1. Risk Factors for Impaired Wound Healing and Nursing Interventions
Robert has several risk factors that could affect his ability to heal from his surgical wound. First
and foremost, his age plays a big part in this. At 82 years old, his skin is thinner, less elastic, and
more fragile compared to younger people, which makes it much more likely to break down and
heal slowly (Lewis et al., 2023). Aging also leads to decreased circulation, which means there’s
less oxygen and fewer nutrients being delivered to the wound site. Another big factor is his
diabetes, which makes it harder for his body to fight off infections and slows down the wound
healing process. High blood sugar levels can damage small blood vessels and nerves, making it
more difficult for oxygen and nutrients to reach the wound and for the body’s immune system to
work properly (McIsaac, 2025). Robert also has a history of coronary artery disease and chronic
obstructive pulmonary disease (COPD), which further decreases blood flow and oxygen delivery
to tissues, both of which are critical for wound healing. On top of that, he has been bedridden
since his fracture, and immobility increases his risk for pressure injuries, skin breakdown, and
delayed healing. His hemoglobin level is also low, which means there’s not enough oxygen
being carried in his blood, and his high white blood cell count suggests that there may already be
an infection developing in the wound.
To help Robert’s wound heal and reduce the risk of complications, I would make sure we
monitor his blood sugars closely and aim to keep them within a healthy range. He needs to be
repositioned at least every two hours to relieve pressure on his skin, especially over bony areas
like his hips. I’d also encourage him to eat a diet high in protein and iron, with lots of vitamins
and minerals, because his body needs those nutrients to repair tissue and fight off infection. I’d
check his wound daily for signs of infection—like increased redness, swelling, warmth, or a foul
smell—and use sterile technique for all dressing changes to avoid introducing new bacteria.
Encouraging Robert to do small movements and deep breathing exercises is also important to
improve circulation and keep his lungs healthy. Working as part of a team with his doctor,
wound care nurse, dietitian, and physiotherapist would help make sure all aspects of his care are
covered and his wound has the best chance of healing (Lewis et al., 2023; McIsaac, 2025).
2. Phases of Wound Healing and Robert’s Current Phase
Wound healing is a complex process that happens in four main phases: hemostasis,
inflammation, proliferation, and maturation. Hemostasis is the very first step that happens right
after an injury, and its main purpose is to stop the bleeding. The body sends platelets to form a
clot and seal off the damaged blood vessels. The next phase is inflammation, which usually lasts
a few days. During this time, white blood cells like neutrophils and macrophages rush to the
wound site to fight off infection and clean up any dead cells or debris. This phase is important,
but if it goes on too long, it can actually slow down healing. After the inflammation phase, the
body moves into the proliferative phase, where new tissue starts to grow, including granulation
tissue and new blood vessels. The wound starts to fill in, and the skin begins to close. Finally, the
maturation phase strengthens the wound over time, forming scar tissue and restoring skin
integrity, although the new skin is never as strong as the original.
Based on the signs Robert is showing—like increased pain, swelling, redness, warmth, and a
“funny smell” coming from the wound—it seems like he is still stuck in the inflammatory phase.
His high white blood cell count also suggests that his body is still fighting off an infection, and
the presence of a foul odor points to possible bacterial growth in the wound. All of these signs
mean that the healing process hasn’t yet progressed into the proliferative phase where new tissue
can start to rebuild. Right now, our focus needs to be on managing the infection and helping his
body move past this inflammatory stage so that healing can continue (Lewis et al., 2023;
McIsaac, 2025).
3. Primary Dressing for the Wound and Rationale
For Robert’s wound, I would recommend using a hydrocolloid dressing. This type of dressing is
especially good for wounds like his because it helps create a moist healing environment, which
has been shown to promote faster and better-quality wound healing compared to letting the
wound dry out (Lewis et al., 2023). A hydrocolloid dressing also helps protect the wound from
bacteria and outside contaminants, which is really important since Robert’s body is already
struggling with infection and his immune system is weakened by age, diabetes, and other chronic
conditions. Another reason I would choose a hydrocolloid is that it helps with autolytic
debridement, meaning the dressing keeps the wound moist and allows the body’s own enzymes
to break down dead tissue without needing more invasive or painful treatments like sharp
debridement. Hydrocolloids are also easy to apply and don’t need to be changed as often as other
types of dressings, which is great for Robert because frequent dressing changes can damage
fragile skin and cause discomfort. Overall, a hydrocolloid dressing supports healing while
reducing pain and the risk of infection, which is exactly what Robert needs right now (McIsaac,
2025).
4. Preparing to Provide Wound Care
Before starting Robert’s wound care, I would make sure to gather all the supplies I need, like
gloves, normal saline, gauze, the hydrocolloid dressing, and a waste bag for disposal. I would
perform proper hand hygiene and put on gloves to prevent contamination and protect both Robert
and myself from infection. It’s important to explain the procedure to Robert beforehand, so he
feels comfortable and knows what to expect. I would make sure the bed is at a proper height and
that the lighting is good so I can see the wound clearly. I’d also make sure Robert is in a
comfortable position with his hip exposed for easy access to the wound. When cleaning the
wound, I would use normal saline, working gently from the cleanest part outward to prevent
introducing bacteria into the wound. After the wound is clean, I would carefully apply the
hydrocolloid dressing, making sure it’s the right size to cover the wound completely without
sticking to the surrounding healthy skin. Once the dressing is in place, I would dispose of the
used materials, remove my gloves, perform hand hygiene again, and document everything I did
in Robert’s chart. It’s also important to check in with Robert afterward to see how he’s feeling
and if he has any questions or concerns about his wound care (McIsaac, 2025).
