Chronic Wound Evaluation and Consultation
Any wound that does not heal within three months is considered a chronic wound. Chronic wounds are detained in one or more phases of healing. If these wounds ever heal, they may take years to do so, causing patients severe physical, mental, emotional, and financial stress, and placing a financial burden on the healthcare system.
Consultations are an important first step in providing access to appropriate treatments and specialists. Since many immobile, hospitalized patients are prone to developing chronic wounds, many wound care consultations now take place through telehealth applications. This less costly alternative to an in-person consultation refers to contact between a patient and a healthcare provider through electronic communications such as audio, video, and other telecommunications. It is an especially helpful option for patients in long-term care settings as it enables nurses with specialized wound knowledge and skills to provide support to nurses directly caring for patients, which improves the chance for wound healing.
Proper wound assessment can have a significant impact on patient outcome. When evaluating a chronic wound, a full physical examination of the patient must be done focusing on the patient’s height, weight, and skin characteristics. Trends in a patient’s weight must be noted as adequate nutrition is essential for wound healing. Skin color, texture, turgor (elasticity), and temperature must also be evaluated. Healthy skin will feel smooth and firm, have good turgor, and lack erythema (redness.)
The wound’s circumference and depth, along with the condition and location of the wound bed, must be documented weekly and should take place after wound cleaning and debridement. Wound depth must be classified as partial (does not penetrate the dermis) or full (involves tissue below the dermis) thickness.
The surrounding skin and tissue must also be carefully inspected. Any compromised skin near a wound is at risk for breakdown, making preventive measures a necessity. The color, amount, and odor of exudate (drainage) in the wound, as well as undermining (space between intact skin and wound bed) and tracts (channels extending from one part of the wound to another) must also be checked. Pain level should be evaluated by the patient utilizing the pain scale designated by the healthcare facility they are in.