Wound Care: Wound Management, Cleaning, Debridement, and Dressings Flashcards
what are 3 electrotherapeutic modalities good for wound healing
- e-stim
- high voltage pulsed current
- transcutaneous electrical nerve stimulation
goal of wound cleansing
remove necrotic tissue and maintain a clean wound bed for promotion of healing
according to insurance, a chronic wound is greater than ____ days
30
4 things you look at when preparing a wound bed
TIME
T = tissue
I = infection/inflammation
M = moisture imbalance
E = epidermis/edge
what are some indications to debride
1 - eschar or non-viable tissue
2 - purulence
3 - infection
4 - foreign objects
precautions to debride
- bone or tendon exposure
- complications like cellulitis, gross purulence, excessive underminding, excessive bleeding
contraindications to debridement
- clean, non-infected wounds
- stable eschar
- dry gangrene/ischemia
- pulseless wound
- extreme pain at wound
- bleeding tendencies
- goal is to maintain comfort
mechanical debridement
physically removing something from the wound
forms of mechanical debridement
- dressing changes
- whirlpool/pulsed irrigation
- sharp/scrub debridement
- low frequency ultrasound
autolytic debridement
using body’s own mechanism to remove nonviable tissue
autolytic debridement can be facilitated through
dressings
e-stim
ultrasound
enzymatic debridement
pharmaceutical
Do pTs do selective or nonselective debridement
selective (non-surgical)
contraindications of whirlpool
-incontinence
-epilepsy
-danger of hemorrhaging
-post-op incisions w/ dehiscence, sutures, staples
-infection
-skin grafts
-venous insufficiency, edema, lymphedema
whirlpool parameters
frequency
duration
water temp
additives
vitals
expected outcomes
which has better evidence: whirlpool or pulsed irrigation
pulsed irrigation
T or F: pulsed irrigation involves single use machines
T
what psi should you set for pulsed irrigation
4-15psi
what temp should saline be for pulsed irrigation (cold or warm?)
warm b/c you want to keep the wound close to body temp
pulsed irrigation documentation
pt position
fluid pressure
duration
water additives
outcomes
when would you not want to use a wet to try dressing and why
if there is a lot of healthy tissue b/c it is a form of mechanical debridement
what is the fastest type of debridement
sharps
you should do sharps debridement for no more than _____. mins at a timw
15
according to their license, can PTAs debride? what does the APTA say about it
yes, but the APTA says that debridement requires assessment and that is something only a PT can do
T or F: when debridement is done in conjunction with WP or PI you cannot bill them seperately
T
you should debride from the ______ edge up
inferior
autolytic debridement is highly __ but it is slow
selective
what medication is used for enzymatic debridement
santyl
digests native and denatured collagen in necrotic tissue
T or F: debridement is a single event
F: you have the initial phase (which may take multiple sessions) and then the maintenance phase
function of dressings
-moist wound environment
-thermal insulation
-barrier to microorganisms
-protect exposed nerve endings
-hemostasis
-edema control
-elimination of dead space
-assists with removal of necrotic tissue
-provide adequate gas exchange
primary dressing
goes directly onto wound bed
secondary dressing
wound dressing placed over the primary dressing to hold it on
*for deeper wounds
T or F: gauze dressings are highly permeable and can be used as primary or secondary dressings
T
impregnated gauze dressings
mesh gauze dressings into which materials such as petroleum, bismuth or zinc have been incorporated
is impregnated gauze primary or secondary
primary
semipermeable film dressings
thin, flexible sheets of transparent polyurethane with an adhesive backing
*used a lot for protection (ex. while showering)
- can be primary or secondary
hydrogels
80-90% water or glycerin based dressing available in sheets, amorphous gels, or impregnated gauzes
are hydrogels primary or secondary
primary
foam dressings
made of polyurethane foam with a hydrophilic wound side and hydrophobic outside
what kind of wounds are foam dressings good for? are they primary or secondar>
good for wounds with excess moisture
can be primary or secondary
hydrocolloids
- contain hydrophilic colloidal particles with a very strong adhesive backing
- works good for protection but not absorption
is a hydrocolloid primary or secondary
primary
alginates
salts of alginic acid extracted prom certain types of brown seaweed and converted into calcium/sodium salts
are alginates primary or secondary
primary
silver dressings are good for…
infections
burn
T or F: iodine harms healthy tissue
F: it is non-cytotoxic
medicinal honey
donates moisture and cleans wound bed
alpigraft and dermagrafts are both approved for…
diabetic foot ulcers
what is the theory behind wound vacs?
-reduce bacterial load and chronic wound exudate
-increased vascularity
-increased cytokines
-physically contract wound margins
contraindications for wound vac
-malignancy
-untreated osteomyelitis
-fistulas
-necrotic tissue w/ eschar
-over exposed vessels/organs
what kind of primary dressing do you use with wound vacs?
foam (black, white, or silver)
how often do you change wound vac dressings?
48-72 hours
what is the pressure set at on wound vacs
125mmHg
can be continuous or intermittent
