Healing difficult wounds: A primer for advanced practice registered nurses

Abstract

There are a variety of factors that cause wounds to become chronic and non-healing, all of which can be categorized as either local or systemic. Local factors include ischemia, infection, edema and pressure while systemic factors include co-morbidities such as diabetes, cardiovascular and peripheral vascular failure, neurological compromise, immobility issues, and renal insufficiency/failure. This paper describes those factors from the standpoint of an actual clinical situation with a particular emphasis on the elderly and influences that make healing wounds difficult in this population. The tools available to heal chronic wounds are also described with emphasis on skills for the advanced practice registered nurse (APRN), primarily the nurse practitioner and clinical nurse specialist. From comprehensive wound centers to sharp debridement, hyperbaric oxygen therapy, and vacuum assisted closure, advanced wound therapies are described. Finally, competencies expected of APRNs working with this population including direct care, consultation and education of patients, family members and other wound care staff are also discussed.