Risk Factors/Comorbidities for Chronic Wound Development

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

2. 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

3. 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!

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

5. 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. 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

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

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

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

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

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

13. 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

14. 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

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

16. Key Nursing Concepts - Prevention - Chronic disease management - Health promotion

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

18. Key Nursing 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

19. Websites for Further Information on Types of Wounds - Association for the Advancement of Wound Care www.aawc1.org - Canadian Association for Wound Care www.cawc.net - National Pressure Ulcer Advisory Panel www.npuap.org - World Union of Wound Healing Societies www.wuwhs.org - Wound Ostomy Continence Nurses Society www.wocn.org

20. www.WhyWoundCare.com