Nutritional Assessment

Michael Miller's picture

em>By Michael Miller DO, FACOS, FAPWCA

RAMBLINGS OF AN ITINERANT WOUND CARE GUY, PT. 12

There are many colloquialisms we use to describe a variety of situations. When someone appears to make a real commitment, we call it “full bore” or “going whole hog” or to use the gambling epithet, “all in”. Commitment is an important part of what we as health care practitioners stand for. You have all read ad infinitum, ad astra, ad mortem of my strongest belief that patients must take an equal role in their care. We provide the recommendations, the rationale and the risks (and benefits, of course) and they decide which of our offerings best suits their beliefs, their desires and for better or worse, their purses. The marketing profession has made millions of consumers purchase items they do not need based on the sex appeal of the turn of a phrase, changing a question of doubt into “iron clad”.

Mary Ellen Posthauer's picture

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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Mary Ellen Posthauer's picture

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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Mary Ellen Posthauer's picture

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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Mary Ellen Posthauer's picture

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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Mary Ellen Posthauer's picture

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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Mary Ellen Posthauer's picture

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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Laurie Swezey's picture

By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS

Patient care must always be centered holistically, considering the specific problem that the patient is being treated for, as well as all other factors that may affect patient wellbeing. Wound care is no different: in addition to wound assessment and treatment, all other considerations that may impact the patient must be taken into account. Such considerations may include social, psychological, physical, nutritional, and lifestyle factors. Overlooking one of these important realms may lead to non-adherence on the part of the patient, which in turn may lead to a non-healing, chronic wound.

Laurie Swezey's picture

By Laurie Swezey RN, BSN, CWOCN, FACCWS

Our eating habits are ingrained in us from an early age, and are often difficult to change. Eating is not only a physical necessity, but a social act that can have psychological components as well. As practitioners, we often know what our patients need to do to speed wound healing. Getting our patients on board, however, can be a challenge.

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Mary Ellen Posthauer's picture

By Mary Ellen Posthauer RDN, CD, LD, FAND

For many years clinicians have relied on serum proteins, such as albumin and pre-albumin, as markers of nutritional status. However, current research indicates that there is little data to support this practice. Albumin and pre-albumin (transthyretin) are acute phase proteins. The advent of the inflammatory process - including infection, trauma, surgery, burns, and other wounds - elicits the acute phase response. During this acute phase response, these proteins decline and are called negative acute phase reactants.

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