As a nurse, you will see and care for a lot of different wounds on the job. Naturally, you will run into patients with certain lifestyles or medications among other things that affect their skin to heal properly. Here is a compiled handy list of common factors that affect the wound healing process.
Aging affects everything in the body, and yes, that includes the structure and function of the skin. Everything slows down during the aging process, including the phases of wound healing. Functional changes in the skin include thinning of the skin and a decreased inflammatory response. Thinning of the skin predisposes the elderly to injuries and fragility. There are a few physical findings in the elderly that affect their ability to heal normally within the layers of the skin:
- Decreased thickness in the epidermal layer that causes increased transparency and fragility
- A decrease in cell replacements means a delay in wound healing
- Reduced number of Langerhans cells
- Change in the shapes and sizes of the keratinocytes
- Dry skin brought on by a decrease in dermal blood flow
- Decreased dermal thickness, which causes a paper-thin, transparent appearance, increasing the risk of pressure ulcers
It is vital that the patient has proper nutrition to promote healing. The wound is unable to heal properly if the patient lacks the necessary nutrients to maintain adequate energy for collagen synthesis.
A patient who weighs 20 percent more than his or her ideal body weight has a higher risk of infection leading to an interruption of the healing process. Nurses can reduce the risk of complications by encouraging the patient to utilize a binder or splint over the incision during straining or coughing.
Presence of debris, necrotic tissue, and infection
Collagen lysis can occur when an infection is present. Tissue necrosis occurs from radiation treatments which may increase the risk of local or systemic ischemia.
The patient’s body’s defense mechanisms become limited due to overuse if the patient has multiple wounds or surgeries.
Skin and moisture
Skin must have an adequate amount of fluid to ensure proper functioning and viability of the tissue. The patient may experience drying and scaling of the skin if the moisture is altered in any format, thus predisposing the patient to further skin breakdown and infection. The formation of eschar commonly associated with pressure ulcers is brought on in severe cases when dehydration induced by the death of the underlying dermal structures occurs. Keep this in mind: if the skin is too wet the patient is at risk for developing maceration or infections and if the skin is too dry epithelialization will be delayed.
Common systemic disorders include diabetes mellitus, malnourishment, and immunodeficiency. Diabetes mellitus plays an enormous role in the healing process of wounds. It predisposes patients to wounds due to diminished sensation and poor arterial flow. It is vital to gain control of the blood glucose in the diabetic patient to promote wound healing. There are countless medications and other diseases that compromise the healing of wounds, and many of the medications such as prolonged steroid use leads to thinning skin.
The most common causes of tissue hypoxia are related to arterial occlusions or vasoconstrictors, hypotension, hypothermia and peripheral venous congestion. If there is a limited supply of oxygen to the wound, it prevents the production of collagen. When the patient lacks the proper amount of oxygen in the bloodstream, the patient will endure vasoconstriction. This may be the result of low blood volume, unrelieved pain or hypothermia. Any time a wound has excessive tension on the edges, it induces local tissue ischemia and necrosis of the area, delaying normal wound healing. Smoking also leads to tissue hypoxia.
Patients who are prone to dry skin, especially the elderly are at risk for skin lesions, excoriations, infection, and thickening due to scratching and rubbing the skin. This leads to difficulty for the skin to heal adequately.
Due to the injury process, all wounds are contaminated with bacteria. However, the patient’s immune competence and the size of the bacterial inoculum determine whether the wound will become infected. If the patient has normal host defenses, the wound will heal effectively. It’s essential that nurses recognize that due to the lack of inflammatory response that occurs in the elderly, they may not exhibit the typical signs and symptoms of infection such as fever, erythema, and swelling at the site. However, in the elderly, the patient may have increasing pain, fatigue, anorexia or changes in the mental status.
Figuring out why a patient isn’t healing can be frustrating at times. Skin is fragile, and every patient is different, but with these tips, you’ll be able to solve your patient’s inability to heal a wound correctly without a problem.
For a more in-depth overview of wound care, check out our continuing education course about it at www.nursing.elitecme.com. With over 70 courses you’re sure to find something of interest to you. As always, review the entire course for free. Pay after you pass.