Dec 12, 2017
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Nutrition and Wound Care

Decubitus ulcers, or pressures sores, are areas of skin that break down due to something rubbing against it or pressing on it. Vascular ulcers (stasis ulcers) are ulcers that occur with poor circulation in the lower extremities. These can be either venous or arterial. Venous ulcers are painless. Arterial ulcers are painful.   Diabetic ulcers are caused by the lack of sensation in the extremities (peripheral neuropathy), which often leads to injuries that go untreated for a period. Ulcers are staged in I to IV as follows:

  • Stage I: A reddened area on the skin that, when pressed, does not turn white. This is a sign that a pressure ulcer is starting to develop.
  • Stage II: The skin blisters or forms an open sore. The area around the sore may be red and irritated.
  • Stage III: The skin now develops an open, sunken hole called a crater. There is damage to the tissue below the skin.
  • Stage IV: The pressure ulcer has become so deep that there is damage to the muscle and bone, and sometimes to tendons and joints.2

Optimal nutrition is important in the healing of all wounds and cannot be overstated. However, there are other components of treatment that are just as important, if not more so, in each case. For pressure sores, patient positioning and methods to reduce pressure-related tissue damage is among the top interventions for healing. For diabetic ulcers, improving vascular flow, medical therapy for neuropathy, and surgical decompressions all contribute to effective management. Restoration of blood flow by revascularization is most likely to lead to healing for arterial ulcers and compression therapy for venous ulcer healing.3

The National Pressure Ulcer Advisory Panel (NPUAP) has a number of guidelines for nutrition recommendations for treatment.

To summarize these guidelines:

  1. A nutrition assessment is performed by the facility’s registered dietitian.
  2. Sufficient calories are provided. 30-35 cal/kg is recommended for a baseline. More may be needed if there has been unintended weight loss. Liberalize diets and offer enhanced foods to meet goals.
  3. Offer adequate protein. 1.25-1.5 gm pro/kg is recommended for a baseline. More or less may be needed depending on kidney status.
  4. Provide adequate fluid. Watch for signs and symptoms of dehydration. Allow more fluid if there is vomiting, fever, diarrhea, profuse sweating, or dehydration.
  5. Provide adequate vitamins and minerals. Order a supplement if a deficiency is suspected or intake is poor. Zinc should only be used if there is a suspected deficiency and 40 mg/day for no more than 2-3 weeks is advised. Vitamin C has not been proven to speed wound healing. Good food sources should be encouraged. A multivitamin/mineral or high-cal, high-pro supplement often contains adequate micronutrients to meet needs.

The Association of Nutrition and Foodservice Professionals further explains that even though all measures have been taken by a facility to avoid or prevent a skin breakdown, sometimes they may happen.   Also, the resident who is non-compliant with treatment may develop an unavoidable sore. A revised definition of unavoidable sores has been proposed to CMS by the NPUAP to include this scenario. Once again, education is of utmost importance and will help to improve compliance and treatment outcomes.

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