Question

Norma James, a 65-year-old widow who lives alone, presents at the geriatric nursing clinic at the local senior center with a wound on her ankle about the size of a quarter. The wound is sore, with yellowish drainage. The skin around the wound is red and inflamed. Ms. James says that she has had the sore about 3 weeks and that she treated it with butter for a while but that that seemed to make it worse. Ms. James says that her foot hurts when she walks on it. The nurse at the clinic smells cigarette smoke on Mrs. James clothing. When asked, Ms. James reports that she smokes about a pack a day. In response to a question from the nurse, Ms. James says that she has diabetes and high blood pressure. Ms. James is not able to say what medicines she takes but estimates that she takes "about four different ones."

Question 1

What metabolic factors will increase the risk of delayed wound healing?

Question 2

What teaching can the nurse provide Ms. James to promote wound healing in relation to metabolic concerns?

Linking the exemplar of wound healing with the concept of perfusion:

Question 3

What factors related to perfusion will increase the risk of delayed wound healing for Ms. James?

Question 4

What teaching will you provide Ms. James to reduce these risks related to perfusion?

Answer 1

ANSWERS

Question 1

         Metabolic factors increase the risk of delayed wound healing

                        * Carbohydrates,fat and proteins are the main nutrients needed for meet the

                           energy requirement and body development so malnutrition delay the wound

                           healing process.

                        * Vitamins (A,B,C) and minerals (Zinc) are needed for proper wound healing.

Question 2

           Teaching to promote wound healing by avoiding risk related to metabolic factors

                        * Carbohydrates are the energy source of the body which meet the energy requirements

                           and tissue production during wound healing so including carbohydrate foods (grains,

                           starchy vegetables) in diet make progress in wound healing process.

                         * Proteins are the building blocks of the body and it helps to repair tissues and organs at

                           the time of injury through production of collagen and remodelling of wound so protein

                           containing foods (seafoods.eggs) should be used.

                      * Lipids are essential for tissue production and reducing inflammatory changes in the

                          wound fat containing foods (milk,nuts) is essential for wound healing.

                     *Vitamins and minerals act as supplements of nutrition and anti-inflammatory,antioxidant

                     properties of vitamins (Vitamin A,C,E,D) help to enhance wound healing and minerals

                   act as co factors in healing process so diet should meet the vitamin and mineral demand

                     of the body.

    Question 3

            *Ms.James smoking habit result in delaying of wound healing process.

          * Diabetic melitus result in narrowing of arteries and impairment in blood circulation delay

                the wound healing process.

              * High blood pressure damages blood vessels result in problems in wound healing process.

   Question 4

          * Teaching to reduce the risk related to perfusion

                                * Smoking result in vasoconstriction due to effect of nicotine in the smoke and

                                   decrease oxygen supply to tissues of the body so completely avoid use of

                                   cigarettes.

                                * Proper use of antidiabetic drugs and diet control needed for control diabetes

                               to improve wound healing.

                              * Antihypertensive therapy and low sodium diet needed to control blood pressure

                              which enhance the wound healing process.