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Physical Agents > Wound Debridement Skills > Flashcards

Wound Debridement Skills Flashcards

1
Q

Wound healing depends on what 3 things

A
  • adequate vascularity
  • adequate nutrients
  • adequate oxygen (stimulates growth factors)
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2
Q

normal wound healing is inhibited by:

A
  • poor vascularity (PVD)
  • inadequate nutrients (poor protein consumption)
  • poor oxygenation (smoking, pulmonary conditions)
  • continued injury (pressure, etc)
  • medications (steroids)
  • devitalized tissues (infection)
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3
Q

4 characteristics of necrotic tissue

A
  • Increases the likelihood of infection
  • Inhibits white blood cell function
  • Encourages an anaerobic environment
  • Produces Necrotic Tissue Products (Toxins)
  • Inhibits the growth and granulation of tissue
    and epithelial growth
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4
Q

what is debridement?

A

One of the best methods for advancing the healing process in the wound with necrotic tissue

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5
Q

what does debridement do?

A
  • Remove tissue heavily contaminated by bacteria
  • Decrease the possibility of infection
  • Remove the source of toxins produced in the wound
  • Allow phagocytosis to remove remaining bacteria
  • Eliminate factors that prevent effective healing
  • Reduce wound odor
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6
Q

types of debridement

A
  • Autolysis
  • Enzymatic
  • Mechanical
  • Sharps
  • Surgical
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7
Q

what is autolysis used for?

A
  • Superficial to full thickness wounds with min/moderate exudate
  • Superficial eschar
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8
Q

advantages of autolysis

A
  • selective
  • safe
  • painless
  • effective
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9
Q

disadvantages of autolysis

A
  • slow process
  • potential for infection
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10
Q

enzymatic debridement

A
  • Partial and full thickness
    wounds
  • Penetrates eschar
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11
Q

advantages of enzymatic debridement

A
  • fast process
  • fairly selective
  • many products
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12
Q

disadvantages of enzymatic debridement

A
  • expensive
  • MD orders
  • possible adverse reaction
  • many products
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13
Q

mechanical debridement

A
  • superficial slough
  • small, visible foreign matter (dirt, gravel, etc)
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14
Q

advantages of mechanical debridement

A

easy
low cost

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15
Q

disadvantages of mechanical debridement

A
  • not everything is as superficial as it seems
  • sometimes painful
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16
Q

sharps debridement

A
  • Patrial and full thickness
    wounds with large
    amounts of necrotic
    tissue
  • Scoring of eschar
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17
Q

advantages of sharps debridement

A
  • very selective
  • fast
  • very effective
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18
Q

disadvantages of sharps debridement

A
  • MD orders
  • possible pain
  • possible bleeding
  • special training and equipment
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19
Q

surgical debridement

A

-Any extensive tissue removal
- Remove of necrosis around functional structures (tendons, nerves, etc.)

20
Q

advantages of surgical debridement

A
  • very selective
  • fast
  • very effective
21
Q

disadvantages of surgical debridement

A
  • $
  • decreased functional status
  • may not return to therapy immediately
22
Q

indications for debridement

A
  1. Soft/ hard necrotic tissue
  2. Loosely adherent necrotic tissue
  3. Stringy necrotic tissue
23
Q

debride as a means to:

A
  • Help topical agents work
  • Properly stage a wound
24
Q

patient contraindications to debridement

A
  • Bleeding disorder or on an anticoagulant therapy
  • Medical condition the precludes procedure (shock, ischemic extremity)
25
Q

wound contraindications to debridement

A
  • Densely adherent necrotic tissue
  • Dry gangrene
  • Visible vital structures
  • Questionable tissue
  • A wound with previous problems with debridement
26
Q

black color concept

A
  • Necrotic tissue
  • Black eschar
  • May have pus or fibrin associated
27
Q

black color concept therapy

A

Debridement
(mechanical, sharps,
surgical, chemical) to
remove necrotic tissue

28
Q

yellow wound

A
  • pus, debris, fibrin, yellow exudate
29
Q

therapy for yellow wound

A
  • cleansing
  • minor debridement
  • topical antimicrobial
30
Q

red wound

A
  • read and ready to heal
  • definite borders
  • granulation present
31
Q

therapy for red wound

A
  • keep wound moist and clean
32
Q

what should you debride?

A
  • Mostly stage partial and full thickness wounds
  • Yellow and black
  • Visible necrosis or slough (yellow clingy stuff)
33
Q

blunt tip scissors

A

avoids injury to deeper structures

34
Q

curved blade scissors

A

easy to change direction (get under necrosis)

35
Q

short handle scissors

A

easier to control

36
Q

serrated blade scissors

A

grips tissue well

37
Q

scalpel

A
  • # 15 blade (all purpose)
  • # 3 handle (fits hand well)
  • disposable handle - safety
38
Q

forceps

A
  • Fine toothed tips: Precise, secure tissue grip with minimal injury to tissue
  • light spring action: good control and minimizes user fatigue
39
Q

“Mosquito” Hemostat

A
  • Precise application
  • Holds well with minimal tissue injury
  • Good for bleeding control
40
Q

holding the scissors

A
  • 3 points of fixation
  • Thumb and ring finger through rings
  • Index finger guiding blade
  • Always visualize tips (usually point tip upward)
41
Q

holding the forceps

A
  • Use thumb and index
    finger
  • Rest back end on web
    space
  • Use minimal force
42
Q

holding the scalpel

A
  • Like you would hold a
    pencil
  • Three finger precision
    grip
43
Q

if tissue is dry and leathery, consider:

A
  • saline irrigation
  • covering with occlusive dressing for a day
  • scoring eschar
44
Q

preparation for sharps debridement

A

S elect patient and wound
H ave all equipment ready
A ssess tissue to be removed
R emove necrotic tissue
P ain/bleeding addressed

45
Q

address bleeding with

A
  • hemostat
  • silver nitrate
  • pressure

Physical Agents (11 decks)

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