Nutritional Assessment

Michael Miller's picture

By Michael Miller DO, FACOS, FAPWCA, WCC

Life is 10% reality and 90% perception. There are many conundrums in wound care that may never have an answer. How can one product produce remarkable healing for one caregiver and yet is, in the hands of another, lackluster. Fortunately, one of the unquestionable constants in the vast universe of wound care is that wounds do not heal in the face of abject starvation. For all the hype of the essential nature of nutrition to wound healing, let’s face it, most people pay lip service to the topic and nothing more. Of course, there are entities lurking about in hospitals, long-term care, and high school cafeterias who profess to hold one of the keys to healing. Like many secret societies, their methods and actions are steeped in ancient rituals and secret handshakes passed down from generation to generation. In our society, they are better known by the title, dietician.

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Mary Ellen Posthauer's picture

By Mary Ellen Posthauer RDN, CD, LD, FAND

The NPUAP/EPUAP Pressure Ulcer Prevention and Treatment Guidelines published in 2009 have been widely circulated around the globe and translated into 17 languages. Successful implementation of any guideline requires a "buy-in" by all the members on the interprofessional team. As a member of the wound care team at a long-term care facility, I participate in weekly wound care rounds. Prior to our meeting, the wound care nurse has measured the wounds and documented them on an information sheet that also includes the type of wound (pressure vs. circulatory etc.) plus support surfaces and nutrition interventions.

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Mary Ellen Posthauer's picture

By Mary Ellen Posthauer RDN, CD, LD, FAND

Did you ever notice that 4 or 5 of the ten most popular New Year's resolutions involve food? We either want to eat more or less of certain foods, usually in an effort to lose weight or improve our appearance with exercise and diet. What about your clients who visit your wound care clinic and are struggling to heal chronic wounds? What advice should you give them? Your advice should be practical, achievable and cost-effective for them. Consider these options for your resolutions in guiding your patients in their own:

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Mary Ellen Posthauer's picture

By Mary Ellen Posthauer RDN, CD, LD, FAND

Microbiota are living organisms that coat the lining of the stomach, small intestine and the colon, which has the highest concentration. They serve as the front line of defense by protecting against incoming microbes, modulating the immune system, exerting anti-inflammatory activity and maintaining intestinal cell activity. While many factors disturb the intestinal microbiota such as age, stress, and poor hygiene, the wide spread use of broad-spectrum antibiotics has led to the increase and severity of Clostridium difficile (C. diff). C. diff is a spore-forming bacterium that releases toxins in the intestine, causing mucosal inflammation, intestinal damage and diarrhea.

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Mary Ellen Posthauer's picture

By Mary Ellen Posthauer RDN, CD, LD, FAND

Frequently I am asked to review medical records to determine if an individual’s pressure ulcers failed to heal because of inadequate or inappropriate nutritional care. The majority of the cases involve long-term care facilities and the patients are older adults who had unintended weight loss (UWL) and pressure ulcers. After devoting 35 years as a consultant dietitian to nursing homes, I am well aware of the challenges faced by providers as they strive to provide care for our frail elderly.

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Mary Ellen Posthauer's picture

By Mary Ellen Posthauer RDN, CD, LD, FAND

Since we are fast approaching the deadline for the national elections, I decided to join the fray and campaign for accurate completion of the Braden Scale nutrition sub-score. The Centers for Medicare and Medicaid Services (CMS), Minimum Data Set (MDS) 3.0 Section M, Skin Conditions requires pressure ulcer risk assessment. Nursing facilities may use a formal assessment instrument such as the Braden or Norton tool to determine pressure ulcer risk. The most commonly used pressure ulcer assessment tool is the Braden Scale and one of the sub-scales is nutrition. Studies completed by Bergstrom and Braden in skilled nursing facilities found that 80% of pressure ulcers developed in two weeks after admission and 90% within three weeks of admission.

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Lydia Corum's picture

By Lydia A Meyers RN, MSN, CWCN

I have been thinking for awhile about what to do for this month’s blog. During the time I worked for CTI nutritional I realized that many wound care nurses, including myself, are not well trained in nutrition. I also noted the impact that nutrition has on patients and their quality of life.

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Mary Ellen Posthauer's picture

By Mary Ellen Posthauer RDN, CD, LD, FAND

During the wound healing process, aggressive nutritional support can reverse the body's hypermetabolic state, which occurs when lean body mass is used for energy rather than tissue repair. When energy stores are rapidly depleted in a healthy adult, this can lead to acute malnutrition. In the already compromised individual, however, it can lead to severe protein-calorie malnutrition. Malnutrition increases the risk of morbidity and mortality, and decreases function and quality of life. When the return to the previous quality of life is anticipated, individuals with continued compromised intake along with the burden of increased nutrient needs from stress and chronic wounds may benefit from enteral nutrition (tube feeding). Parenteral nutrition should be used only when the GI tract is not functional, cannot be accessed, or when the individual cannot be adequately nourished by enteral nutrition.

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Mary Ellen Posthauer's picture

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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