Nurse Teaching on Local Factors Contributing to Delayed Wound Healing

Nurse educated the patient and caregiver upon local factors, inherent to the wound condition, contributing to delayed wound healing as follows:

1. Excessive edema involving the wound site: Healthy blood flow to the wound site is needed for quicker wound healing, as it brings in oxygen and nutrients to the healing wound tissue. Ample blood flow also brings in white blood cells into the wound tissue, which can help fight wound infection, if any, thus contributing to improved healing. Excessive edema with fluid accumulation involving the wound site can increase the local pressure at the wound site. This increased local pressure can disrupt the healthy blood flow to the wound site. Compromised blood flow to the wound site can result in reduced delivery of oxygen and nutrients to the healing wound tissue, contributing to increased cell death, development of necrotic tissue, which can lead to delayed wound healing. Compromised blood flow to the wound site can also lead to reduced flow of white blood cells into the wound site, which can increase the risk for infection in the wound site and contribute to delayed healing.
2. Wound contamination with excreta: Contamination of wounds, especially pressure ulcers on the hips in bedbound patients, with urine and stool can lead to recurrent infections and contribute to poor healing. Continuous exposure of skin to body excreta in bedbound & incontinent individuals can result in further maceration of skin surrounding the wound. This can result in enhanced compromise to the skin integrity, increase in the wound size, and poor healing.
3. Presence of necrotic tissue in the wound: Necrotic tissue in the wound can present itself as slough or eschar. Slough is the yellowish white moist tissue often found in the wound, adhered to the wound bed as a thin coating or in patchy distribution. Eschar is often black in color, dry in appearance and found adhered to the wound bed. Both slough and eschar are dead tissue cells and increasing deposition of dead tissue inside a healing wound can slow down the progress on healing front. Periodical debridement of the wound to remove the deposited necrotic tissue from the wound surface can help faster healing.
4. Increased pressure at the wound site: Healthy blood flow to the wound site is needed for quicker wound healing, as it brings in oxygen and nutrients to the healing wound tissue. Ample blood flow also brings in white blood cells into the wound tissue, which can help fight wound infection, if any, thus contributing to improved healing. Undue amount of pressure involving tissue at the wound site, such as, in individuals with foot ulcers wearing tight compression stockings, in individuals with torso wounds wearing tight corsets, and in bedbound individuals with pressure ulcers on dependent body parts can result in disrupted blood flow to the wound site. Disrupted blood flow to the wound site can result in reduced delivery of oxygen and nutrients to the healing wound tissue, contributing to increased cell death, development of necrotic tissue, which can lead to delayed wound healing. Compromised blood flow to the wound site can also lead to reduced flow of white blood cells into the wound site, which can increase the risk for infection in the wound site and contribute to delayed healing.
5. Infection in the wound site: Presence of infection in any wound site as evidenced by local elevation of temperature, unresolving erythema of the wound site, foul smelling drainage, undue swelling of the wound site can contribute to poor healing of the wound and result in further complications. Obtaining a culture of the wound site can help identify the infecting bacteria and start the patient on appropriate antibiotics that the bacteria are sensitive to. Timely diagnosis of the infection with appropriate management measures can promote healing of the wound.
6. Dry environment inside the wound: Excessive dry environment inside the wound can typically dehydrate the cells and result in increasing cell death, which can slow down healing. The dry environment also promotes formation of scab, which can further slowdown the wound healing. Maintaining the right amount of moisture inside the wound can promote comfort and pace up the wound healing. Choosing appropriate wound dressing materials that can retain a healthy moisture inside the wound proper can assist with healing. Encouraging the individual to keep up with the fluid intake recommendations can contribute to improved healing.