Nutrition & Wound Care Mary Dullea

Senior Dietitian

Cork University Hospital

Aims

Wound Management Guidelines 2018 – Nutrition Relationship: Wounds and Nutrition Nutrition Assessment The Guidelines in practice – MDT strategies to improve nutrition

support in context of wound healing/prevention - discuss

Clinical questions

Associated recommendations

Good Practice Point

A referral to a registered dietitian should be sent if the patient is identified at risk of malnutrition and/or

experiencing delayed wound healing

Screening?

The Role of Nutrition in the Prevention and Management of Pressure Ulcers

Good Practice Point

Adequate nutrition is essential to manage pressure ulcers

with individualised dietary prescription based on

thorough nutrition assessment

Nutritional Assessment

Assessment of requirements based on: Appearance Nutrition Focused Physical Exam Wound/GI losses/Temperature Body weight/weight loss Biochemistry Appetite and diet and fluid intake

Ongoing monitoring

and review

Energy

Increased resting energy expenditure in patients with pressure ulcers

Adequate energy from carbohydrate and fat is necessary to:

• Supply energy for tissue synthesis and repair

• Preserve subcutaneous tissue for padding and protection for bony sites

• Prevent protein breakdown for energy

Energy in excess can lead to obesity and impede wound healing due to decreased mobility

and increased weight

Protein

Pressure Ulcer catabolic state increased protein requirement

An adequate amount is required for:

• Tissue synthesis and repair (Cell membranes, collagen, fibroblast proliferation,

connective tissue, keratin)

• Metabolic function (Nucleic acid, hormones, enzymes)

• Immune system (lymphocytes, neutrophils, T cells, macrophages)

• Energy

Arginine is a conditionally essential amino acid in wound healing

Fatty Acids are essential for:

• Cell structure

• Their involvement in the inflammatory process

• Meeting demand for polyunsaturated fatty acids during

healing

Fat

Fluid

• Sufficient fluid is necessary to prevent any further skin breakdown, to maintain

skin turgor and delivery of oxygen and nutrients to both healthy and healing

tissues

• Pyrexia, wound losses, perspiration, loose/watery stools/vomit must be considered

in assessment of fluid requirements

• Monitoring the following to ensure adequate hydration is important:

biochemistry, skin turgor, urine output and colour

Micronutrients (vitamins, minerals and trace elements) – required

by the body in small but critical amounts for metabolism

MDT effort to improve nutrition

Food fortification

and enrichment

Communication is key between team members

Dental/oral

Holistic approach – what else is going on?

Community – meals at home?

Hospital - Protected mealtimes, assistance

Barriers to adequate nutrition?

Nursing, Health Care Assistants,

Tissue Viability,

Speech & Language Therapy, Occupational

Therapy

Guidelines in Practice

Useful resources

www.indi.ie

www.irspen.ie

http://www.healthyireland.ie

www.hseland.ie

https://www.hse.ie/eng/services/list/2/primarycare/community-funded-

schemes/nutrition-supports/

https://www.bapen.org.uk/

https://www.bda.uk.com/foodfacts/home

References

Green, K., 2018. Pressure Ulcers. CN (2018); 18(4): 19-21 HSE, Making the most of every bite. Available online: https://www.hse.ie/eng/services/list/2/primarycare/community-funded-schemes/nutrition-supports/making-the-most-of-every-bite.pdf McManamon, R., 2013. Nutrition and Pressure Sores in the Elderly. CN (2013); 13(3): 23-25 Pandy, A., 2019. The use of a high protein liquid supplement in a patient with pressure ulcers, case study. CN (2019); 19(4): 35-36 Parenteral & Enteral Nutrition Specialist Group, BDA, 2018. A Pocket Guide to Clinical Nutrition, Fifth Edition Wynne, M.M., 2018. HSE National Wound Management Guidelines 2018. Available online:https://www.hse.ie/eng/services/publications/nursingmidwifery%20services/wound-management-guidelines-2018.pdf