A nurse is caring for several clients with wounds. Which of the following clients is at the highest risk for delayed wound healing?

A. Client who urinates frequently due to diuretic therapy: Increased urination may lead to fluid loss and potential dehydration if not managed, which can affect skin turgor and perfusion. However, with adequate fluid replacement, this factor alone does not significantly impair the physiological processes required for wound healing. B. Client with limited mobility recovering from knee surgery: Limited mobility can increase the risk of pressure injuries due to prolonged pressure over bony prominences and reduced circulation. While this may contribute to delayed healing if a wound develops, it does not inherently impair systemic healing processes as chronic metabolic and vascular conditions. C. Client who is NPO one day before abdominal surgery: Short-term NPO status typically does not result in significant nutritional deficiency or impair wound healing. The body’s nutrient stores and perioperative management generally compensate for this brief period without oral intake, making it a minimal risk factor. D. Client with diabetes, obesity and current cigarette smoker: Diabetes impairs wound healing through microvascular damage, reduced tissue perfusion, and impaired leukocyte function, increasing infection risk. Obesity decreases vascularity of adipose tissue and places mechanical stress on wounds, while smoking causes vasoconstriction and reduces oxygen delivery due to carbon monoxide exposure. These factors significantly disrupt all phases of wound healing.