Identifying Systemic Factors for Effective Wound Healing

1. Identifying Systemic Factors for Effective Wound Healing In addition to psychological and local factors, systemic factors also impact wound healing. For successful outcomes, identifying and addressing systemic factors is indispensable. This can be accomplished when the nurses adopt a holistic approach to collect all the information regarding the patient’s wound during wound assessment and document all the crucial details in a standardized manner. Before exploring this, let’s take a detailed look at what constitutes systemic factors. The crucial systemic factors are as follows:  Aging –As people age, their immune function deteriorates and their ability to produce collagen reduces. The skin becomes thinner, which increases the risk of tearing and blistering. The skin becomes drier as well, since there is depletion in the number of sweat and oil glands. As the body’s inflammatory response decreases, healing is impaired when a wound occurs. Older patients often lack the ability to feel and respond to pain and this causes the trauma caused to the skin to go unrecognized. Such patients are also more vulnerable to infections.  Inadequate Nutrition –There is a higher risk of infection for patients who eat a diet that lacks enough nutrition. This will delay wound healing. For example, protein is essential for cell repair and regeneration and a decline in protein level would lead to reduced immune response and alterations in proliferation, maturation and remodeling responses. www.woundemr.com 855-968-6394

2.  Co-morbidities –Co-morbidity is when the patient has one or more additional disorders/diseases that co-occur with a primary disease; or the effect of those additional disorders/diseases. Older patients often have co- morbidities and this will further impair wound healing. Various health conditions including peripheral vascular disease, anemia and chronic obstructive pulmonary disease can affect the body’s ability to provide oxygen to the tissues and impair the healing process. Immunity level gets reduced heavily due to conditions such as diabetes or HIV/AIDs or due to aging -- this affects healing. The inability to move due to physical conditions (arthritis, stroke) or a medical treatment or device can result in developing hard-to-heal wounds such as pressure ulcers.  Medications –Certain medications can hinder the healing process. High dosage of steroids can suppress the immune system. Steroids impact the synthesis of collagens and their strength. Chemotherapy is always damaging to the wound healing process since the therapy involves destroying cells. NSAIDS also delays healing.  Personal Behavior –Some personal choices can adversely affect wound healing. Alcohol abuse can result in malnutrition and impede the healing process. Smoking restricts blood vessels and as a result the platelets will stick together and form clots. Besides, the carbon monoxide inhaled during smoking merges with hemoglobin and reduces the level of oxygen available to the tissues that greatly require oxygen to heal. Nurses must ask patients questions regarding their nutritional status and supportive therapies, medications and lifestyle factors and record them under patient’s medical history. Physical examination can also help identify the symptoms of systemic conditions. For example, changes in nails may be a symptom of a systemic condition. Nurses can examine the patient’s nails for changes in thickness, splitting, discoloration, breaking and separation from nail bed. The information collected from physical www.woundemr.com 855-968-6394

3. examination should be recorded in an accurate manner. In this way, the history and physical examination (H&P) report plays a crucial role in identifying and addressing systemic conditions. Rather than a general EMR, a wound EMR system would be more effective for documenting H&P reports for patients with wounds. In general EMR, there would be several fields and charts, and physicians need to search for a long time to find the electronic records specifically related to wound care. Since wound EMR involves wound-specific templates, physicians won’t take too much time to access H&P reports of patients. With this, they can develop a wound care management plan to address systemic conditions effectively, and help speed up the wound healing process. If such a system is supported with an interface for physicians and nurses, information exchange will take place quickly and facilitate developing a more effective wound care management plan. www.woundemr.com 855-968-6394