A Closer Look at the Role of Nutrition in Wound Healing
Nutrition plays a vital role in wound healing. As such, optimal wound healing requires for patients to have adequate nutritional status. These authors review nutrition recommendations and the role of registered dietitian/nutritionists.
Nutrition is a major determinant of health and also promotes physiological well-being. Good nutrition promotes functionality and is an effective approach to disease management.
It’s no wonder that food and nutrition play a major role in the prevention and treatment of pressure injuries. Assessment of and treatment for malnutrition needs an interdisciplinary approach. Nutrition deficiencies can be corrected once the underlying causes are identified.
Good nutrition status includes a well-balanced diet, adequate hydration, a stable healthy weight, and a body composition consistent with age and activity. The management of chronic diseases also has an impact on the healthcare provider’s ability to promote nutritional health. Many chronic conditions must be treated with medication, before diet can have a full impact.
About half of American adults—117 million people—have at least one preventable chronic disease. Research has found that many of these diseases correlate with subpar eating patterns and a lack of physical activity.1
The hallmarks of undernutrition and malnutrition include an imbalanced diet; dehydration; unplanned weight loss or weight gain; poor management of nutrition-related diseases with diet and medication; and a loss of muscle mass or fat due to diet, disease or medication.
How can we combat the adverse events of malnutrition? “Pre-habilitation” has shown numerous benefits.2 Preoperative lifestyle interventions such as exercise, nutrition, stress reduction, smoking cessation, and spirometer exercise can mitigate muscle loss. The low muscle mass, often seen in sarcopenia, correlates with increased morbidity and mortality.
To prevent pressure injuries due to malnutrition, the National Pressure Ulcer Advisory Panel Clinical Guideline, published in 2014, outlines the following nutrition recommendations:3
- Provide 30-35 calories per kilogram of body weight to estimate energy needs
- Protein needs should be calculated utilizing 1.25-1.5 grams of protein per kilogram of actual body weight
- Vitamins supplementation should be provided if deficiency is suspected or confirmed
- Minerals supplementation should be provided if deficiency is suspected or confirmed
- To calculate fluid needs, use one of two methods:1 mL/kcal consumed with a minimum of 1,500 mL/d or 30-35 mL/kg body weight
A focus on collaborative, patient-centered care includes the patient, family, MD/NP/PA and nursing, nutritionists, therapists and the community.4
The role for nursing as part of collaborative care for nutrition includes screening all patients admitted to the facility for malnutrition using a validated screening assessment tool.4,5 It is a good practice for nurses, and other members of the interprofessional team to taste oral nutrition supplements (ONS) to ensure they are palatable for patients, and also take note of both what and when patients eat (e.g., grazer vs. 3 meals a day).
The RDN should participate in wound care rounds or meetings. A nutrition-focused physical exam should be conducted by the RDN on all patients screened at risk for or with actual malnutrition. The nutrition diagnosis (if present) and the plan of care developed as part of the nutrition assessment should be shared with the team.
The nursing team must alert RDN of changes in wound healing. RDNs should work with wound care nurses to define individualized interventions for the patients. This includes utilizing ONS defined in the facilities formulary and fortified foods, and also encouraging nurses and other members of the team to be familiar with these products and tasting them. Changes in practice and research related to nutrition and pressure injuries should be reviewed and used to drive care. RDNs should talk with charge nurse about what wound care patients are eating and when, and all care takers should observe patients at mealtime.
In conclusion, in ensuring proper nutrition, it may be helpful to consider the way nursing, medicine, and nutrition care services communicate with each other. Focus on nurses’ use of nutrition screening tools and the way nutrition screening tool scores are disseminated to other healthcare professionals. Also consider the way decisions are made on which fortified foods and oral nutritional supplements are stocked.
Mary Litchford, PhD, RDN, LDN is the President of CASE Software & Books.
Nancy Munoz is a lecturer at University of Massachusetts Amherst, a freelance writer, and the assistant chief, nutrition and food services, at VA Southern Nevada Healthcare System, Las Vegas. She may be reached at dr.nmunozrd@outlook.com
“Nutrition Pearls” will be the subject of a session at SAWC Spring on May 17 in San Diego.
This was curated by WCLN editor, Brian McCurdy.
References
1. U.S. Department of Agriculture. Dietary Guidelines for Americans 2015–2020. Available at https://www.dietaryguidelines.govhttps://s3.amazonaws.com/HMP/hmp_ln/imported/2019-05/2015-2020_Dietary_Guidelines.pdf. Accessed August 19, 2019.
2. Prado CM, Purcell SA, Alish C, et al. Implications of low muscle mass across the continuum of care: a narrative review. Ann Med. 2018;50(8):675-693.
3. National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. Emily Haesler (Ed.). Cambridge Media, Osborne Park, Western Australia, 2014.
4. Litchford MD. Nutrition & Pressure Injuries: Putting the New Guidelines into Practice. CASE Software & Books, Greensboro, NC, 2016.
5. Tappenden KA, Quatrara B, Parkhurst ML, et al. Critical role of nutrition in improving quality of care: an interdisciplinary call to action to address adult hospital malnutrition. J Acad Nutr Diet. 2013;113(9):1219-1237.
