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By Mary Ellen Posthauer RDN, CD, LD, FAND

Food is a major part of our lives with strong emotional and symbolic implications that encompasses nurturing, cultural, religion, tradition and social values. Nutrition and hydration has an effective role in healing wounds, but cannot prevent an individual with co-morbid conditions at the end of life from suffering or imminent death. This concept is often difficult to explain to the individual and especially to the caregivers who view nutrition and hydration as essential for life.

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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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By Mary Ellen Posthauer RDN, CD, LD, FAND

Function/Recommended Dietary Allowance:

Zinc is an essential trace mineral for DNA synthesis, cell division, collagen formation, protein synthesis, and immune function - all necessary processes for tissue regeneration and wound repair. Zinc is necessary to develop and activate T-lymphocytes, which are important for the immune system. Alterations in immune function increase the risk of infection, especially in the elderly and the very young.

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By Mary Ellen Posthauer RDN, CD, LD, FAND

Metabolic Roles of Vitamin C

The major function of vitamin C (ascorbic acid) in wound healing is assisting in the formation of collagen, the most important protein of connective tissue. Vitamin C, a water-soluble vitamin found in water-filled foods, dissolves in water and is transported in the bloodstream. Excess amounts are excreted in the urine; however, since the body does not store vitamin C, food sources should be consumed on a regular basis. Vitamin C supplementation has been shown to increase tensile strength and collagen synthesis by assisting in the hydroxylation of lysine and proline, major constituents of collagen.

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