As wound care practitioners, we become very used to seeing and assessing new wounds and tend to follow the necessary procedures routinely without necessarily stopping to think about what we are doing. For this reason, it is worth taking a few moments to consider one of the most important part of a wound examination – the systems review.

After a complete medical and wound history has been obtained, the next step in the examination of a new wound should be to undertake a full review of all relevant body systems. Although this sounds like a time-consuming and complex process, in fact it can usually be done very quickly, particularly with experience.  A wider systems review reaching beyond the integumentary system is important as impairments in other areas may need to be addressed as part of the overall wound management strategy. For example, immobile patients presenting with a pressure ulcer may require physical therapy to enable them to reposition themselves to relieve pressure on the affected area.

The body systems covered by the systems review should include:

• Cardiovascular/pulmonary system – including heart rate, blood pressure, respiratory rate, and assessing for edema.  This allows the wound care professional to identify problems of circulation or inadequate oxygenation which may impair wound healing.
• Musculoskeletal system – including a screening of patient structure and posture, range of motion, and strength, allowing identification of problems in the patient’s ability to reposition and avoid pressure ulcers.
• Neuromuscular system – including an assessment of gait, bed mobility, transfer of position, and balance.
• Gastrointestinal system – including a review of a patient’s daily food and water intake to assess nutritional status.
• Urogenital system – including a check for undiagnosed diabetes or urinary tract infections which may inhibit healing
• Integumentary system – including an examination of skin integrity, color, and presence of scar formation. A closer look at the integumentary system review, including direct wound assessment, will be covered in the next article.

To refresh your knowledge on wound management techniques, and to learn about new and emerging areas of wound management, you may wish to consider becoming certified in wound management. A certification in wound management allows you to improve your own knowledge and skills, helping you to improve the lives of your patients while advancing your own career. For further details of the benefits of wound care certification, please visit: www.woundeducators.com.

References
Myers BA. Wound management principles and practice. 2nd ed. Upper Saddle River, NJ: Pearson; 2008.
Sussman C & Bates-Jensen B. A collaborative practice manual for health professionals. 1st ed. Baltimore, MD: Lippincott Williams & Wilkins; 2007.