Nurse Teaching on Systematic Factors Contributing to Delayed Wound Healing

Nurse educated the patient and caregiver upon overall systematic factors contributing to delayed wound healing as follows:

1. Poor nutritional status: Adequate nutrition intake, especially protein intake, is needed for timely wound healing. Protein is essential for development of granulation tissue, resulting in quickening of the healing process. Individuals with history of malnutrition can present with poor protein intake, which can compromise growth of granulation tissue, thus contributing to delayed wound healing.
2. Poor hydration status: Proper hydration status is very important to promote wound healing. Some individuals, especially senior citizens, could be poorly sensitive to thirst sensation and thereby, can be often noncompliant with daily fluid intake recommendations. Individuals with debilitating illnesses, such as, congestive heart failure or dialysis dependency, could be recommended limitation on daily fluid intake, and thus are limited on this front. So, all these individuals, irrespective to the reason for poor fluid intake, can present with compromised hydration status, resulting in delayed wound healing.
3. Chronic anemia: Red blood cells have iron containing pigment heme that binds to the oxygen, transports, and helps deliver oxygen to all the body tissues. Optimum functioning red blood cell count is needed for the required oxygen binding and transport to the body tissues. Oxygen and nutrients carried in the blood are highly essential elements for wound healing. Wound tissues always have an increased demand for these elements to help healing. Individuals with poorly treated or untreated chronic anemia have a low red blood cell count, which results in reduced oxygen supply to all the tissues. Compromised oxygen supply to wound tissues thus result in delayed wound healing.
4. Immunosuppression: Individuals with serious debilitating illnesses, such as, cancer or chronic kidney disease, can present with compromised immune status. Also, individuals with chronic inflammation of tissues could be prescribed high dose of steroids to control the inflammation and steroids carry the side-effect of compromising immunity. Individuals with compromised immune status inherently have reduced ability to fight against infections and thus are more prone for the same. Thus, wounds in immunocompromised individuals can have a hard time healing and get delayed on the healing front. Co-existing factors, such as, smoking and diabetes in these individuals can contribute to furthering the delay.
5. Chronic smoking history: Individuals with chronic smoking history can be at increased risk for disrupted peripheral circulation and thereby develop peripheral artery disease in the extremities. 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. Compromised blood flow in the extremities of individuals with PAD 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.
6. Poorly managed cardiac conditions: Poorly managed cardiac conditions, such as, coronary artery disease (CAD) and congestive heart failure (CHF) contribute significantly to poor wound healing. Individuals with poorly controlled coronary artery disease and heart failure can present with progressively reduced heart function and consequently, result in reduced volume of blood pumped out of the heart into the circulation. 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. Compromised blood flow in the extremities of individuals with poorly managed chronic health conditions, such as, CHF & CAD 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.
7. Poorly managed diabetes: Individuals with poorly controlled diabetes mellitus can present with high blood sugar numbers, which can result in inflammation of smaller blood vessels, especially in the distal extremities. Progressive unresolved inflammation of the smaller blood vessels leads to them becoming swollen and thick, which reduces the caliber or lumen of blood vessels. This results in reduced capacity to accommodate blood flow, thus contributing to reduced blood flow. 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. Compromised blood flow in the extremities of individuals with poorly managed diabetes 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.