Wound assessment – where do you start?
When assessing a new client with a wound, it is important to obtain a comprehensive medical history, including a wound history. Gathering this information will assist the clinician in preparing a plan of care tailored to the patient and taking into account any medical issues that may affect wound healing.
Obtaining a Past and Current Medical History
Obtaining a medical history is imperative to proper wound assessment. It is important to ask the patient about any past or current medical issues which may have an impact on wound healing. Examples of conditions that might affect wound healing include:
- Hypertension– high blood pressure that is undiagnosed or ineffectively managed can lead to damage to the heart and blood vessels, which can impact blood flow. This may translate to decreased nutrients and oxygen being delivered at the cellular level, which may impede wound healing.
- Coronary artery disease (CAD) – hypertension and coronary artery disease often go hand in hand and can exacerbate each other. Coronary artery disease can also affect blood flow to the tissue and cells.
- Peripheral vascular disease (PVD) – diabetics are particularly prone to peripheral vascular disease, often resulting in wounds that are difficult to heal: “Peripheral vascular disease (PVD) deprives the extremities of vital nutrients, oxygen, and even antibiotics, making infection in these extremities difficult to eradicate” (Fife, 1999).
- Congestive heart failure (CHF) – in CHF, the heart gradually loses its ability to pump effectively. Excess fluid collects in the lungs, affecting oxygenation, and also in the legs and feet, causing peripheral edema which can impede wound healing.
- Chronic obstructive pulmonary disease (COPD) – COPD results from damage to the lungs and is most often associated with smoking. COPD, like CHF and CAD, leads to reduced blood flow and oxygen to the tissues.
- Diabetes– diabetes has a huge impact on wound healing. When blood glucose levels are not tightly controlled, the wound may become infected; in addition, diabetes damages blood vessels at the microvascular level, which results in less oxygen and nutrients being delivered to where they are most needed.
- Cancer– cancer patients who develop wounds may experience delayed wound healing and infection due to immunosuppression following treatment for cancer. Wounds in cancer patients can be dangerous to the patient if they become infected and can lead to serious complications, including sepsis. Patients undergoing radiation may have radiation burns requiring treatment. They may also have surgical wounds from biopsies, exploratory, staging and/or debulking surgeries.
- HIV/AIDS- patients with HIV/AIDS have a decreased ability to fight off infection; as well, malnutrition may be an issue due to GI tract infections which are common in these patients and which can delay wound healing. Because of their altered immune function, these patients may become infected with unusual or resistant microorganisms.
- Anemia- patients who are anemic may lack red blood cells and hemoglobin, which is necessary for the transport of oxygen in the blood. This can result in poor oxygenation, particularly to the peripheral extremities.
Of course, these are just a few of the common conditions that can have a major impact on wound healing. The above conditions serve to illustrate how seemingly unrelated conditions can influence the progression of wound healing and why it is so important to obtain a thorough past and present health history. Oftentimes, the patient will not connect past conditions with their current wound- it is up to the clinician to make these connections.
In Part 3 of this series, we’ll look at medications and how they can affect wound healing. Obtaining a list of patient medications and allergies is an important part of wound assessment.(read Part 1 of this series)
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Meyers, B. (2008). Wound Management: Principles and Practice. 2nd edition. Pearson Prentice Hall. Upper Saddle River, New Jersey. pg. 41-44.
Fife, C. (1999). PVD: A practical approach to promoting healing. http://www.thedoctorwillseeyounow.com/content/diabetes/art2126.html
Sussman, C. (2014). Wound care: Assessment of the patient. https://www.atrainceu.com/course-module/1473398-57_assessment-of-wounds-module-02