Nutritional Assessment

Ryan Cummings's picture

By Ryan Cummings, FNP, CWS

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.

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The Alliance of Wound Care Stakeholders's picture

By Catherine D’Andrea, RDN, LDN, and Marcia Nusgart, RPh

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.

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Heidi Cross's picture
Nutrition Management

By Heidi Cross, MSN, RN, FNP-BC, CWON

"Defendants failed to provide adequate nutrition to prevent plaintiff from suffering severe malnutrition and weight loss. This allowed the development of a severe pressure ulcer, numerous infections, and dehydration and malnutrition. Had defendants provided proper care, the pressure ulcer, infections, and malnutrition and dehydration would not have occurred."

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Heidi Cross's picture

By Heidi Cross, MSN, RN, FNP-BC, CWON

In the previous blog, I briefly went through the standards of care when it comes to nutrition and pressure injury (PI) prevention and development and discussed what a large role nutrition plays in PI litigation. Here are several instances: Punitive damages of $92 million, later lowered to $11,855,000, were imposed where malnutrition and dehydration were proven against a nursing home. A dietary manager for a nursing home told state surveyors that her nursing home had "dropped the ball" on a resident's nutrition needs when that resident had lost 17 pounds in 75 days; a $1,385,000 settlement was reached. Malnutrition with a loss of 27% of body weight in 15 months led to a $380,000 settlement just before trial. Shocking, isn't it? It literally "pays" to pay attention to nutrition standards of care.

Heidi Cross's picture

By Heidi Cross, MSN, RN, FNP-BC, CWON

Pressure injury risk and development are multifactorial, individualized processes. Each patient presents with a unique set of circumstances and needs. In looking at charts for attorneys to determine whether standards of care related to pressure injuries have been met, key elements include turning and positioning measures, support surfaces, mobility, proper and timely assessment of risk factors and wounds, physician communication and notifications, communication with family, proper wound treatments, and nutrition assessment and measures.

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Fabiola Jimenez's picture
Nutrition Management

Fabiola Jimenez, RN, ACNS-BC, CWOCN

While I was providing foot care to a patient, one of my coworkers overheard me advising the patient that she will need a lot more protein to heal her wound, and some changes to her diet will be necessary and therefore tighter control of her blood glucose and improved hemoglobin A1c. Later, I was approached by a coworker who told me: "Because you are not a Registered Dietitian, you cannot discuss dietary needs with the patient." I disagree.

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WoundSource Editors's picture
Edema

By the WoundSource Editors

Edema is the abnormalaccumulation of excess fluid within tissue. The swelling associated with edema can be localized to a small area following an acute injury, it can affect an entire limb or a specific organ, or it can be generalized throughout the entire body. Edema is not a disease, but rather a symptom that can indicate general health status, side effects of medications, or serious underlying medical conditions.

Nancy Munoz's picture
Arginine

by Nancy Munoz, DCN, MHA, RDN, FAND

Pressure injuries (pressure ulcers) claim over 60,000 lives and affect over 2.5 million Americans each year. The US health care system spends $9.1–11.6 billion annually in the treatment of pressure injuries. Aside from the financial cost, pressure injury is a devastating health concern that affects quality of life and well-being.

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Emily Greenstein's picture
Wound Care

by Emily Greenstein, APRN, CNP, CWON, FACCWS

"When I grow up, I want to be a wound care specialist." That's not something you hear kids going around saying. Sure, kids want to be doctors or nurses. But wound care specialist?

When you think about it, being a wound specialist is not a glamorous position, unlike being a neurosurgeon. The best quote that I ever heard from a colleague of mine was, "No one wants to do wound care; wound care isn't sexy." This may be true, but what is wound care then? To me it is ever changing, it is learning new things (most of which are not found in text books), and it is about helping patients heal both emotionally and physically from a chronic condition.