Nutritional Assessment

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.

By Emily Greenstein, APRN, CNP, CWON, FACCWS

After attending the Spring Symposium for Advanced Wound Care and hearing many great lectures, I got to thinking, “What are the pillars of chronic wound care?” We have all heard of the concept “look at the whole patient and not the hole in the patient.” Heck, I have even written about it. But we also need to have a good foundation for how to implement this phrase or where to even start. I did a quick Internet search and came up with some interesting articles that talked about the basics of wound care and management. I found discussions on everything from maintaining a moist wound environment to being financially responsible. All of this information leads me to the concept of developing easy-to-understand pillars or categories to consider when caring for a patient with a chronic wound.

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

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).

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.

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.

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."

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.

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.

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.

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.