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Risk Factors/Comorbidities for Chronic Wound Development

Learn about the risk factors and comorbidities associated with chronic wounds, including patient factors and external influences. Discover how these factors relate to nursing concepts and clinical practice. Prevention and holistic assessment are key in promoting positive wound healing.

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Risk Factors/Comorbidities for Chronic Wound Development

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  1. Risk Factors/Comorbidities for Chronic Wound Development JaniceBeitz PhD, RN, CS, CNOR, CWOCN, CRNP, APNC, FAAN Module #2 Revised September 2018

  2. Disclaimer The Why Wound Care? education and recruitment campaign has been developed by our all-volunteer nursing and medical advisory boards. Website, logistics, marketing and exhibition support is provided by HMP with help from unrestricted educational grants from our corporate sponsors. A list of corporate sponsors can be found in the “About” tab. All educational materials were developed and are donated by our advisory board members. Neither HMP nor our corporate sponsors were involved in the selection, development, or content of these educational materials. Conflict of Interest: Dr. Janice Beitz declares that she has no potential conflict of interest related to the content of this presentation.

  3. Objectives Identify characteristics of chronic wounds Describe risk factors/co-morbidities for chronic wounds associated with patient status Explain risk factors/co-morbidities for chronic wounds related to external or environmental influences Correlate wound risk factors and patient co-morbidities with nursing concepts, diagnoses and clinical practice issues

  4. Risk Factors and Co-Morbidities Associated with Chronic Wounds Factors can be singular but are very often multifactorial. Prevention is key to promoting a positive balance!

  5. Chronic Wound Definition A wound that deviates from the expected sequence of repair in terms of time, appearance, and timelyresponse to appropriate therapy

  6. Chronic Wound Characteristics Have higher levels of proteolytic enzymes (e.g., matrix metalloproteases ‘MMPs’) Have lower levels of growth factors (e.g., PDGF) Fibroblasts fail to produce extracellular matrix proteins

  7. Pressure Ulcer/Injury Exemplar

  8. Risk Factors/Co-Morbidities for Chronic Wounds Categorized as intrinsic vs. extrinsic Intrinsic: Associated with patient factors Extrinsic: Associated with external or environmental influences Health care provider needs to assess all aspects

  9. Chronic Wound Risk Factors Malnutrition Blood flow (perfusion) problems Diabetes (especially poorly controlled) Kidney disease Weight (cachexia and obesity) Smoking

  10. Chronic Wound Risk Factors Age (both very young and very old) Swelling (edema) Infection Immunosuppression Severe stress Immobility Altered mentation

  11. Chronic Wound Risk Factors Medications - Steroids - Non-steroidal anti- inflammatory drugs (NSAIDs) - Cancer chemotherapy - MANY others!! Alcohol abuse Chronic mechanical stress (repetitive injury)

  12. Chronic Wound Risk Factors Chronic venous insufficiency Sickle cell disease Arthritis and connective tissue diseases Spinal cord damage/immobility

  13. Chronic Wound Risk Factors Vasculitic disorders - Polyarteritisnodosa - Thromboangiitisobliterans - Protein C / protein S deficiency

  14. Chronic Wound Risk Factors Iatrogenesis (caregiver generated) Device-related skin/tissue damage Unsafe/ineffective topical therapy (e.g., Betadine in wounds; saline wet to dry dressings) Dry gauze (instead of moist wound healing approaches) Failure to turn and reposition immobilized person

  15. Critical Questions for Consideration What risk factors and co-morbidities are modifiable? Smoking Diet Unhealthy lifestyle Stress Glucose levels in persons with Diabetes Nutritional state and diet

  16. Critical Questions for Consideration What risk factors and co-morbidities are not modifiable? Age Presence of concomitant disease(s) Use of necessary lifesaving medications

  17. Key Concepts - Prevention - Chronic disease management - Health promotion

  18. Key Diagnoses - Alteration in Skin Integrity - Impaired Skin Integrity - Impaired Comfort - Risk for ineffective peripheral tissue perfusion - Risk prone health behavior

  19. Key Practice Issues Assessment for chronic wounds’ risk factors and co-morbidities should occur early in care and be ongoing Risk factors and co-morbidities can change with patient status All disciplines should cooperate to assess patient holistically for potential and actual negative wound healing conditions

  20. Websites for Further Information on Types of Wounds - Association for the Advancement of Wound Care www.aawconline.net - National Pressure Ulcer Advisory Panel www.npuap.org - Wound Healing Society www.woundheal.org - Wound Ostomy Continence Nurses Society www.wocn.org - Wounds Canada www.woundscanada.ca

  21. www.WhyWoundCare.com

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