Chapter 4: Wound Care
4.2 Wound Healing and Assessment
Critical Thinking Exercises: Questions, Answers, and Sources / References
Critical thinking questions are in bold type, and the answers are italicized. Additional resources or references are provided below.
- A patient is 75 years old, smokes cigarettes, has renal disease, and is overweight. What additional factors should you consider prior to assessing the patient’s wound? Provide your rationale.
- Type of wound: This helps the nurse to anticipate findings.
- Medications: Corticosteroids delay wound healing. Chemo = potential bone marrow suppression = ↓WBC = impaired immunity
- Other chronic disease: Diabetes is characterized by delayed wound healing due to circulatory changes associated with fat, and carbohydrate and protein metabolism. Anemia lowers oxygen availability to tissues. Impaired autoimmunie respnse = impaired healing
- Age: Associated with vascular changes = potential ↓ oxygen to the tissues = ↓ potential for healing
- Smoking: Results in vasoconstriction and arterial damage = potential ↓ oxygen to the tissues = ↓ potential for healing
- Obesity: Obese tissue is poorly vascularized = potential ↓ oxygen to the tissues = ↓ potential for healing
- Diet: does the patient have a well balance diet to provide the necessary fats, carbohydrates and protein needed for healing? What is the patient’s hydration status?
Source:
Potter, P., Perry, A., et al (2019). Canadian fundamentals of nursing (6th ed.). Elsevier; Mosby.
2. What indications might lead the nurse to suspect that a patient is malnourished and, therefore, at risk for delayed wound healing?
- Recent unexplained weight loss, lethargy, loose skin, low prealbumin / albumin, poor dietary (food & fluids) intake, poorly healing wounds
- Note: A diagnosis of malnutrition is based on a multitude of factors. Often through observations, the RN suspects malnutrition is present. The RN can implement dietary strategies / dietary consults as initial strategies to address this important health issue.
Source:
Potter, P., Perry, A., et al (2019). Canadian fundamentals of nursing (6th ed.). Elsevier; Mosby.
3. What phase of wound healing is indicated by the presence of epithelialization and wound contraction?
- Proliferation phase
4. Name three extrinsic factors that can contribute to the risk of pressure injury.
- Shear force: e.g., when being pulled up in the bed
- Friction: e.g., repetitive rubbing on the surface
- Immobility: If blood supply to areas of compression is diminished anoxia occurs, which can lead to tissue damage or death. This includes immobilization procedures such as restraints, or medication induced.
- Humidity: e.g., wet incontinence products
Source:
Magalhães, M., Gragnani, A., Veiga, D., Blanes, L., Galhardo, V., Kállas, H., Juliano, Y., Ferreira, J. (2007). Risk factors for pressure ulcers in hospitalized elderly without significant cognitive impairment. Wounds, 19(1), 20-24. https://www.woundsresearch.com/article/6708
Sa