SIMPLY STATED, a chronic wound is an insult or injury to tissue that's failed to heal. Generally, a host of factors that impede healing are in play. For example, chronic diseases such as diabetes, peripheral arterial disease, and various autoimmune diseases can affect the skin's overall condition and inhibit wound healing. Clinical interventions depend on your patient's condition.

Thoroughly review the patient's health history, including her chief complaint, current and past illnesses, medications, and allergies. A review of body systems can help the healthcare provider determine the cause of the skin condition or wound and may provide insight into why the wound isn't healing. Remember to include:

* diagnostic study results, including results of lab tests and imaging studies

* the patient's family history. Focusing on grandparents, parents, siblings, and children, determine the age and general health of living relatives, the cause of death of all deceased family members, and any chronic diseases in the immediate family. This information may alert you to an inherited condition or disease.

* the patient's personal and social history. Document age-appropriate information about past and current activities, such as marital status; living arrangements; occupational history; use of drugs, alcohol, or tobacco; sexual history; level of education; and other social factors that may influence the patient's health or activities of daily living.

* a list of past and current medications, including prescription and nonprescription drugs, vitamins, mineral or herbal supplements, oral contraceptives, and medications borrowed from family members or friends

* any type of wound dressing or wound therapy used in the past, including skin replacements or substitutes and growth factors. Note which ones have been effective and which have failed.

* a thorough wound assessment (see Wound assessment pointers)

* the patient's nutritional status and nutritional support therapies

* support surfaces and positioning devices used (if indicated)

* any use of graduated compression stockings, custom shoes or braces, and assistive devices, if indicated

* clinician consultations related to skin and wound care

* the patient's knowledge of her disease and any special learning needs.

Remember that a comprehensive patient assessment is the first step in starting and coordinating a successful skin and wound care plan.

Wound assessment pointers

A thorough wound assessment includes the:

* condition of the patient's skin

* condition of the periwound

* status of the wound (acute or chronic)

* amount of wound exudate, if any

* presence or absence of necrosis

* appearance of the wound

* evidence of possible infection

* degree of cleaning and packing required

* nature of the dressings needed

* amount of drainage present, if any

* the patient's pain intensity rating.