A client has a wound on the ankle that is not healing. Which three risk factors are associated with delayed wound healing? (Select all that apply.) Multiple options may be correct

A. Borderline hypertension: Mild or borderline hypertension does not typically interfere with the wound healing process. While severe or poorly controlled hypertension can affect tissue perfusion over time, borderline elevations in blood pressure alone are not considered a significant risk factor for delayed wound healing. B. Acute atrial fibrillation: Acute atrial fibrillation primarily affects cardiac rhythm and may increase the risk of thromboembolism, but it does not directly impair tissue repair or the local wound healing process. Unless it leads to compromised perfusion or oxygen delivery over time, it is not considered a primary factor in delayed wound healing. C. Tobacco smoking: Smoking impairs wound healing by causing vasoconstriction, reducing tissue oxygenation, and impairing immune function. Nicotine and other chemicals in tobacco compromise collagen synthesis and fibroblast activity, which are critical for tissue repair, thereby increasing the risk of infection and delayed wound closure. D. Diabetes mellitus type 2: Diabetes is a major risk factor for delayed wound healing due to hyperglycemia-induced vascular changes, impaired leukocyte function, and reduced collagen synthesis. High blood glucose levels can also increase susceptibility to infection and neuropathy, further complicating the healing process. E. Peripheral vascular disease: Peripheral vascular disease reduces blood flow to extremities, limiting oxygen and nutrient delivery to tissues. Poor perfusion slows the inflammatory and proliferative phases of wound healing and increases the risk of tissue necrosis and chronic ulcers, making it a significant contributor to delayed wound repair.