A nurse is caring for a client with a chronic wound. Which of the following is a systemic cause of chronic wounds?

A. Metabolic acidosis:

Metabolic acidosis is characterized by a low pH (<7.35) and a low bicarbonate level (<22 mEq/L) due to an excess of acids in the body or a loss of bicarbonate. However, in the given ABG values, the pH is low (7.22), but the bicarbonate level is elevated (28 mEq/L), which does not align with metabolic acidosis. Therefore, metabolic acidosis is not the correct interpretation in this case.

B. Respiratory acidosis:

Respiratory acidosis occurs when there is inadequate removal of carbon dioxide (CO2) by the lungs, leading to an accumulation of CO2 in the blood and a decrease in pH. In the ABG values provided, the pH is low (7.22), and the PaCO2 is elevated (68 mm Hg), indicating respiratory acidosis as the primary disturbance. This interpretation is supported by the elevated PaCO2 and the low pH, making it the correct choice based on the given data.

C. Respiratory alkalosis:

Respiratory alkalosis results from hyperventilation, leading to excessive elimination of CO2 and a decrease in PaCO2 levels. However, in the ABG values presented, the PaCO2 is elevated (68 mm Hg), which contradicts the expected decrease seen in respiratory alkalosis. Therefore, respiratory alkalosis is not the correct interpretation of the ABG values in this case.

D. Metabolic alkalosis:

Metabolic alkalosis is characterized by a high pH (>7.45) and a high bicarbonate level (>26 mEq/L) due to excessive loss of acids or an increase in bicarbonate levels. However, in the ABG values provided, the pH is low (7.22), and the bicarbonate level is elevated (28 mEq/L), which is not consistent with metabolic alkalosis. Therefore, metabolic alkalosis is not the correct interpretation based on the given data.

A. Keeping the wound clean and non-infected: When caring for a client with a pressure injury, the priority in the plan of care is to keep the wound clean and prevent infection. This involves regular wound assessment, proper wound cleaning techniques, application of appropriate dressings, and monitoring for signs of infection such as increased redness, swelling, warmth, or drainage. Preventing infection is crucial for promoting healing and preventing complications.

B. Application of a negative pressure wound care device: While negative pressure wound therapy (NPWT) can be beneficial in promoting wound healing, it may not be the immediate priority unless specifically indicated by the healthcare provider based on the stage and characteristics of the pressure injury. Keeping the wound clean and preventing infection take precedence over NPWT in the initial plan of care.

C. Client education on wound prevention: While client education is important for preventing future pressure injuries, it is not the immediate priority when caring for an existing pressure injury. The focus initially should be on managing the current wound to promote healing and prevent complications.

D. Promoting a high carbohydrate, low protein diet: Nutritional interventions are important in wound healing, but promoting a specific diet is not the immediate priority in the plan of care for a pressure injury. Providing adequate nutrition and addressing any nutritional deficiencies may be part of the overall plan, but it is secondary to keeping the wound clean and preventing infection.