1. Risk Factors/Comorbidities for Chronic Wound Development
Janice Beitz
PhD, RN, CS, CNOR, CWOCN, CRNP, APNC, FAAN
 Module #2
Revised September 2018

2. Disclaimer
The Why Wound Care? education and recruitment campaign has been developed by our all-volunteer nursing and medical advisory boards. Website, logistics, marketing and exhibition support is provided by HMP with help from unrestricted educational grants from our corporate sponsors. A list of corporate sponsors can be found in the “About” tab. All educational materials were developed and are donated by our advisory board members. Neither HMP nor our corporate sponsors were involved in the selection, development, or content of these educational materials.
Conflict of Interest: Dr. Janice Beitz declares that she has no potential conflict of interest related to the content of this presentation.

3. 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

4. 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!

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

6. 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. Pressure Ulcer/Injury Exemplar

8. 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

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

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

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

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

13. Chronic Wound Risk Factors
Vasculitic disorders
- Polyarteritis nodosa
- Thromboangiitis obliterans
- Protein C / protein S deficiency

14. 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

15. 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

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

17. - Prevention - Chronic disease management - Health promotion
Key Concepts
- Prevention
- Chronic disease management
- Health promotion

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

19. Key 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

20. Websites for Further Information on Types of Wounds
- Association for the Advancement of Wound Care
- National Pressure Ulcer Advisory Panel
- Wound Healing Society
- Wound Ostomy Continence Nurses Society
- Wounds Canada