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Practice topics Exam 3 > Wound Interventions: Debridement > Flashcards

Wound Interventions: Debridement Flashcards

1
Q

Principles

A 
Determine the cause
Minimize/correct issues that impair healing
Assess the wound
Bacterial load management
Moisture balance
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2
Q

Procedural interventions - the goal is to

A

create an environment for optimal wound healing
Less invasive is better
Always protect viable tissue as much as possible

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3
Q

Debridement - preparing the wound bed

A 
Rid of debris (including necrotic tissue)
Prevent/Dec risk of infection
Activate cellular process
Inc effectiveness of topical agents
Correct abnormal wound repair
Dec wound odor
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4
Q

Debridement risks

A

Can harm viable tissue

Can increase risk of infection

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5
Q

Pain

A

Consider the level of pain that is likely to occur with specific forms of debridement
Check pt pain schedule

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6
Q

Pain - What can you use

A

topical agent for analgesia during debridement

Most common is lidocaine-prilocaine cream (need to make sure pt is not allergic)

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7
Q

Types of debridement

A

Non selective

Selective

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8
Q

Types of debridement - Non selective

A

Removal of non specific areas of material

Includes mechanical, surgical, non enzymatic agents, or dressings

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9
Q

Types of debridement - selective

A

Removal of selected areas of wound matter

Enzymatic agents, sharp and autolytic

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10
Q

Red
Wound bed description
Goals

A

Wound bed = pale pink to beefy red, Granulation tissue

Goals = Protect the wound, maintain warm, moist environment

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11
Q

Yellow
Wound bed description
Goals

A

Wound bed = Moist, yellow slough, may be adherent

Goals = Debride, absorb drainage, protect peri wound area

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12
Q

Black
Wound bed description
Goals

A

Wound bed = thick, black eschar, adherent, indicates full thickness
Goal = debride

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13
Q

Debridement contraindications

A 
1 Granulation tissue
2 Viable tissue
3 Electrical burns
4 Deep tissue structures 
5 Arterial insufficiency
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14
Q

Debridement considerations

A

Efficiency - pt tolerance and their medical status
Cost
Skill of practitioner

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15
Q

Mechanical debridement - description

A

Non selective
Cleans wound effectively
Tends to damage the wound bed

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16
Q

Mechanical debridement - types

A

Whirlpool
Scrubbing (soft abrasion)
Wet to dry dressings
Forceful irrigation (pulsed lavage)

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17
Q

Mechanical debridement - Whirlpool: Indications

A

1 More than 50% necrotic or debris
2 Infected wounds (dec bacterial load)
3 Removal of topical agents

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18
Q

Mechanical debridement - Whirlpool: Indications - what is the caveat to using it with Infected wounds to dec bacterial load

A

If used with high forces/agitation of greater than 15 psi, it has been shown to drive bacteria deeper

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19
Q

Mechanical debridement - Whirlpool: Disadvantages

A

1 Tends to dry out the wound bed (but might moisten the wound margins or calluses)
2 Will damage granulation bed
3 Inc edema and tissue metabolic demand
4 Significant set up and time requried

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20
Q

Mechanical debridement - Scrubbing AKA soft abrasion - what is it

A

the use of a sponge, brush, or gauze along with fluid to remove debris
Often done in conjunction with whirlpools

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21
Q

Mechanical debridement - Scrubbing AKA soft abrasion - characteristics

A
  • Is a rapid form of mech debridement
  • Begin with center of wound and move outward
  • Will damage wound bed and wound margins
    (control of wound margin growth may be a goal though)
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22
Q

Mechanical debridement - Wet to dry dressings are what

A

Use of large weave gauze, wet with saline solution, apply to wound and allow it to dry before you remove it

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23
Q

Mechanical debridement - Wet to dry dressings: Indications

A

Wounds with more than 70% necrotic tissue
Stage 3 (maybe 4)
Insoluble debris present

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24
Q

Mechanical debridement - Wet to dry dressings: Contraindications

A 
Less than 70% necrotic (relative)
Shallow wounds
Wounds with exposed mm, bone, nn, tendon
Bleeding wounds
Infections
Pain
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25
Q

Mechanical debridement - Syringe and needle irrigation: What is it

A

Flushing debris
Dec bacterial load
35 mL syringe/ 12 or 19 gauge needle

26
Q

Mechanical debridement - Syringe and needle irrigation: What wounds is it used for

A

Clean, small wounds, with little amounts of loose debris

27
Q

Mechanical debridement - Pulsed Lavage is what

A

Wound irrigation under pressure

Includes concurrent suction which promotes neg pressure over the wound bed

28
Q

Mechanical debridement - Pulsed Lavage - negative pressure has been shown to

A

promote granulation

So wounds might heal faster with pulsed lavage

29
Q

Mechanical debridement - Pulsed Lavage - most common irrigant used

A

Saline solution

30
Q

Mechanical debridement - pulsed lavage - positives

A

Useful in wounds that require constant cleaning
Can be used with tunneling wounds
Quick, and less expensive than whirlpool

