S9 · Slow wound or surgical healing
Risk Safety and protection
Definition
Poor nutrition, infection, or illness may slow healing.- Poor nutrition
- diabetes
- infection
- smoking
- steroids
- older age
- Wound edges apart
- redness
- drainage
- fever
- pain that worsens
📋 Scenario
A diabetic smoker has a surgical wound on day 3 after surgery.
Subjective (S): "I smoke, and my sugar is not always good."
Objective (O): Surgical wound day 3; edges together, no redness or drainage; smoker; diabetic; blood sugar 13 mmol/L; poor appetite.
Assessment tools for this scenario: CP-SAFE Safety & Falls Score CP-SKIN Skin & Wound Score CP-FLUID Fluid Balance & Nutrition Score
Validated scales to consider: Morse Fall Scale, Braden Scale, TIME wound chart, MUST, fluid chart, glucose
**CarePath diagnosis:** Slow wound or surgical healing related to diabetes and smoking (risk factors); no signs of the problem are present yet.
**Interventions and rationale**
| Intervention | Rationale |
|---|---|
| Check the wound every shift. | Looking at the wound each shift finds early signs of trouble, such as redness, drainage or separated edges, so care can start sooner. |
| Support nutrition. | Protein, vitamins and calories are needed to build new tissue, so good nutrition helps the wound heal, which matters when appetite is poor. |
| Control blood sugar. | High blood sugar weakens defenses against infection and slows repair, so keeping it near target helps healing. |
| Keep the dressing clean. | A clean, intact dressing protects the wound from germs and keeps conditions right for healing. |
| Encourage stopping smoking. | Smoking narrows blood vessels and cuts oxygen to tissue, so stopping or cutting down improves healing. |
| Report signs of infection. | Reporting infection signs promptly allows early treatment before the wound breaks down. |
**Expected outcomes**
- By day 10: wound edges closed with no pus or redness.
- Blood sugar within the doctor's target.
- Patient states a plan to cut down or stop smoking.
**Linking the data to the diagnosis**
On day 3 after surgery the wound edges are together with no redness or drainage, so healing is on track so far. The patient is diabetic, smokes, has a blood sugar of 13 mmol/L and a poor appetite, and says their sugar is not always good. Because the wound has not broken down or become infected, this is a risk diagnosis resting on diabetes and smoking. The plan aims by day 10 for closed wound edges with no pus or redness, blood sugar within the doctor's target, and a patient plan to cut down or stop smoking.
CarePath diagnosis
Slow wound or surgical healing related to diabetes and smoking (risk factors); no signs of the problem are present yet.
Interventions and rationale
Listed in priority order.
| Intervention | Rationale |
|---|---|
| 1. Check the wound every shift. | Looking at the wound each shift finds early signs of trouble, such as redness, drainage or separated edges, so care can start sooner. |
| 2. Support nutrition. | Protein, vitamins and calories are needed to build new tissue, so good nutrition helps the wound heal, which matters when appetite is poor. |
| 3. Control blood sugar. | High blood sugar weakens defenses against infection and slows repair, so keeping it near target helps healing. |
| 4. Keep the dressing clean. | A clean, intact dressing protects the wound from germs and keeps conditions right for healing. |
| 5. Encourage stopping smoking. | Smoking narrows blood vessels and cuts oxygen to tissue, so stopping or cutting down improves healing. |
| 6. Report signs of infection. | Reporting infection signs promptly allows early treatment before the wound breaks down. |
Expected outcomes
- By day 10: wound edges closed with no pus or redness.
- Blood sugar within the doctor's target.
- Patient states a plan to cut down or stop smoking.
Linking the data to the diagnosis
On day 3 after surgery the wound edges are together with no redness or drainage, so healing is on track so far. The patient is diabetic, smokes, has a blood sugar of 13 mmol/L and a poor appetite, and says their sugar is not always good. Because the wound has not broken down or become infected, this is a risk diagnosis resting on diabetes and smoking. The plan aims by day 10 for closed wound edges with no pus or redness, blood sugar within the doctor's target, and a patient plan to cut down or stop smoking.