Nutrition Management

Education is key in sustained positive outcomes and it is the first step in understanding pressure injury prevention, for both patients and staff. It's very difficult to hold people accountable for something that they did not know. Therefore, prevention starts with education. For education to be impactful, it should also be fun. Interactive games, small prizes or candy, and engaged and energetic educators are key to fostering an environment where people will remember what they are taught. The teach-back method and continued follow-up and reinforcement are also essential elements of a successful education plan.

By Ivy Razmus, RN, PhD, CWOCN The very old and the very young are more alike than you might think when you consider risk for skin injuries. They are alike regarding their limited sensory perception, mobility, and activity. They are also alike in their potential for inadequate nutrition and their skin's supporting structures (muscle, collagen and elastin). These similarities place them at greater risk for pressure injuries.

Malnutrition is a leading cause of morbidity and mortality, especially among older hospitalized adults, yet it often goes undiagnosed and therefore untreated. It has been established that malnourished hospitalized patients experience slower wound healing, higher risks of infection, and longer length of stay. Malnutrition is a burdensome condition associated with a 34% higher cost for a hospital stay compared with a non-malnourished patient. Sufficient macronutrients (carbohydrates, protein, fats, and water) and micronutrients (vitamins and minerals) are vital for the body to support tissue integrity and prevent breakdown. Research supports that weight loss and difficulties with eating can increase the incidence of pressure injuries.

Wounds have a significant negative impact on patients, including pain, decreased quality of life, and social isolation. Optimal wound healing can help patients and the health care system cope with the burden of chronic wounds. Wound management may not always be the priority in patients whose cases are complicated by severe comorbidities, palliative care, hospice care, surgery, chemotherapy, radiation, or management of a chronic condition.

As detailed in my last few blogs, nutrition plays a huge role in risk for skin breakdown as well as healing of wounds. Just about ALL wound litigation involves nutrition in one way or another, be it diabetes control (or lack thereof) or weight loss, which occurs often in patients with dementia and toward end of life, or general malnutrition.

The following is a wrap up of the 2019 pressure injury guidelines of the National Pressure Injury Advisory Panel (NPIAP)1 related to nutrition, of which there are 15. For guidelines #1 to #10, see my last few blogs (Parts 1, 2, 3 of this blog series).

As clinicians know, wound healing is a complex biological process that involves the migration and proliferation of cells along with other molecular events like extracellular matrix deposition. Regardless of the process for healing a wound at the cellular level, a patient’s ability to get adequate nutrition can also play a role in this healing process. It has been shown that malnutrition can cause increased levels of infection, along with a decrease in tensile strength. As a result, the lack of nutritious foods further delays the wound healing process, potentially putting a patient at risk of developing a non-healing wound.

The human body possesses an amazing ability to heal itself, if given the right nutrients to carry out the necessary biologic processes involved. The need for nutritional assessment and support is critical for both acute and chronic wound healing and prevents an impaired immune defense that results in infection. Dietary intake must meet the increased demands of the body for recovery from the break in skin integrity. Nutrition in general is often overlooked when assessing healing potential in a patient’s plan of care.

Appropriately balanced nutrition is a cornerstone of high-quality wound care, and this isn’t a new revelation. Nearly all modern wound centers include some version of nutritional screening, along with ever-expanding recommendations regarding overall protein intake, complex carbohydrate needs, and micronutrient supplementation as clinical evidence for these is presented.