W1 · Wound not healing
Actual Wounds and skin
Definition
A wound stays open or shows little progress over the expected time.- Poor blood flow
- infection
- diabetes
- poor nutrition
- pressure
- No change in size
- pale base
- dead tissue
- foul smell
📋 Scenario
A leg ulcer stays open after six weeks.
Subjective (S): "This ulcer won't heal."
Objective (O): Leg ulcer for 6 weeks; 4 cm; pale base; slough; foul odor.
Assessment tools for this scenario: CP-SKIN Skin & Wound Score
Validated scales to consider: Braden Scale, TIME wound chart
**CarePath diagnosis:** Wound not healing related to poor blood flow, as evidenced by no change in size and pale base.
**Interventions and rationale**
| Intervention | Rationale |
|---|---|
| Assess the wound. | Measuring size, depth, tissue type, drainage and odor shows whether the wound is improving and what is blocking healing. |
| Treat the cause. | Healing needs blood flow and a controlled cause, so treating poor circulation, infection or pressure addresses why it is not healing. |
| Dress as ordered. | The right dressing keeps the wound moist and clean, protects it and manages drainage and odor, supporting tissue repair. |
| Support nutrition. | Protein, calories and vitamins are needed to build new tissue, so good nutrition supports closure. |
| Refer to a wound specialist. | A wound specialist can offer advanced treatments and a plan for a wound that has not responded for weeks. |
**Expected outcomes**
- Within 2-4 weeks: wound size reduced by 20-30%, no infection, care plan followed.
**Linking the data to the diagnosis**
The patient says, 'This ulcer won't heal.' The leg ulcer has been open for 6 weeks, measures 4 cm, has a pale base, slough and a foul odor. Healing should show progress by now, and there is none, so the problem is actual. The statement rests on poor blood flow, with no change in size and a pale base. The plan aims, within 2 to 4 weeks, for the wound to shrink by 20 to 30 percent, stay free of infection and follow the agreed care plan.
CarePath diagnosis
Wound not healing related to poor blood flow, as evidenced by no change in size and pale base.
Interventions and rationale
Listed in priority order.
| Intervention | Rationale |
|---|---|
| 1. Assess the wound. | Measuring size, depth, tissue type, drainage and odor shows whether the wound is improving and what is blocking healing. |
| 2. Treat the cause. | Healing needs blood flow and a controlled cause, so treating poor circulation, infection or pressure addresses why it is not healing. |
| 3. Dress as ordered. | The right dressing keeps the wound moist and clean, protects it and manages drainage and odor, supporting tissue repair. |
| 4. Support nutrition. | Protein, calories and vitamins are needed to build new tissue, so good nutrition supports closure. |
| 5. Refer to a wound specialist. | A wound specialist can offer advanced treatments and a plan for a wound that has not responded for weeks. |
Expected outcomes
- Within 2-4 weeks: wound size reduced by 20-30%, no infection, care plan followed.
Linking the data to the diagnosis
The patient says, 'This ulcer won't heal.' The leg ulcer has been open for 6 weeks, measures 4 cm, has a pale base, slough and a foul odor. Healing should show progress by now, and there is none, so the problem is actual. The statement rests on poor blood flow, with no change in size and a pale base. The plan aims, within 2 to 4 weeks, for the wound to shrink by 20 to 30 percent, stay free of infection and follow the agreed care plan.