31
Q

Mechanical debridement - pulsed lavage - negatives

A 
May be messy
Expensive
Not appropriate for really large wounds
One time use of tubes and tips
Need to use caution when near vital anatomical structures
32
Q

Mechanical debridement - pulsed lavage - infection control principles

A 
Private area with walls and doors
Cover exposed surfaces and pt belongings
Cover other wounds, tubes, ports...
Mask for the patient 
No visitors during tx
Personal protective equipment
Disinfectant procedures for cleanup
33
Q

Surgical Debridement is performed by who

A

Physician

Viable tissue is often sacrificed

34
Q

Surgical debridement - contraindications

A

medically unstable (depends though on why they are unstable)

35
Q

Surgical debridement - Indications

A

more than 70% necrotic tissue
abnormal wound repair
need for rapid debridement

36
Q

Selective debridement includes

A

1 Sharp
2 Autolytic
3 Enzymatic

37
Q

Legal standards with sharp debridement

A

State practice acts - most are silent
Company and policy procedures
National standards of professional practice (APTA)

38
Q

APTA guidelines on sharp debridement

A

It is within scopr - however there might be some legal/community standard limitations
PTAs cannot perform it

39
Q

Selective sharp debridement is what

A

the removal of specific areas of devitalized tissue without prior tissue
preparation
It is often painful!

40
Q

Selective sharp debridement often occurs where

A

at the line of demarcation between the viable and non viable tissue

41
Q

Selective sharp debridement - what is used to remove tissue

A

Sharp instruments

Scalpel, scissors, forceps

42
Q

Selective sharp debridement - bleeding

A

SHOULD NOT OCCUR! but if it does, requires hemostatic controls

43
Q 
Necrotic tissue table - Slough
Nature: 
Adherent: 
Appearance:
Texture: 
Color:
A 
Nature: Moist
Adherent: Loose
Appearance: Stringy
Texture: Thick
Color: Yellow/Gray/Tan
44
Q 
Necrotic tissue table -  Eschar 
Nature: 
Adherent: 
Appearance:
Texture: 
Color:
A 
Nature: Desiccated fibrin
Adherent: tightly
Appearance: concave
Texture: smooth
Color: dark yellow/brown/black
45
Q 
Necrotic tissue table - scab 
Nature: 
Adherent: 
Appearance:
Texture: 
Color:
A 
Nature: dehydrated body fluid
Adherent: loosely
Appearance: convex
Texture: rough
Color: yellow/red/black
46
Q

Tissue differentiation table - Fat that is necrotic vs. Viable

A 
Necrotic = Dull, gray/brown to black 
Viable = Shiny, yellow
47
Q

Tissue differentiation table - Fascia that is necrotic vs. viable

A 
Necrotic = Dull, gray/brown to black
Viable = Glistening, white
48
Q

Tissue differentiation table - Muscle that is necrotic vs. viable

A 
Necrotic = dark red/brown to gray
Viable = dull red, possible contraction if pinched
49
Q

Tissue differentiation table - All tissue - necrotic vs. viable

A

Necrotic = insensate
Avascular (no bleeding)
Frequently foul odor
Viable = Vascular bleeding possible, little or no odor

50
Q

Contraindications for selective sharp debridement

A 
1 Bleeding disorders or abnormalities
2 Malignant wounds
3 Pyoderma gangrenosum 
4 Non infected heal ulcers covered with eschar
5 Dry gangrene
6 Undermining/tunneling 
7 Arterial insufficiency
51
Q

Termination of sharp debridement

A

1 Bleeding
2 Pain
3 Exposure of tendon, nn, or bone - NOTIFY PHYSICIAN

52
Q

Termination of sharp debridement - bleeding - what to do

A

Firm pressure for 10 minutes

If bleeding continues, contact the physician for rx for coagulating agents like silver nitrate

53
Q

Autolytic debridement is what

A

Use the normal cellular activity of the wound healing process
Requires proper choice in wound dressing
Tends to be less painful
Might take longer to heal, but could also be less expensive than other types

54
Q

Autolytic debridement is contraindicated in

A

infected wounds!

55
Q

Enzymatic debridement is what

A

Use of a topical agent to remove devitalized tissue (collagen/fibrin specific)

56
Q

Enzymatic debridement is contraindicated in who

A

Wounds that are infected

57
Q

Enzymatic debridement - do not use what types of dressings

A

Silver or zinc based dressings - secondary to decreased effectiveness

58
Q

What is important to remember with enzymatic debridement

A

Read product guidelines!

It is a drug - need physician orders!

59
Q

Enzymatic debridement - advantages

A

Generally comfortable for patient
Ease of use by pt and caregivers
Some of the agents promote granulation

60
Q

Enzymatic debridement - disadvantages

A

Expensive
Contraindicated in wounds with exposed structures
May cause irritation/inflammation of intact skin

Practice topics Exam 3 (9 decks)

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