A client comes to the clinic with a wound that does not seem to be healing. Which assessments should the nurse make on this client specific to the wound? (Select all that apply.)
a. Client's height and weight
b. Diet and nutritional history
c. Long-term use of steroids
d. Size of the wound and amount of drainage
e. Smoking and alcohol intake
B, C, D, E
Good wound healing requires a diet high in vitamin C, protein, carbohydrates, calories, and flu-ids. Steroids reduce the number of lymphocytes available for appropriate inflammatory response, and clients receiving long-term steroids have delayed wound healing. The size of the wound and any drainage coming from it are important parts of the physical assessment of a wound. Smoking causes vasoconstriction, which will delay the delivery of oxygen and nutrients to the wound. Height and weight, while part of a general assessment, do not provide information specific to a wound. Weight loss might indicate poor nutritional status.
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