Nutrition

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By Mary Ellen Posthauer RDN, CD, LD, FAND

My first year in practice, I volunteered with the local dietetic association when they launched “Dial a Dietitian”. The goal of the program was to capture the attention of the community and encourage people to phone a dietitian and seek help to solve their nutritional problems.

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By Mary Ellen Posthauer, RDN, CD, LD, FAND

Fat-soluble vitamins A, E, and K dissolve in fat and are transported in the body attached to lipids and require pancreatic enzymes and bile for absorption. They are stored in the liver and fatty tissue, which is why an excess concentration of fat-soluble vitamins can be toxic. When blood concentrations of fat-soluble vitamins decline, the body simply retrieves them from storage. Individuals with pancreatic insufficiency, cirrhosis or malabsorption syndrome may have low concentrations of fat-soluble vitamins. Consuming sources of fat-soluble vitamins daily is not necessary, but average intake of these vitamins consumed over time is beneficial. The impact of these fat-soluble vitamins in the management of wounds and other conditions will be discussed.

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By Mary Ellen Posthauer RDN, CD, LD, FAND

One component of the nutritional assessment process in wound care is reviewing and evaluating biochemical data. In a previous blog I discussed the relationship of albumin and pre-albumin (transthyretin) to nutritional status. Many lab values are affected by hydration status and/or medications, which may increase or decrease levels.

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By Mary Ellen Posthauer RDN, CD, LD, FAND

Last month I discussed the importance of implementing a system for screening the nutritional status of individuals. When the screening tool triggers nutrition, timely referral is critical. Each facility should establish the appropriate time frame for completion of a nutrition assessment. For example, is 24 hours appropriate in acute care and seven days in a skilled nursing facility? Establish a time frame appropriate for your facility and adhere to it.

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By Mary Ellen Posthauer RDN, CD, LD, FAND

Since undernutrition is considered a reversible risk factor for pressure ulcer development, then early detection and management of undernutrition is essential.

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By Mary Ellen Posthauer RDN, CD, LD, FAND

In addition to providing calories and protein to promote wound healing, fluid intake is equally important. Achieving hydration needs and preventing dehydration, a risk factor for pressure ulcer development due to its effect on blood volume and skin turgor, is vital.

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By Mary Ellen Posthauer RDN, CD, LD, FAND

Previously, I discussed the value of protein for wound healing. Protein is responsible for cell multiplication, repair, and synthesis of enzymes involved in wound healing. Protein supplies the binding material of skin, cartilage, and muscle. The 2009 National Pressure Ulcer Advisory Panel/European Pressure Ulcer Advisory Panel (NPUAP/EPUAP) guidelines recommend 1.2-1.5 grams of protein/kilogram of body weight for individuals with pressure ulcers, when compatible with goals of care.

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Nutritional Supplements

By Mary Ellen Posthauer RDN, CD, LD, FAND

The protein in the food we eat supplies the body with the amino acids necessary to make its own protein. There are certain amino acids that the body cannot produce, and some that are unable to be made fast enough to meet the body’s needs. The nine amino acids that must be supplied from the protein in foods are called “essential” or “indispensable” amino acids.

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By Mary Ellen Posthauer RDN, CD, LD, FAND

The role of protein in wound healing has been documented in many studies with the focus on offering high calorie, high protein supplements in addition to diet. Protein is responsible for cell multiplication, repair, and synthesis of enzymes involved in wound healing. Protein supplies the binding material of skin, cartilage, and muscle. In wound cases, research supports offering protein above the traditional 0.8 grams/kilogram of body weight recommended for the healthy adult.

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