28
UNIT 4 Supporting Physiological Function
Knowledge Check 32-9 ■ Identify goals for wound care before applying a dressing to a wound. ■ What solutions are used to cleanse a wound? ■ How can you control the amount of force applied for wound irrigation? ■ Identify three nursing responsibilities when caring for a patient with a wound drain. Think Like a Nurse 32-5: Clinical Judgment in Action ■ Describe the percentage and type of tissue found in Mr. Harmon’s (Meet Your Patient) wounds. ■ What are the goals of treatment for each of Mr. Harmon’s wounds? Débriding a Wound Débridement is the removal of devitalized tis- sue or foreign material from a wound (Manna & Morrison, 2022). It also helps remove cells that are alive but not functioning (senescent) from the wound bed and edges. Removal of necrotic tissue, exudate, and Hatibie, M. J., Islam,A.A., Hatta, M., Moenadjat,Y., Susilo, R. H., & Rendy, L. (2019, March). Hyperbaric oxygen therapy for second-degree burn healing:An experimental study in rabbits. Advances in Skin & Wound Care, 32 (3), 1–4. https://10.1097/01. ASW.0000553110.78375.7b In laboratory rabbits with second-degree burns, those that received HBOT showed more active inflammatory cells for healing and greater epithelization for repair of injured tissue. Researchers found no improvement in blood supply to the burn injury using HBOT. Toward Evidence-Based Practice Hyperbaric OxygenTherapy Hyperbaric oxygen therapy (HBOT) may have beneficial effects on wound healing and recovery by alleviating hypoxia, meeting the high metabolic demand for oxygen, and providing the oxygen needed for almost all stages of wound healing.The following studies examined the effects of oxygen on various types of skin injuries. Huang, E., Heyboer, M., & Savaser, D. J. (2019, May 29). Hyperbaric oxygen therapy for the management of chronic wounds: Patient selection and perspectives. Chronic Wound Care Management and Research, 6, 27–37. https://doi. org/10.2147/CWCMR.S175721 Researchers investigated the impact of HBOT on other types of wounds besides diabetic foot ulcers.The findings indicate that HBOT could improve wound healing in all chronic wounds, although more rigorous studies are needed to evaluate the effectiveness of HBOT for chronic wounds that are not diabetic foot ulcers.
infective material helps stimulate wound healing and prepare the wound bed for advanced therapies or bio- logical agents. Key Point: Keep in mind that there are reasons not to débride a wound. It is critical not to remove eschar if the wound has poor circulation at the ulcer site. You would also not débride a stable heel eschar. Additionally, débridement would not benefit the patient who is critically unstable or those with a grave prognosis. There are five types of débridement: sharp (surgical), mechanical, enzymatic, autolytic, and biotherapy (maggot) therapy. Sharp Débridement This is the use of a sterile, sharp instrument, such as a scalpel or scissors, to remove devitalized tissue. This method provides an immediate improvement of the wound bed and preserves granula- tion tissue. ■ A physician, nurse, or physical therapist may perform this procedure at the bedside if they have received specialized training. ■ If a wound requires extensive débridement, it may be performed in the operating room. Chen, C.,Wu, R. Hsu, M., Hsieh, C., & Chou, M. (2017). Adjunctive hyperbaric oxygen therapy for healing of chronic diabetic foot ulcers. Journal of Wound, Ostomy and Continence Nursing, 44 (6), 536–545. https://doi.org/10.1097/WON. 0000000000000374 Chen and colleagues compared the results of the use of HBOT to standard wound care for patients with diabetic foot ulcers. In this study, HBOT significantly reduced the risk of amputation of the affected limb.The study also showed that at least 20 HBOT sessions are required to be effective. Lalieu, R. C., Brouwer, R. J., Ubbink, D.T., Hoencamp, R., Bol Raap, R., & van Hulst, R.A. (2019, October 31). Hyperbaric oxygen therapy for nonischemic diabetic ulcers:A systematic review. Wound Repair and Regeneration, 28 (2), 266–275. https:// doi.org/10.1111/wrr.12776 Based on current evidence, researchers were not able to demonstrate accelerated healing in patients with diabetic foot ulcers who received HBOT for wound care.The rate of amputations was not lower in those receiving HBOT.Therefore, Lalieu and colleagues could not recommend routine clinical use of this therapy for the treatment of diabetic foot ulcers. 1. How does HBOT improve wound healing? 2.What are some benefits of using HBOT on chronic wounds? 3.Why is HBOT not used often in wound care?
61
Powered by FlippingBook