Pressure ulcer clean with ?

Appeared in: NORCET 1 - 2020

Explanation

Normal Saline is the standard of care for cleaning most wounds, including pressure ulcers.
It is an isotonic solution, which means it does not harm or dehydrate the healthy cells required for healing.
It effectively removes wound debris and bacteria through gentle irrigation without being cytotoxic (toxic to cells).
Using a non-damaging agent like normal saline supports the body's natural wound healing process.

Option A: Hydrogen peroxide (H2O2) is a cytotoxic agent. While it can kill bacteria, it also destroys healthy fibroblasts and new granulation tissue, which significantly impairs and delays wound healing.
Option B: Dettol (chloroxylenol) is a phenolic antiseptic designed for disinfecting surfaces and intact skin. It is a harsh chemical that is toxic to the delicate tissues within an open wound.
Option C: Glutaraldehyde is a high-level chemical sterilant used for medical equipment. It is extremely toxic and corrosive to human tissue and must never be used on a patient.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Wound care principles, specifically the selection of appropriate cleansing solutions for pressure ulcers as background academic context rather than a clinical decision trigger.
A core nursing responsibility in wound care is to 'first, do no harm.' This involves selecting cleansing agents that support, rather than hinder, the healing process.
Using cytotoxic solutions like H2O2 or Dettol on a pressure ulcer can worsen the wound, increase patient pain, and prolong recovery time, leading to a higher risk of infection and complications.
Patient safety is paramount. Incorrectly using a sterilant like glutaraldehyde on a patient would constitute a serious medical error with severe consequences.

How to Approach the Question

First, identify the core of the question, which is asking for the safest and most appropriate agent to clean a pressure ulcer.
Recall the fundamental principle of wound healing: to protect fragile new tissue (granulation tissue and epithelial cells).
Evaluate each option based on its properties and effect on living tissue.
Eliminate options that are known to be cytotoxic (cell-killing) or are intended for disinfecting inanimate objects. Hydrogen peroxide, Dettol, and Glutaraldehyde fall into this category.
Identify the option that is isotonic and non-damaging to tissue. Normal saline is the only choice that fits this description, making it the standard of care for wound cleansing.

Concept Tested & Keywords

Concept Tested: Wound care principles, specifically the selection of appropriate cleansing solutions for pressure ulcers.
Stem keywords: Pressure ulcer, clean
Lead-in keywords: with
Negative lead-in flag: false

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E6 Parks TextBook of Preventive & Social Medicine part 1 — Subpart A (pp 26-201 of 604) pp. 128-130, 127-129

E6 Pharmacology Katzung 16e p. 1398-1400

Practise the full NORCET 1 - 2020

Attempt every question from this paper in a timed mock, then review the full solution for each one.