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.
which intervention is essentialwhen 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...
so then my question still needs to be answered in nclex mode =/
in nclex mode the question didn’t ask “what” you would do with a diabetic foot ulcer. the question asked what “intervention is essential?”
answering this question in nclex mode can be done using test taking strategies from saunder’s nclex review book 3rd ed. pg. 28.
look for key words that indicate the need to prioritize?
questions that require prioritizing
common key words that indicate the need to prioritize
--best --highest priority --most important --vital
--essential --immediate --next
--first --initial --primary
a key word in the question is “essential”.
[color=#333333]definition of “essential” is --a basic, indispensable, or necessary element.
looking at all the answer choices the only choice that is “indispensable” or a “necessary element” is answer choice 3. using sterile technique during dressing change. the nurse may or may not need to debride a wound although debriding would not be necessary for every wound it all depends on the condition of the wound. again povidone-iodine may or may not be needed for a wound. as diabetics (due to increased sugar in the blood and the pathophys of diabetic ulcers) have an increased risk for infection; then taking measures to prevent infection would be “essential.”
another of saunders test taking strategies would help here as well.
how to avoid reading into the question
1. read every word in the question and “specifically” determine what the question is asking
2. focus only on the information in the question.
(i notice you do the same thing i often do, which is, reading the question and then the answer choices and then end up focusing more on the answer choices than we need to) the reason i say this is; many of the questions you asked are in reference to the answer choices not in reference to the actual question. obviously we can fill in the gaps of our knowledge by researching for a better understanding of any answer choices that we have less knowledge of, however this is not needed to answer the question.
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?
[color=#003663]according to the following articles wounds would be treated differently according to their type (chronic vs acute), and (healable, maintenance, or non-healable) and their cause and any underlying disease processes.
(note: these articles are not 2009, there may be more current info available but these are excellent articles and i did not readily find any articles more current)
[color=#231f20]this document is a collaborative effort of the association for professionals in infection control and [color=#231f20]epidemiology, inc. (apic) and the wound, ostomy continence nurses society (wocn). its purpose is to review the evidence on which chronic wound care practice is based and to present approaches for chronic wound care management.
[color=#003663]one of the most controversial issues in wound management is whether all wounds should be debrided-especially the use of active surgical debridement of necrotic heel ulcers. some clinicians advocate not debriding a heel ulcer if it has stable adherent eschar with no exudate or signs of infection (tenderness, slough around the edges, or febrile response without another identifiable cause). the theory is that the eschar acts as a protective barrier for the wound.[color=#003663]26
[color=#003663] other clinicians, including brem et al,[color=#003663]25
[color=#003663] believe that although caution is indicated, these necrotic heel ulcers should be debrided.
[color=#003663]black eschar develops on ischemic toes when blood flow to the extremity is decreased and oxygen deficiency produces necrosis and cell death. ischemic toes are nonviable and have no supporting blood supply, so they should not be debrided. if the underlying vascular insufficiency is not resolved, debridement may cause a dry inert gangrenous toe to convert into moist active gangrene with local bacterial invasion and limb-threatening proximal cellulitis.[color=#003663]27
[color=#003663] patients with septicemia, in the absence of systemic antibacterial coverage, as well as medically unfit patients, should not have their wounds debrided.[color=#003663]3
diabetes, nutrition and wound healing
also wet to dry and wet to damp dressing serve the same purpose, to debride and prevent infection correct?
yea i'm most likely wrong about it preventing infection but i remember reading that somewhere.
i have read differing expert opinions on this. some experts say that debriding prevents infection by removing bad tissue that would otherwise be a breeding ground for bacteria. others say that debriding also disturbs and removes good granulating tissue needed for wound healing. i have also read expert opinions that keeping a diabetic wound wet or damp can lead to gangrene which can then lead to sepsis, sepsis can lead to death.
hope this helps.
and thanks for asking such good questions. i learn a lot by answering questions too.