Week 1 Debridement Part 1

Question 1

what are some reasons you would do debridement

Answer 1

• 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

Question 2

when might you debride

Answer 2

non-viable or eschar, callus, blister. Never granulation tissue or healthy viable tissue

Question 3

what are the goals of debridement

Answer 3

convert from chronic to acute 
reduce bateria 
improve environment for closure 
prep for grafting or surgical closure 
tissue protection or exam

Question 4

what must you consider when you are trying to think about whether you should debride or not

Answer 4

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

Question 5

what are contraindications for debridement

Answer 5

arterial compromise (hard, dry or stable eschar)
viable or granular tissue
electrical burns
deeper tissues

Question 6

is sharp fast or slow

Answer 6

fast

Question 7

is sharp aggressive? how so

Answer 7

yes, it takes a high skill level

Question 8

it is painful?

Answer 8

only if attached to viable tissue

Question 9

do you need a specific MD order for sharp

Answer 9

yes

Question 10

if sharp selective

Answer 10

yes, you use forceps, scissors, scalpel and curette

Question 11

forceps: dominant or non-dominant hand

Answer 11

non dominant

Question 12

scissors which hand

Answer 12

dominant

Question 13

what are common scalpels for debridement

Answer 13

10,11, 15

Question 14

what size and what hand for curettes

Answer 14

dominant hand and 3 and 7mm

Question 15

what is the indication to use sharp

Answer 15

presence of non-viable tissues or callus

Question 16

TF: we would use sharp if the amount of non-viable tissue renders other methods too slow

Answer 16

true, because of infection or risk of not taking care of it

Question 17

what method do we use on advancing cellulitis

Answer 17

sharp

Question 18

what are precautions to sharp

Answer 18

anticoagulants
pain
immunosuppression
unable to be still

Question 19

what are contraindications of sharp

Answer 19

PT comfort and skill 
cannot see or ID tissues 
not consistent with POC
ischemic ulcers (AI)
hyper-granulation, or live tissue 
pyoderma gangrenosum

Question 20

when do we stop debridement

Answer 20

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

Question 21

how do we control bleeding

Answer 21

elevate and put pressure on for 10 continuous minutes, and use silver nitrate (given by the doctor)

Question 22

TF: always cut in areas that pulsate

Answer 22

false, that is an artery

Question 23

what kind of pain control meds can we give for sharps

Answer 23

30 minutes before, topical, deep breathing, music, meditation and distraction

Question 24

when do we contact the MD

Answer 24

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.

Question 25

do you go parallel or perpendicular to the wound surface

Answer 25

parallel

Question 26

what do you lift necrotic tissue with

Answer 26

forceps

Question 27

TF: avoid sawing

Answer 27

true

Question 28

do we remove in thin or thick layers

Answer 28

thin

Question 29

what kinds of cuts do we make

Answer 29

small slices, we need to avoid sawing the tissue because we can hurt good tissue

Question 30

can we expect bleeding?

Answer 30

should be little to none, cause nonviable tissue should not bleed. the viable tissue it is attached to might

Question 31

what do we put the patient at risk for if we open a direct path into the vascular system

Answer 31

infection

Question 32

what can we warn patient about before using sharp

Answer 32

that it will get deeper and bigger when we are done (because we cut away tissue)

Question 33

when do we remove blisters

Answer 33

bigger than a nickel
likely to rupture or tear
worried about tissue injury
great place for bacterial growth

Question 34

how do we remove a blister

Answer 34

secure it with forceps, release the tension carefully, make a cut in the skin, blister line and clean out the residue