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Risk Factors/Comorbidities for
Chronic Wound Development
Janice Beitz
PhD, RN, CS, CNOR, CWOCN, CRNP, APNC, FAAN
Module #2
Objectives
1. Identify characteristics of chronic wounds
2. Describe risk factors/co-morbidities for chronic
wounds associated with patient status
3. Explain risk factors/co-morbidities for chronic
wounds related to external or environmental
influences
4. Correlate wound risk factors and patient comorbidities with nursing concepts, diagnoses and
clinical practice issues
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!
Chronic Wound Definition
A wound that deviates
from the expected
sequence of repair in
terms of time,
appearance, and
timely response to
appropriate therapy
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
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
Chronic Wound Risk Factors
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Malnutrition
Blood flow (perfusion) problems
Diabetes (especially poorly controlled)
Kidney disease
Weight (cachexia and obesity)
Smoking
Chronic Wound Risk Factors
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•
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Age (both very young and
very old)
Swelling (edema)
Infection
Immunosuppression
Severe stress
Immobility
Altered mentation
Chronic Wound Risk Factors
• Medications
- Steroids
- Non-steroidal antiinflammatory drugs
(NSAIDs)
- Cancer chemotherapy
- MANY others!!
• Alcohol abuse
• Chronic mechanical stress
(repetitive injury)
Chronic Wound Risk Factors
• Chronic venous
insufficiency
• Sickle cell disease
• Arthritis and
connective tissue
diseases
• Spinal cord
damage/immobility
Chronic Wound Risk Factors
• Vasculitic disorders
- Polyarteritis nodosa
- Thromboangiitis obliterans
- Protein C / protein S deficiency
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
Critical Questions for Consideration
What risk factors and co-morbidities are
modifiable?
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Smoking
Diet
Unhealthy lifestyle
Stress
Glucose levels in persons with Diabetes
Nutritional state and diet
Critical Questions for Consideration
What risk factors and co-morbidities are not
modifiable?
• Age
• Presence of concomitant disease(s)
• Use of necessary lifesaving medications
Key Nursing Concepts
- Prevention
- Chronic disease management
- Health promotion
Key Nursing Diagnoses
- Alteration in Skin Integrity
- Impaired Skin Integrity
- Impaired Comfort
- Risk for ineffective peripheral
tissue perfusion
- Risk prone health behavior
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
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
www.WhyWoundCare.com