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INTRODUCTION

The evaluation of the patient with a non-healing wound consists of the following three components: subjective history, medical history, and wound assessment. The histories usually allows the clinician to make a diagnosis of wound etiology, and if not, at least indicate what needs to be ruled out. Thorough histories also give indications as to why a wound is not healing. The wound assessment provides data for objective, measurable outcomes and progress, as well as information on how to treat the wound initially. The most important aspects of treating any wound are to treat all underlying co-morbidities and to address any issues that may be impeding wound healing. Finally, the initial treatment will consist of appropriate debridement of necrotic tissue and application of a dressing that will ensure adequate moisture for wound healing to advance. Signs and symptoms that suggest the patient be referred to the primary care physician, a medical specialist, or the emergency room are listed in Table 1-1.

TABLE 1-1Signs and symptoms that suggest a patient be referred to a primary care physician or an emergency room

SUBJECTIVE HISTORY

Pertinent information to obtain during the subjective interview includes origin and duration of the wound; any notable precipitating events; what treatment has been used (especially what has been used to cleanse and dress the wound); other signs and symptoms such as fever, pruritis, pain levels, and pain description; any co-morbidities such as diabetes, cardiovascular disease, or auto-immune disorders; medications, both prescribed and over-the-counter; allergies; nutritional status; activity level and assistive devices being used; and social habits such as smoking (including vaping), alcohol intake, and drug use. These questions not only assist in making a wound diagnosis, but are ...

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