Holistic Wound Care Nursing: What You Need to Know

Why wound “management” is not enough

Don’t get me wrong – implementing the most appropriate topical treatment is an essential part of healing a wound.

But there are so many other factors that can get overlooked when caring for a wound care patient.

Here are some of the most important considerations when deciding on a holistic wound care plan for a patient with wounds…

8 Key Components of the Total Picture of Health

AGE

Unfortunately, no one escapes this factor.

As we get older, there’s a decrease in the dermal layer and in lots of other components that make up our skin.

The basement membrane gets flatter, so older skin becomes more fragile, less effective at nutrient transfer, and more susceptible to shearing.

MEDS

Lots of medications can affect the healing process and can contribute to slow or even non-healing wounds. To name a few…

• Corticosteroids decrease inflammation in general, which prolongs inflammatory phase of healing for a wound
• NSAIDS like Ibuprofen decrease production of new blood vessels in healing tissue, which results in slower healing
• Anti-neoplastic (cancer) drugs can cause damage to normal tissue
• Transplant rejection drugs can delay healing because they suppress the body’s immune response
• Anticoagulants like heparin prevent normal production of clotting agents necessary for the healing process

ACTIVITY

Mobility status is important to consider when planning interventions to boost wound healing and for prevention of future wounds.

Friction and shearing are some of the most common causes of bed-sores and other skin injuries.

A specialized low air-loss mattresses can be effective for a patient who’s not very mobile, but it’s overkill for a patient who’s ambulatory.

Educate your patient on good body mechanics and encourage participation when physical therapy comes around! 

LABS

It’s hard to narrow it down to only a few, but there are some key labs to be familiar with when you’re looking at how you expect wound healing to go down.

A few important lab values to pay attention to in wound care patients:

• Total Lymphocyte Count (TLC)
• Pre-albumin
• Glucose
• Hemoglobin A1C
• Hemoglobin / Hematocrit

WEIGHT

Patients can get into trouble when their weight goes out of range in either direction.

Underweight

If a patient is not taking in enough calories, they experience weight loss, slowed wound healing, and higher risk for developing additional wounds.

Studies estimate that around 40% of hospital patients are malnourished, so this is a big deal!

When the body doesn’t get enough protein, it can cause something called protein energy malfunction. When this occurs, the body dips into stored protein for energy, which causes the patient to lose lean body mass (LBM).  If more than 10% LBM is lost, protein is actually shifted away from being used for wound healing and thrown into restoring LBM.

This process is an impressive natural defense to keep the most essential parts going strong…but is also the reason poor nutrition and insufficient protein intake can bring wound healing to a halt.

Overweight

Obese patients are more at risk of skin breakdown due to an increased risk of tissue ischemia. These patients have more adipose (or fat) tissue, which is poorly vascularized.

The workload of the heart is also higher, in effort to supply all tissue with enough oxygen.

Less oxygen available in tissues results in: decreased collagen synthesis, decreased WBC activity, and slower proliferation and migration of epithelial cells in healing.

DIET

I could easily make dietary needs in wound healing an entire post of its own, but for the sake of this post I’ll keep it concise.

The body’s calorie and protein requirements significantly increase when there’s any open wound or injury (this may not be appropriate for all patients, so be sure to get a dietary consult!).

Patients may not be eating well because they’re sick, in the hospital, or a number of other reasons. Or, they may be eating normally, but don’t realize that their wound creates a higher demand for extra calories and nutrient dense, high protein foods.

This is a great opportunity to teach patients something they can do to support the healing process. When you take the time to explain this and involve your patient, it can give them a sense of control over their situation.

DIABETES

Diabetic patients need to be extra cautious in avoiding skin issues since diabetes slows down the healing process.

Patients whose blood sugars are not well controlled are at especially high risk. These patients often experience reduced collagen synthesis, decreased wound contraction, and decreased migration of epithelial cells, all of which slow the healing of a wound.

Prevention is the key!  Be sure to implement wound prevention measures like regular skin inspection and moisture control-especially for your diabetic patients. 

INFECTION

As nurses, we are often some of the first to notice subtle signs of infection, like strange behavior or confusion. Often, these red flags can show up even before the infection is detected in any diagnostic tests.

Early signs are especially important to catch in our wound care patients because the presence of infection can significantly prolongs the inflammatory phase of healing. This puts patients in a state of increased metabolic demand, which also slows the rate of tissue repair.

Any infection can also increases the risk of a wound spreading to the bone and resulting in osteomyelitis (bone infection).

If you notice any early signs of infection, don’t be afraid to speak up! Be an advocate for your patient and get an order for a blood, urine, or other culture based on their symptoms.