BALNEOTHERAPY AND DEBRIDEMENT - Indications and Nursing Care Considerations
BALNEOTHERAPY AND DEBRIDEMENT
BALNEOTHERAPY – Indications and Nursing Care Considerations
BALNEOTHERAPY (therapeutic bath) is useful in applying medications to large areas of the skin, as well as for debridement, or removing old crusts; for removing old medication; and to relieve itching and inflammation. The temperature of the water should be kept at a comfortable level, avoiding hot baths.
Water and saline are utilized for weeping, oozing and erythematous lesions. Colloidal bath (such as oatmeal or aveeno) are utilized for widely distributed skin lesions, for drying, and for relief of itching. Medicated tar baths, such as Almar-Tar or Baineter are used for chronic eczema problems and psoriasis. Any loose skin crusts can be removed after the bath. The room should be well ventilated because tars are volatile.
To increase hydration after the bath, a lubricating agent is applied to damp skin if emollient action is prescribed. Bath oils, such as Alpha-Keri, Avenol, and Lubath, are used for lubrication and to relieve itching.
- Vesicular disorders, eczema, atopic dermatitis
- Acute inflammatory conditions
- Erosions and exudative, crusted surfaces
NURSING CARE CONSIDERATIONS
- Prepare the bath or teach the patient to prepare a lukewarm bath at 90 to 100 degree Fahrenheit; with the tub half full, add the prescribed quantity of medication, and mix thoroughly to prevent sensitivity reaction
- Do not rub the skin. Soaking for at least 5 to 10 minutes will promote removal of loosened scales
- Fill the tub half full. Keep the room and water at comfortable temperatures and limit bathing to 20 to 30 minutes; the bath area should be well ventilated if tars are used because they are volatile.
- Tell the patient to use a bath mat inside the tub and to use a rug outside the tub when bathing at home because medication may make the tub and wet surfaces slippery.
- Blot skin dry with a towel and apply emollient or topical medication to moist skin, if prescribed. While skin is wet, apply steroid to inflamed areas if prescribed
- Advise the patient to wear loose clothing after the bath
Debridement is the removal of dead or nonviable tissue from a wound to help clean up the wound and facilitate formation of granulation tissue. It may be done surgically or non surgically. Non surgical debridement includes mechanical, enzymatic and autolytic methods. Surgical debridement is used only if the patient has sepsis or cellulitis, or to remove extensive eschar. Eschar is a black or brown hard scab or dry crust that forms from necrotic tissue. It may hide the true depth of the wound and must be removed for the wound to heal
- Mechanical Debridement: Scissors and forceps can be used for mechanical debridement to selectively debride non viable tissue. Whirlpool baths and wet-to-dry saline gauze dressings may also be sued for mechanical debridement. For wet-to-dry dressings, the wet gauze is placed directly on the wound (avoiding, surrounding healthy tissue) and allowed to dry completely. The drying process causes the gauze to adhere to the wound; when it is pulled off, tissue is pulled off with it. This results in nonselective debridement because viable tissue may also be removed in this process. These methods are painful, so the patient should be premedicated for pain and assessed frequently.
- Enzymatic Debridement: enzymatic debridement involves the application of a topical debriding agent. These agents vary as to application methods, so careful reading of instructions is necessary. Most of these debriding agents are proteolytic enzymes that selectively digest necrotic tissue. Be careful to keep them off of healthy tissue.
- Autolytic Debridement: it is the use of a synthetic dressing or moisture-retentive dressing over the ulcer. The eschar is then self-digested via the action of the enzymes that are present in the fluid environment of the wound. This method is not used for infected wounds.
- Surgical Debridement: it is the removal of devitalized tissue, slough, or thick, adherent eschar, utilizing a scalpel, scissors, or others sharp instrument. Slough is a loose yellow to tan stringy necrotic tissue. Slough, like eschar, can be tightly adhered to the wound bed.
Depending on the amount of debridement to be done, this may be performed in the operating room, a treatment room, or the patient’s room. Following surgical debridement, grafting may be required to close the wound. This becomes necessary if it is a full-thickness ulcer, if there is loss of joint function, or for cosmetic purposes. For procedures performed without anesthesia, be sure to premedicate the patient. Continually monitor for pain during the procedure, especially if there is a donor site for grafting.