Taking a history for patients with an ulcer or wound

Undertake a comprehensive medical history (including previous ulcers, surgical and social history) and medication history (including prescription, over-the-counter and complementary and alternative medicines). Ask about the patient’s smoking status and alcohol intake. Identify relevant comorbidities, such as those that:

• limit circulation and oxygenation to skin—chronic venous insufficiency, peripheral arterial disease, heart failure, impaired respiratory function, blood disorders (eg anaemia, polycythaemia, thrombocythaemia)
• affect skin integrity—dryness, purpura, atrophy, solar exposure and skin cancer, dermatitis, allergy to topical products (including dressings; see Previous reactions to ulcer and wound dressings), neuropathy, tinea
• alter immune function—rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel disease, HIV
• impair healing—endocrine or metabolic disorders (eg diabetes mellitus, thyroid dysfunction, estrogen deficiency), disseminated malignancy, peripheral oedema, disorders affecting nutrition (eg malabsorption)
• affect mobility or ability to self-care—poor vision, reduced hand function or range of movement, neurological conditions, arthritis, obesity, dementia or other cognitive or developmental disorder, major psychiatric disorders, incontinence.

Ask patients what concerns them about their wound (eg pain, restricted mobility, swelling, exudate leakage, odour). Also explore their physical, mental, social, spiritual and cultural wellbeing¹. Determine their financial situation. Acknowledge and address their concerns and priorities at the initial visit and subsequent reviews.

Review the following aspects:

• location (aids diagnosis [eg venous leg ulcers typically occur on the lower third of the leg] and management [eg for patients with a foot ulcer, find out their types of footwear and if they use orthotics])
• details of wound onset (spontaneous, traumatic, caused by foreign body) and duration
• progress (consider if the wound is advancing appropriately through the phases of healing)
• treatments already used and response.

Ask about other healthcare professionals involved and their role. Discuss changes in the management plan with all practitioners.

Determine if the patient has previously had a chronic wound, and ask about its progression and if any investigations (including imaging) were performed. It is also important to know whether there has been trauma, radiotherapy or surgery in the region of the current wound.