Wound Care And Nutrition

Pressure injuries are recognized as a serious medical condition.  Substantial evidence exists surrounding the relationship between pressure injuries and pain, along with decreased quality of life, and increased mortality in older populations.1 The occurrence rate of pressure injuries differs greatly amongst varying health care settings.  According to The National Pressure Injury Advisory Panel (NPIAP) ranges in skilled nursing facilities are from 2.2% to 23.9%.2 Aging individuals in skilled nursing facilities have a wide range of impairments or medical conditions that increase their risk of developing pressure injuries.  These may include impaired mobility, malnutrition or under-nutrition, obesity, stroke, diabetes, dementia, cognitive impairments, circulatory diseases, and dehydration.

Pressure injuries can be linked to undernutrition or malnutrition.  Several studies support that the incidence and risk of developing pressure injuries increases when individuals experience weight loss or are undernourished.3 A resident with a pressure injury at any risk for malnutrition would benefit from a dietitian evaluation and nutritional intervention to aid in the healing or prevention of skin breakdown or alterations.  Research has shown that increased protein intake along with adequate energy intake has been associated with improved healing rates.4 The 2019 NPIAP guidelines for nutrition assessment and treatment include5:

  1. Conduct a nutritional screening for individuals at risk of a pressure injury
  2. Conduct a comprehensive nutrition assessment for adults at risk of a pressure injury who are screened to be at risk for Malnutrition and for all adults with a pressure injury
  3. Develop and implement an individualized care plan for those with or at risk of a pressure injury, who are malnourished or at risk of malnutrition
  4. Adjust protein intake for those at risk of developing a pressure injury
  5. Provide 30-35 kcal/kg body weight for adults with a pressure injury who are malnourished or at risk of malnutrition
  6. Provide 1.25-1.5 gm/kg body weight for adults with a pressure injury who are malnourished or at risk of malnutrition
  7. If usual intake does not support estimated needs, offer high calorie/high protein fortified foods or supplements
  8. Provide high-calorie, high protein, arginine, zinc, & antioxidant oral nutritional supplement for Stage II or greater
  9. No separate Vitamin C or Zinc supplements consider Multivitamin/Mineral instead
  10. Enteral/parenteral feedings for those who cannot meet their nutritional requirements through oral intake
  11. Adequate water/fluid intake for hydration

Consultant dietitians are equipped to identify underlying causes of undernutrition such as a lack of appetite, dentition issues, or dysphagia.  They can recommend appropriate interventions to best support nutritional needs and coordinate care with other disciplines.  Not all wounds are the same, consultant dietitians utilize their vast knowledge for different approaches based on the type of wound, severity, and characteristics in order to identify the most appropriate plan of care for each resident. As an integral part of the wound care team, they can assist not only in treating wounds, but in prevention as well through counseling, education, goal setting, and monitoring of residents needs and their nutritional status.


  1.  https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Downloads/SNF-QRP-Measure-Specifications_October-2016.pdf
  2. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Downloads/SNF-QRP-Measure-Specifications_October-2016.pdf
  3. Posthauer ME, Banks M, Dorner B, Schols JM. The role of nutrition for pressure ulcer management: National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance white paper. Adv Skin Wound Care. 2015;28(4):175-188.
  4. Clinical Nutrition: Nutrition’s Role in Treating Pressure Injuries, Esther Ellis, MS, RDN, LDN, Today’s Dietitian, Volume 20, Number 7, p. 14. https://www.todaysdietitian.com/newarchives/0718p14.shtml
  5. http://www.internationalguideline.com/static/pdfs/Quick_Reference_Guide-10Mar2019.pdf