When do you debride and when do you just leave a wound alone?

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    One question asked what I would do with a diabetic foot ulcer. I picked debride it 3 times a day. The answer was use sterile technique to change do the dressing change.

    The rationale for not debriding this wound is to allow for granulation to form. When would we have to debride a wound? And when do we allow it to granulate?

    Also wet to dry and wet to damp dressing serve the same purpose, to debride and prevent infection correct?

    Thank you again.
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  4. 1
    Quote from IcanHealYou
    One question asked what I would do with a diabetic foot ulcer. I picked debride it 3 times a day. The answer was use sterile technique to change do the dressing change.

    The rationale for not debriding this wound is to allow for granulation to form. When would we have to debride a wound? And when do we allow it to granulate?

    Also wet to dry and wet to damp dressing serve the same purpose, to debride and prevent infection correct?

    Thank you again.
    Wow.there's just so much wrong with this question that I don't know where to start. What kind of debriding are they talking about....

    Sharp Debride- doctors only.

    Wet to dry debriding...TOTALLY wrong and shouldn't be used ever.

    What does the wound bed look like? If there's fibrin, slough or eschar it needs to be sharp debrided or no granulation will occur. Debriding promotes granulation tissue, it's doesn't inhibit it.

    Sterile dressings for a chronic wound...nope, no sterile dressing required for a wound that isn't sterile, clean is just fine.

    Wet to dry will not prevent/stop infection. In fact it can create trauma in the wound bed, damaging granulation tissue making infection a greater possibility.

    You allow a wound to granulate if it's a clean wound bed. Keep it moist(not with saline) with a gel like Hydrogel, or Silvasorb gel(if you need the antibacterial properties of silver)
    KateRN1 likes this.
  5. 0
    Quote from lsyorke
    Wow.there's just so much wrong with this question that I don't know where to start. What kind of debriding are they talking about....

    Sharp Debride- doctors only.

    Wet to dry debriding...TOTALLY wrong and shouldn't be used ever.

    What does the wound bed look like? If there's fibrin, slough or eschar it needs to be sharp debrided or no granulation will occur. Debriding promotes granulation tissue, it's doesn't inhibit it.

    Sterile dressings for a chronic wound...nope, no sterile dressing required for a wound that isn't sterile, clean is just fine.

    Wet to dry will not prevent/stop infection. In fact it can create trauma in the wound bed, damaging granulation tissue making infection a greater possibility.

    You allow a wound to granulate if it's a clean wound bed. Keep it moist(not with saline) with a gel like Hydrogel, or Silvasorb gel(if you need the antibacterial properties of silver)

    Yea I'm most likely wrong about it preventing infection but I remember reading that somewhere.
    However Wet to dry dressing is used for debridement... according to www.woundcentral.com at least. I haven't looked in my book yet but I remember specifically from nursing school wet to dry is for debridement.

    Only recently did I start to see wet to damp dressing on NCLEX questions.

    So you're saying this question from NCLEX4000 is totally bogus yea?

    Which intervention is essential when performing dressing changes on a patient with a diabetic foot ulcer?
    1.Apply heating pad
    2. Debride the wound 3 times a day
    3.Using sterile technique during the dressing change
    4. Cleaning the wound with a povidine - iodine solution

    Here's the rationale:
    The nurse shoudl perform the dressing change using sterile technique to prevent infection. Applying heat should be avoided in a client with DM because of the risk of injury. Cleaning the woudn with povidine - iondine solution and debreding the wound with each dressing chagne prevents the development of granulation tissue, which is essential in the wound healing process.

    So either way someone is definitely wrong...
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    regardless of what the latest evidence states, i would use sterile technique w/dsg changes.
    would much rather err on the side of caution.

    besides, where did this say it was a chronic wound?

    leslie
  7. 0
    Quote from leslie :-D
    regardless of what the latest evidence states, i would use sterile technique w/dsg changes.
    would much rather err on the side of caution.

    besides, where did this say it was a chronic wound?

    leslie
    It didn't i think lsyorke was "reading into the question" lol
  8. 0
    Whoever is writing the questions isn't up on the latest wound care stuff. Isyorke? Yes, yorke is!
  9. 0
    "If the goal is to maintain a moist environment for a clean granulating wound, it is important to not let the saline-moistened gauze dressing dry and stick to the healing wound. This is in direct contrast to the dressing technique that you use if the goal is to mechanically debride the wound using a saline wet-to-dry dressing. When wounds require debriding, such as a necrotic wound, you use wet-to-dry dressing technique."

    Potter, P.A. & Perry, A. G. (2009). Fundamentals of nursing 7th Edition. St. Louis: Mosby Elsevier. , pg. 1312


    I also read somewhere online that now hospitals are using wet-to-damp dressings. This is why I was thrown off when I first saw wet-to-damp on the NCLEX questions.

    So what do you guys suggest I do for NCLEX?
  10. 0
    Quote from IcanHealYou
    "If the goal is to maintain a moist environment for a clean granulating wound, it is important to not let the saline-moistened gauze dressing dry and stick to the healing wound. This is in direct contrast to the dressing technique that you use if the goal is to mechanically debride the wound using a saline wet-to-dry dressing. When wounds require debriding, such as a necrotic wound, you use wet-to-dry dressing technique."


    Potter, P.A. & Perry, A. G. (2009). Fundamentals of nursing 7th Edition. St. Louis: Mosby Elsevier. , pg. 1312






    I also read somewhere online that now hospitals are using wet-to-damp dressings. This is why I was thrown off when I first saw wet-to-damp on the NCLEX questions.

    So what do you guys suggest I do for NCLEX?
    Our mantra when I was in school is there is a major difference between NCLEX world and real world. For your tests you go by the book - not common practice.
  11. 0
    So then my question still needs to be answered in NCLEX mode =/
  12. 1
    Frustrating, huh? I HATED that instructors/NCLEX would explain the rationales as if "This is clearly the *only* possible correct answer any *reasonable* person could ever consider" when there were many instances where the answer was flat out wrong or involved a number of assumptions that WEREN'T spelled out or when more than one answer COULD be correct depending on how you interpret the often vague questions...

    And I hated when instructors would then dismiss questions about the rationales by saying "if you use your critical thinking skills, it will make perfect sense!"

    And when we tried to ask about how we'd handle something in the real-world, the instructors would plead that we "didn't have time and had to move on".... Arghh!!!
    Tait likes this.


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