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Integumentary 1 - Midterm > Wound Debridement's - Class 3 > Flashcards

Wound Debridement's - Class 3 Flashcards

1
Q

clinical decision making

A

know the pts history

what are the goals of care

what is the clinical presentation of the wound?

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2
Q

goals of care

A

to achieve full closure

to prepare for surgical closure

to manage wound deterioration

to maintain a stable non healing ulcer

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3
Q

clinical presentation of the wound

A

helps identify treatment objects

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4
Q

granulating/epithelializing

A

protect and keep moist

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5
Q

necrotic

A

debride it

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6
Q

infected

A

antiseptic/antibiotics/debride

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7
Q

heavily draining

A

absorb it

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8
Q

desiccated

A

moisten it

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9
Q

odorous

A

charcoal based

antiseptics

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10
Q

undermined/tunneled

A

lightly pack wound

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11
Q

bone/tendon exposure

A

protect and keep moist

xeroform

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12
Q

flap/graft exposure

A

protect and keep moist

xeroform

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13
Q

organ/mesh exposure

A

protect and keep moist (xeroform)

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14
Q

wound bed preparation

A

debridement

dressing selection

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15
Q

types of wound debridement

A

surgical

sharp

mechanical

enzymatic

autolytic

biosurgical

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16
Q

surgical debridement is only performed by

A

physicians

podiatrists

certified PAs

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17
Q

surgical debridement includes

A

removal of both viable and nonviable tissue

w/ sterile, sharp instruments

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18
Q

surgical debridement is

A

quick

but non-selective form of debridement

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18
Q

when is surgical debridement done

A

when wide excision into viable tissue is required

when removal of necrotic or infected bone is necessary

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18
Q

where is surgical debridement done

A

bedside or OR

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18
Q

surgical debridement is likely to be

A

very painful

so premedication is required

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19
Q

sharp debridement can be performed by

A

PTs, PAs, some nurses

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20
Q

who is not allowed to do sharps debridement

A

PTAs

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21
Q

sharp debridement is

A

removal of non viable tissue

only w/ sterile instruments

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22
Q

sharp debridement is a ____ form of debridement

A

quick and selective form

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23
Q

sharp debridement can be

A

very painful

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24
Q

sharp debridement has an

A

increased risk for infection

25
Q

sharp debridement requires

A

skill

comfort form clinician

26
Q

indications for sharps debridement

A

extensive necrotic tissue

advancing cellulitis or sepsis

thick adherent eschar

as adjunct to other therapies

callous formation

27
Q

contraindications for sharp debridement

A

arterial insufficiency (ABI < 0.5)

gangrene

stable heel ulcers

unidentifiable structures

terminally ill

28
Q

key to comfort in debridement

A

knowing your anatomy

recognizing what is normal

29
Q

viable fat is

A

shiny and yellow

30
Q

nonviable fat is

A

dull gray/brown to black

31
Q

viable fascia is

A

glistening white

32
Q

nonviable fascia

A

dull gray/brown to black

33
Q

muscle viable

A

dull red

contractile if pinched

34
Q

nonviable muscle

A

dark red/brown –> gray

35
Q

viable bone

A

shiny and white

periosteum intact

36
Q

nonviable bone

A

dull and yellow –> brown/black

37
Q

vessels viable

A

shiny white and pulsatile

38
Q

reasons to stop sharps debridement

A

clinician/pt fatigue

bleeding

pain

to viable tissue

location of fascial plane

location of named structure

high anxiety level

achieved set limit time

39
Q

how to stop bleeding

A

pressure x 10 min

elevation

calcium alginate

xylocaine jelly-vasoconstrictor

nitrate sticks-cauterizes tissue

40
Q

bleeding to fear

A

those that you can hear

those that you can’t see

41
Q

mechanical debridement

A

scrubbing

wet to dry dressing

hydrotherapy/whirlpool

forced irrigations/pulsed lavage

42
Q

scrubbing

A

non selective form of debridement

use gauze

43
Q

wet to dry dressing

A

non selective form of debridement

dessicates wound bed

44
Q

what can wet to dry dressings be used on

A

necrotic wounds (<30% granulation tissue)

infected wounds

45
Q

hydrotherapy/whirlpool

A

non selective form of debridement

softens adherent necrotic eschar and slough for easier sharp debridement

46
Q

to clean dirt –> hydrotherapy

A

foreign materials or residues from topical agents in the wound

47
Q

what does hydrotherapy aid with

A

removal of dressing with burn wounds

48
Q

systemic effects of hydrotherapy

A

increased HR and RR

sedation, analgesia, muscle relaxation

changes in thermoregulatory system

49
Q

forced irrigation/pulsed lavage

A

non selective form of debridement

costly

painful

labor friendly compared to whirl pool

50
Q

enzymatic debridement

A

selective form of debridement

51
Q

enzymatic debridement is

A

slower than surgical/sharp

less traumatic for the wound and pt

52
Q

what does enzymatic use

A

topical enzymatic debriding agents to liquefy devitalized or necrotic tissue

53
Q

topical enzymatic debridement agents

A

heavy metals

silver dressings

collagenase santyl

(inactivates enzymatic properties)

54
Q

autolytic debridement

A

most selective form of debridement

55
Q

what does autolytic debridement use

A

moisture retentive dressings to the wound

body’s own macrophage, neutrophil and other phagocytic cells to digest necrotic tissue

56
Q

autolytic debridement is

A

relatively painless

57
Q

autolytic debridement requires

A

the least skill in performing

58
Q

autolytic debridement should not be used

A

on grossly infected wounds

59
Q

biosurgical debridement other names

A

maggot debridement therapy (MDT)

larval therapy

biodebridement or

biosurgery

60
Q

MDT uses

A

live maggots

“green bottle fly”

61
Q

MDT is a

A

selective form of debridement

62
Q

how is MDT a surgical form of debridement

A

clean wounds by dissolving dead and infected tissue

disinfect wounds by killing bacteria

promote growth of fibroblasts

Integumentary 1 - Midterm (23 decks)

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