
Gauze Dressings
- Highly permeable & nonocclusive
- for wounds that require packing & frequent dressing changes
Petrolatum-impregnated gauzes
- used for burns
Zinc-impregnated gauze
- unna boot
- used for venous insufficiency ulcers
- used as the contact layer, and requires a secondary dressing
what dressings support Autolytic Debridement?
- transparent films
- Hyrocolloids
- Hydrogels
- Alginates
Transparent films are permeable & impermeable to?
- Permeable to water vapor, oxygen, and carbon dioxide
- Impermeable to bacteria and water
Semipermeable films are used for what type of wounds?
- minimal to no drainage
- useful to superficial or partical-thickness wounds
Hydrogels
- not for fluid absorption
- donate moisture to dry wounds
- can decrease pain, and often require secondary dressing
Benefits of Semipermeable Foams
- moisture retentive
- encourage autolytic debridement & provide therma insulation
- provide thermal insulation
- many provide cushioning
Hydrocolloids are used for?
- provide moderate absorption to wet wounds
Alginates
- Highly permeable and noocclusive
- Require secondary dressing
Three composite dressings layers
- inner contact layer: nonadherent, preventing trauma
- middle layer: absorbs moisture
- outer layer: becaterial barrier (usually composed of a semipermeable film)
Silver Antimicrobial Dressings are used to?
- reduce wound bioburden
Charcoal Antimicrobirla Dressings
- control wound odor
- infection management
Honey Antimicrobial Dressings
- decrease wound-related pain
- reduce wound healing time
- improve scar tissue formation
Skin Sealants
- Alcohol based wipes used on intact periwound skin
Moisture Barriers
- Prevent rashes and skin breakdown in areas of incontinence
pH value for Vulnerable skin
pH> 7.5
Pressure Redistribution can be achieved through?
- seating
- positioning
- support surfaces
