Nutritional Assessment

Michael Miller's picture

RAMBLINGS OF AN ITINERANT WOUND CARE GUY, PT. 18

By Michael Miller DO, FACOS, FAPWCA, WCC

One of the problems with writing a blog is not the lack of material on which to vent, vex or vociferate. Rather, I deal with the much desired situation in which there are simply so many aberrancies that appear before my now trifocaled vista, that I have to decide which of many potential entities to offend.

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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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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”.

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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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