Wound Debridement's - Class 3

Question 1

clinical decision making

Answer 1

know the pts history

what are the goals of care

what is the clinical presentation of the wound?

Question 2

goals of care

Answer 2

to achieve full closure

to prepare for surgical closure

to manage wound deterioration

to maintain a stable non healing ulcer

Question 3

clinical presentation of the wound

Answer 3

helps identify treatment objects

Question 4

granulating/epithelializing

Answer 4

protect and keep moist

Question 5

necrotic

Answer 5

debride it

Question 6

infected

Answer 6

antiseptic/antibiotics/debride

Question 7

heavily draining

Answer 7

absorb it

Question 8

desiccated

Answer 8

moisten it

Question 9

odorous

Answer 9

charcoal based

antiseptics

Question 10

undermined/tunneled

Answer 10

lightly pack wound

Question 11

bone/tendon exposure

Answer 11

protect and keep moist

xeroform

Question 12

flap/graft exposure

Answer 12

protect and keep moist

xeroform

Question 13

organ/mesh exposure

Answer 13

protect and keep moist (xeroform)

Question 14

wound bed preparation

Answer 14

debridement

dressing selection

Question 15

types of wound debridement

Answer 15

surgical

sharp

mechanical

enzymatic

autolytic

biosurgical

Question 16

surgical debridement is only performed by

Answer 16

physicians

podiatrists

certified PAs

Question 17

surgical debridement includes

Answer 17

removal of both viable and nonviable tissue

w/ sterile, sharp instruments

Question 18

surgical debridement is

Answer 18

quick

but non-selective form of debridement

Question 18

when is surgical debridement done

Answer 18

when wide excision into viable tissue is required

when removal of necrotic or infected bone is necessary

Question 18

where is surgical debridement done

Answer 18

bedside or OR

Question 18

surgical debridement is likely to be

Answer 18

very painful

so premedication is required

Question 19

sharp debridement can be performed by

Answer 19

PTs, PAs, some nurses

Question 20

who is not allowed to do sharps debridement

Answer 20

PTAs

Question 21

sharp debridement is

Answer 21

removal of non viable tissue

only w/ sterile instruments

Question 22

sharp debridement is a ____ form of debridement

Answer 22

quick and selective form

Question 23

sharp debridement can be

Answer 23

very painful

Question 24

sharp debridement has an

Answer 24

increased risk for infection

Question 25

sharp debridement requires

Answer 25

skill comfort form clinician

Question 26

indications for sharps debridement

Answer 26

extensive necrotic tissue advancing cellulitis or sepsis thick adherent eschar as adjunct to other therapies callous formation

Question 27

contraindications for sharp debridement

Answer 27

arterial insufficiency (ABI < 0.5) gangrene stable heel ulcers unidentifiable structures terminally ill

Question 28

key to comfort in debridement

Answer 28

knowing your anatomy recognizing what is normal

Question 29

viable fat is

Answer 29

shiny and yellow

Question 30

nonviable fat is

Answer 30

dull gray/brown to black

Question 31

viable fascia is

Answer 31

glistening white

Question 32

nonviable fascia

Answer 32

dull gray/brown to black

Question 33

muscle viable

Answer 33

dull red contractile if pinched

Question 34

nonviable muscle

Answer 34

dark red/brown --> gray

Question 35

viable bone

Answer 35

shiny and white periosteum intact

Question 36

nonviable bone

Answer 36

dull and yellow --> brown/black

Question 37

vessels viable

Answer 37

shiny white and pulsatile

Question 38

reasons to stop sharps debridement

Answer 38

clinician/pt fatigue bleeding pain to viable tissue location of fascial plane location of named structure high anxiety level achieved set limit time

Question 39

how to stop bleeding

Answer 39

pressure x 10 min elevation calcium alginate xylocaine jelly-vasoconstrictor nitrate sticks-cauterizes tissue

Question 40

bleeding to fear

Answer 40

those that you can hear those that you can't see

Question 41

mechanical debridement

Answer 41

scrubbing wet to dry dressing hydrotherapy/whirlpool forced irrigations/pulsed lavage

Question 42

scrubbing

Answer 42

non selective form of debridement use gauze

Question 43

wet to dry dressing

Answer 43

non selective form of debridement dessicates wound bed

Question 44

what can wet to dry dressings be used on

Answer 44

necrotic wounds (<30% granulation tissue) infected wounds

Question 45

hydrotherapy/whirlpool

Answer 45

non selective form of debridement softens adherent necrotic eschar and slough for easier sharp debridement

Question 46

to clean dirt --> hydrotherapy

Answer 46

foreign materials or residues from topical agents in the wound

Question 47

what does hydrotherapy aid with

Answer 47

removal of dressing with burn wounds

Question 48

systemic effects of hydrotherapy

Answer 48

increased HR and RR sedation, analgesia, muscle relaxation changes in thermoregulatory system

Question 49

forced irrigation/pulsed lavage

Answer 49

non selective form of debridement costly painful labor friendly compared to whirl pool

Question 50

enzymatic debridement

Answer 50

selective form of debridement

Question 51

enzymatic debridement is

Answer 51

slower than surgical/sharp less traumatic for the wound and pt

Question 52

what does enzymatic use

Answer 52

topical enzymatic debriding agents to liquefy devitalized or necrotic tissue

Question 53

topical enzymatic debridement agents

Answer 53

heavy metals silver dressings collagenase santyl (inactivates enzymatic properties)

Question 54

autolytic debridement

Answer 54

most selective form of debridement

Question 55

what does autolytic debridement use

Answer 55

moisture retentive dressings to the wound body's own macrophage, neutrophil and other phagocytic cells to digest necrotic tissue

Question 56

autolytic debridement is

Answer 56

relatively painless

Question 57

autolytic debridement requires

Answer 57

the least skill in performing

Question 58

autolytic debridement should not be used

Answer 58

on grossly infected wounds

Question 59

biosurgical debridement other names

Answer 59

maggot debridement therapy (MDT) larval therapy biodebridement or biosurgery

Question 60

MDT uses

Answer 60

live maggots "green bottle fly"

Question 61

MDT is a

Answer 61

selective form of debridement

Question 62

how is MDT a surgical form of debridement

Answer 62

clean wounds by dissolving dead and infected tissue disinfect wounds by killing bacteria promote growth of fibroblasts