5. Teaching for the Client’s Plan of Care
For Robert’s plan of care, I would spend time teaching both him and his spouse about how to
care for the wound at home. I would explain the importance of hand hygiene before and after
touching the wound, and I’d show them how to safely remove the old dressing, clean the wound
with saline, and apply a new hydrocolloid dressing. I’d go over what signs of infection to watch
for, like increased redness, swelling, warmth, pain, or a bad smell, and explain when they should
call the nurse or doctor. Since Robert has diabetes, I’d talk about how important it is to keep his
blood sugars within the target range because high blood sugars can slow down wound healing
and increase the risk of infection (Lewis et al., 2023). I’d also explain the importance of eating
enough protein and iron to support his body in making new tissue, and encourage him to keep
moving as much as possible to improve circulation, even if it’s just small movements or deep
breathing exercises in bed. Finally, I’d remind Robert and his spouse to follow any other medical
advice from his health care team and ask questions if they’re unsure about anything. Education is
so important in Robert’s case because proper wound care at home will play a big role in his
recovery (McIsaac, 2025).
6. Health Care Professionals Involved in Collaborative Care
Robert’s situation requires a collaborative team approach to make sure all of his needs are met
and that his wound has the best chance to heal. The physician is the one in charge of overseeing
Robert’s overall care, prescribing medications like antibiotics or pain management if needed, and
making decisions about his treatment plan. The wound care nurse plays a big role in assessing
Robert’s wound, helping to choose the best dressing (like the hydrocolloid we’re using), and
monitoring how well the wound is healing over time. A dietitian is important in Robert’s case
because his body needs the right nutrition to heal, especially protein, iron, and vitamins that help
rebuild tissue. The dietitian can create a meal plan that supports his recovery. A physiotherapist
is also an important part of the team because they can help Robert with safe mobility, exercises,
and positioning to reduce the risk of pressure injuries and improve blood flow. If Robert is
having trouble with daily activities, an occupational therapist can help him adapt and stay
independent, which is especially important for his quality of life. Lastly, the pharmacist would
review all of Robert’s medications to make sure they are appropriate and safe, checking for any
interactions that could slow wound healing or cause complications. This team works together to
address all the factors that could affect Robert’s health and make sure nothing is missed, which is
especially important for a complex case like his (Lewis et al., 2023; McIsaac, 2025).
7. Nursing Diagnosis and Rationale
The best nursing diagnosis for Robert would be “Impaired skin integrity related to immobility,
diabetes, and reduced circulation as evidenced by the presence of a surgical wound with signs of
infection.” This diagnosis makes sense for Robert because his body is already working against
him in several ways. He’s mostly bedridden because of his hip fracture, so he’s not able to move
much, which increases his risk for pressure injuries and delays healing. His diabetes is another
big factor, as it slows down the healing process by affecting how the body fights infection and
repairs tissues. On top of that, his heart disease and COPD reduce how much oxygen his tissues
are getting, which is essential for healing. The fact that his wound is showing signs of
infection—like redness, swelling, pain, and a foul smell—means that his skin integrity is already
impaired, and we need to act quickly to prevent the wound from getting worse. This diagnosis
helps guide our care by focusing on managing the infection, supporting his healing, and reducing
any further risk of breakdown (Lewis et al., 2023).
8. SMART Goal for the Client
For Robert, a realistic and appropriate SMART goal would be: “Robert’s wound will decrease in
size by 20% within two weeks, as measured by wound assessments during dressing changes, by
following the prescribed wound care plan, maintaining blood glucose levels within target range,
and repositioning every two hours.” This goal is specific because it focuses on the wound size,
measurable because it sets a clear percentage and timeline, and achievable with proper care and
interventions. It’s relevant to Robert’s condition because the main issue we’re working on is
impaired skin integrity and infection, and it’s time-bound because it gives us a clear timeframe to
aim for improvement. Setting this kind of goal helps the whole team stay focused on what we
want to achieve and gives us a way to measure progress so we know if our interventions are
working or if we need to make changes (Lewis et al., 2023).
Part B: Wound Documentation (DAR Format)
D (Data): Robert’s surgical wound on his hip is red, swollen, and has a yellowish drainage with a
slight foul odor. The surrounding skin is warm to touch. Robert reports that the pain at the site is
6/10, and he feels “tired and a little weak.” His temperature is 37.8°C, heart rate is 104 bpm,
respiratory rate is 24, and oxygen saturation is 90% on room air. His blood sugars have been
between 9.7–12.6 mmol/L, and his white blood cell count is 16.2 x10⁹/L. His hemoglobin is 82
g/L.
A (Action): I cleaned the wound using sterile normal saline, working from the cleanest area
outward to avoid contamination. I applied a hydrocolloid dressing to keep the wound moist and
protect it from infection. I taught Robert and his spouse how to properly change the dressing at
home, including hand hygiene, recognizing signs of infection, and safely disposing of the old
dressing. I also discussed the importance of keeping his blood sugar within target range to
promote healing. I encouraged Robert to reposition himself every two hours and to practice deep
breathing exercises to improve circulation and oxygenation. I offered pain medication as needed
and reassured Robert throughout the procedure.
R (Response): Robert tolerated the procedure well and said the new dressing felt more
comfortable. He and his spouse were able to repeat back the dressing change steps, showing they
understood the instructions. Robert agreed to try repositioning every two hours and to continue
deep breathing exercises. The plan is to continue monitoring the wound and his vital signs,
reassess the wound at the next dressing change, and call the physician if there are any signs of
worsening infection.
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