Please enable JavaScript.

Coggle requires JavaScript to display documents.

Ch 5 Debridement (Role of debridement (Contraindications (surgical…

- - - - yellow
        
        moist, yellow slough
        
        treatment goal
        
        absorb drainage
        
        debride necrotic
        
        protect periwound
      - black
        
        eschar
        
        full thickness
        
        moist
        
        dries to leathery
        
        treatment goal
        
        debride dead tissue
      - red
        
        pale pink-red, beefy granulation
        
        treatment goals
        
        protect periwound
        
        protect wound
        
        warm, moist
  - - - muscle,bone,nerve, etc
        
        OUT OF OUR SCOPE
      - limb removal may be better
      - gangrenous tissue
    - - DO NOT DEBRIDE
    - - hard to see the full extent
    - - ischemia, pressure ulcers
  - - - breeds bacteria
        
        decrease bacteria
        
        decrease infection risk
    - - topical antimicrobials
    - - bactericidal activity of leukocytes
    - - inflammation time
      - energy req. by body for healing
      - wound odor
  - - - etiology
      - wound size
      - amt of necrosis
      - infection
      - tunneling? other tissue(muscle?)
    - - laws, w/ in scope of practice?
      - knowledge and skill
        
        YOU CAN REFER IF YOU DONT KNOW HOW
    - - free of x(ie nec. tissue) w/ in x time
      - reduce in size w/ in x time
        
        wound size is NOT a tell all of healing
  - - - re-glove bt all wound interaction
    - - explain procedure to pt.
        
        calm , rational instructions to reduce anxiety
- - - - collagenase only FDA approved
        
        chemical
        
        only digests Type 1 / denatured collagen
        
        promote cell migrations
        
        20% more effective than autolytic
        
        req. DR. RX
      - indications
        
        Contraindications
        
        when sharp or surgical is better
        
        exposed deep tissue
        
        calluses
        
        burns
        
        non necrotic tissue
        
        autolytic
        debridement
        
        promotes bacterial proliferation.
        
        inactivated by heavy metals
        
        ie dressings w. silver , iodine, acetic acid, hydrogen peroxide
        
        both un/infected w/ necrotic tissue
        
        pt who can't do sharp/mechanical
        
        no response to autolytic (acts like a booster)
        
        chronic wounds w/ serial deb.
      - procedure
        
        Termination
        
        necrotic tissue is gone
        
        crosshatch eschar
        
        apply agent and cover with appropriate dressing
    - - uses
        
        scissor
        
        scalpel
        
        forceps
      - fast and most aggressive aside from surgery
        
        physicians & podietrists
        
        other personnel where allowed by law
      - indications
        
        contraindications
        
        procedure
        
        termination
        
        clinician fatigue
        
        uncontrolled pt pain
        
        extensive bleeding
        
        nothing left to debride
        
        2 types
        
        serial instrumental
        
        forceps and scissors
        
        3 more items...
        
        selective sharp
        
        scissors/ scalpel
        
        2 more items...
        
        wound extent not visible ie tunneling/undermining
        
        uninfected ischemic ulcers w/ low ankle brachial index
        
        caution:
        
        thrombocytopenia
        
        anticoagulants
        
        immunosuppressed
        
        hyper granular tissue
        
        lots of necrotic tissue
        
        advancing cellulitis
        
        chronic
        wounds
        
        bc bioburden reaccumulates
      - all clinicians must pass sharps competency
    - - body's endogenous enzymes: collagenase to digest necrotic tissue
        
        apply
        
        sheet hydrogel, hydrocolloid, semipermeable foam
        
        leave for several days
        
        moisture retentive better in auto than gauze
        
        moist wound healing
        
        least
        
        invasive
        
        painful
        
        no intro to cytotoxins
        
        procedure
        
        only uninfected and necrotic
        
        moisture retentive dressing
        
        72-96 hours
        
        skin sealant
        
        sharp debridement during dressing change
        
        crosshatch eschar
        
        termination
        
        may continue w/ moisture retentive dressings
        
        discontinue
        
        better option
        
        necrotic tissue doesn't decrease
      - indications
        
        all wounds! best in:
        
        homecare
        
        longterm
        
        contraindications
        
        infection/
        
        deep cavity
        
        surgery is better
        
        gangrenous/ necrotic tendon
  - - - scalpel, scissors,lasers
        
        procedure
        
        may do incision and drainage
        
        contraindications
        
        too much stress on pt.
        
        could kill them
        
        if another form of debridement is available.
        
        Indications
        
        fast and aggressive
        
        ascending cellulitis, extensive necrosis, extensive tunneling/undermining, osteomyelitis
        
        pt septic
    - - wet to dry
        
        saline moistened gauze in necrotic wound
        
        dry 8-24 hours
        
        rip out
        
        contraindicated granular wound beds
        
        indicated: dead tissues only
        
        not a well liked procedure
      - scrubbing
        
        scrub out dead
        
        damages easily
        
        recommended high pore sponge
        
        minimize damage
        
        useful w/ high bacteria
        
        road rash
      - wound cleansing
        
        cytotoxic
        
        delays healing
        
        inappropriate for chronic
        
        good for cleaning intact skin
  - - - 10 larva per cm
      - eat necrotic
      - release enzymes liquefy
      - good for ulcers and trauma
- - - - remove devitalized tissue
      - sharp, autolytic, enzymatic
    - - remove nonspecific tissue
      - surgical, mechanical
- - - - measurable, objective, time-dependant
        
        in 1 week wound will be free of yellow slough.
    - - refer! no enzymes on a tendon!
      - no more infection? no more antimicrobials/biotics
    - - sharp will hasten infection healing
      - possibly mechanical to rid necrotic, but not required!
    - - only sharp. autolytic may encourage reinfection. wet to dry is no no bc exposed tendon,
    - - Yes. wound didn't close on its own
      - yes enzyme, it's infected
      - antimicrobial and antibiotic is cool too