Wound Care & Nutrition
By Kellie Kirsch, Dietetic Intern
Pressure wounds can be defined as a localized injury to the skin and/or underlying tissue, usually over a bony prominence, that results from pressure. As we age, there are changes that naturally occur in the skin. Some of these changes include loss of skin elasticity, moisture, reduced feeling, and thickness. While skin aging can be a factor that contributes to pressure wounds in residents, they can also be multifactorial. Other factors that can contribute to pressure wounds include activity and mobility limitations, poor nutritional status, factors affecting perfusion and oxygenation, certain drugs, impaired blood flow, friction, and poor general health.
Good nutritional status is important for wound healing. The body needs extra protein, calories, water, and micronutrients to help prevent further skin breakdown. There are several nutrition-related factors that can contribute to the progression of pressure wounds. These include anemia, protein deficiency, dehydration, obesity, being underweight, and malnutrition. Residents who are experiencing problems chewing, swallowing, and independently eating are at a greater risk for poor nutritional status. The National Pressure Ulcer Advisory panel has set guidelines to help determine evidenced based recommendations for the prevention and treatment of pressure ulcers.
A thorough nutrition screening and assessment helps to determine the residents’ specific needs and from there practioners are able to develop an individualized care plan. Nutrition recommendations for pressure wounds can be broken down into four groups. Energy intake, protein intake, hydration, and micronutrients.
Energy Intake: Energy intake should be based on underlying medical conditions and level of activity. 30-35 kcals/kg of body weight is recommended for residents with pressure wounds who are at risk for malnutrition. A liberalized diet may be recommended. A very restrictive diet may be less appealing to a resident and cause a low intake which does not support appropriate wounds healing. If a resident is still unable to meet their nutritional needs, a fortified diet can also be recommended.
Protein Intake: Recommendations for protein include 1.25-1.5 grams/kilograms of body weight for adults with a pressure wound or at risk for one. If a residents protein needs are still not being met, a high protein nutritional supplement is recommended. It’s important to assess renal function to ensure that a high level of protein is appropriate for individualized care. Lastly, studies have shown that a supplement with high protein, arginine and micronutrients have been shown to improve healing times in residents with stage III or IV pressure ulcers whose needs cannot be met with a regular high protein and calorie diet.
Hydration: Adequate fluid intake is encouraged in residents with pressure wounds. Residents experiencing vomiting, dehydration, sweating, and heavily exuding wounds may have increased hydration needs. It’s important to assess the residents’ conditions and goals to ensure hydration intervention is consistent with their needs.
Micronutrients: Encouraging a diet rich in good sources of vitamins and minerals is recommended for residents with pressure wounds. If estimated needs cannot be met or a resident has a known deficiency, supplementation is recommended. Micronutrients related to pressure wound healing include Vitamin C, zinc, and copper.
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Reference: Niedert KC. Nutrition Care of the Older Adult a Handbook for Dietetics Professionals Working throughout the Continuum of Care. American Dietetic Assoc; 2004.
