Week 1 Debridement Part 1 Flashcards
what are some reasons you would do debridement
- decrease bioburden and risk of infection
- increase effectiveness of topical s
- improve bacterial activity of leukocytes
- shorten the inflammatory phase
- decrease energy required by the body to heal
- eliminate physical barriers
- decrease wound odor
when might you debride
non-viable or eschar, callus, blister. Never granulation tissue or healthy viable tissue
what are the goals of debridement
convert from chronic to acute reduce bateria improve environment for closure prep for grafting or surgical closure tissue protection or exam
what must you consider when you are trying to think about whether you should debride or not
urgency (what will happen if I do not)
what kind of resources do they have at home
do I feel comfortable
wound etiology
health status (meds, nutrition, mobility)
yes it line up with the patients goals
what are contraindications for debridement
arterial compromise (hard, dry or stable eschar)
viable or granular tissue
electrical burns
deeper tissues
is sharp fast or slow
fast
is sharp aggressive? how so
yes, it takes a high skill level
it is painful?
only if attached to viable tissue
do you need a specific MD order for sharp
yes
if sharp selective
yes, you use forceps, scissors, scalpel and curette
forceps: dominant or non-dominant hand
non dominant
scissors which hand
dominant
what are common scalpels for debridement
10,11, 15
what size and what hand for curettes
dominant hand and 3 and 7mm
what is the indication to use sharp
presence of non-viable tissues or callus
TF: we would use sharp if the amount of non-viable tissue renders other methods too slow
true, because of infection or risk of not taking care of it
what method do we use on advancing cellulitis
sharp
what are precautions to sharp
anticoagulants
pain
immunosuppression
unable to be still
what are contraindications of sharp
PT comfort and skill cannot see or ID tissues not consistent with POC ischemic ulcers (AI) hyper-granulation, or live tissue pyoderma gangrenosum
when do we stop debridement
pt request pain wound is clean you get tired or unsure exposure of named tissues holes that have no bottom unexpected infection or purulence undermining bleeding
how do we control bleeding
elevate and put pressure on for 10 continuous minutes, and use silver nitrate (given by the doctor)
TF: always cut in areas that pulsate
false, that is an artery
what kind of pain control meds can we give for sharps
30 minutes before, topical, deep breathing, music, meditation and distraction
when do we contact the MD
when bleeding has a pulse and won’t stop
fever chills or a downhill course, no improvement, exposure to named structures, abscess or purulence that is unexpected.
do you go parallel or perpendicular to the wound surface
parallel
what do you lift necrotic tissue with
forceps
TF: avoid sawing
true
do we remove in thin or thick layers
thin
what kinds of cuts do we make
small slices, we need to avoid sawing the tissue because we can hurt good tissue
can we expect bleeding?
should be little to none, cause nonviable tissue should not bleed. the viable tissue it is attached to might
what do we put the patient at risk for if we open a direct path into the vascular system
infection
what can we warn patient about before using sharp
that it will get deeper and bigger when we are done (because we cut away tissue)
when do we remove blisters
bigger than a nickel
likely to rupture or tear
worried about tissue injury
great place for bacterial growth
how do we remove a blister
secure it with forceps, release the tension carefully, make a cut in the skin, blister line and clean out the residue
