Nutrition and

Wound Care
 NUTRITIONAL SCREENING
• To Pinpoint
 Malnourished
 At nutritional risk
 To determine appropriate interventions
• Tools of assessment
 Mini-Nutritional Assessment (MNA)
 Malnutrition Universal Screening Tool (MUST)
 Malnutrition Screening Tool (MST)
 Subjective Global Assessment (SGA).
Persons with mal nutrition may have following factors
 Significant weight loss: 5 lb or more in 1 month, 5% in
30 days, or 10% in 180 days
 Disease states and conditions: diabetes,
malabsorption, dementia, chronic obstructive
pulmonary disease (COPD), cancer, or renal disease
 Immobility and inactivity: hip fracture, spinal cord
injury, stroke
 Chewing and swallowing difficulties (dysphagia)
resulting from stroke, Parkinson’s disease, and
cerebral palsy
 Appetite decline, anorexia, poor food and fluid intake
 Adverse effects of medications
 FACTORS THAT EFFECT WOUND HEALING
AND NUTRITION
• Diabetes
• Renal diseases
• Obesity
• Altered mental status
• Functional limitations
 PRESSURE ULCERS
• key survey issues
• Inadequate nutrition
• Weight loss
• “continuing weight loss and failure of a pressure
ulcer to heal, despite reasonable efforts to improve
caloric and nutrient intake, may indicate that the
resident is in multisystem failure or in an end-stage
or end-of-life condition warranting an additional
assessment of the resident’s overall condition.”
 NUTRITIONAL ASSESSMENT
Assessment review
• Health and medication history
• Physical examination
• Anthropometric(he measurement of the size and
proportions of the human body.) measurements
• Laboratory data
• Nutritional assessment precedes the
implementation of a care plan, intervention,
monitoring, and evaluation.
 KEY NUTRIENTS NEEDED FOR
WOUND HEALING
• Calories
• Carbohydrates
• Proteins
• Fat
• Fluids
• Vitamin C
• Minerals: zinc and copper
• Calories
• Supply adequate energy, prevent weight loss,
preserve lean body mass
• Carbohydrate, protein, and fat, with
carbohydrate and fat the preferred sources
• Carbohydrates
• Deliver energy, spare protein
• Grains, fruits, and vegetables,
• with complex carbohydrates the
• preferred source
 PROTEIN REQUIREMENTS ARE
AFFECTED BY:

• Loss of efficiency in protein turnover

• Increased need to heal wounds, surgical
incisions, repair ulcers, make new bone
• Infection
• Immobilization
• Protein requirements for older adults is 1 g/kg
body weight
• Protein is necessary to make new tissue, fight
infection, heal fractures
• Protein needs may be as high as 2+ g/kg body
weight
• Fat
• Most concentrated energy source carrying the fat
soluble vitamins Provides insulation under the skin
and padding for bony prominences
• Meats, eggs, dairy products, and vegetable oils
• Fluids
• Solvent for minerals and vitamins, amino acids,
and glucose. Help maintain body temperature and
transport materials to cells and waste products
from cells.
• Water, juices, and other beverages; fruits and
vegetables contain approximately 95% water.
 OTHER FACTORS
• Energy needs increase with demands for wound
healing, fracture repair, infection response
• To maintain weight, 20-25 kcals/kg body weight is
usually adequate in a relatively sedentary adult
• For stress, wound healing, infection, fracture,
energy needs may increase to as much as 35
kcals/kg body weight
• Vitamin A is needed for cell differentiation
 VITAMIN C
• Decreases seen with chronic disease including
atherosclerosis, cancer, senile cataracts, lung
diseases, cognition, and organ degenerative
diseases
• Vitamin C is easily replaced
• Vitamin C is important in wound healing
because of its role in hydroxylation but tissue
saturation is achieved easily and large doses
are excreted in urine
 Minerals: zinc
and copper
• Inorganic, non-caloric nutrients
• Zinc is a co-factor for collagen formation,
metabolizes protein, and assists in immune function
• Copper assists in the formation of red blood cells
and is responsible for collagen cross-linking and
erythropoiesis
• Zinc: meats, liver, eggs, and seafood
• Copper: nuts, dried fruit, organ meats, dried beans,
whole grain cereal
 Malnutrition in Wound Healing
• Malnutrition has a negative effect on wound
healing
• Malnutrition increases the chances of
infection
• With malnutrition the wound strength is
decreased
• The healing time for individuals who are
malnourished is prolonged
• Malnutrition is especially prevalent in the
elderly
Pressure Ulcer Management:
Quick Tips
 Wound Priorities
Cause Cause Cause
Establish goal
Systemic factors
Environmental modifications

Then
Optimize wound
 Interventions
• Reduce or eliminate
– Shear / friction
• Moisture /
Incontinence
• Pressure
 Support the Host: Evaluate Systemic
Factors
• Tissue Perfusion
• Nutrition
• Infection
• Medications
• Diabetes
• Aging
 Basic Principles to Optimize the Wound:
Which dressing?!
• M oisture
• I nfection
• N ecrtoic tissue
• D eadspace
• P rotect
• I nsulate
• E xudate