Nutritional Management

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medical records

By Mary Ellen Posthauer RDN, CD, LD, FAND

As Dr. Aletha Tippett noted in her December blog, following wound documentation standards can help clinicians avoid legal issues. Pressure ulcer litigation often involves pressure ulcers and weight loss.

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By Mary Ellen Posthauer RDN, CD, LD, FAND

For the past two years I have been involved in the research and development of the second edition of the Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. Members of the Pan Pacific Pressure Injury Alliance joined National Pressure Ulcer Advisory Panel (NPUAP) and European Pressure Ulcer Advisory Panel (EPUAP) in producing a document that could be used by health professionals around the world.

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By Janis E. Harrison, RN, BSN, CWOCN, CFCN

Monday came with expectations of fixing the problem. It wasn't to be. Daryl was weak and hated the NG tube in his nose and throat. I arrived early at his bedside and waited for the doctor to let us know what the plan of action would be for the blockage problem. I left to use the public restroom and missed the doctor's visit. No one quite new what the plan was when I questioned the staff. So I created my own plan. I made Daryl get out of bed and started walking him in the halls throughout the entire hospital. I did not want him to get any weaker and I wanted to see if the mobility would increase the gastrointestinal motility. He was not happy with me at first but with education and the explanation of why, he was more than willing to try.

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B Mary Ellen Posthauer RDN, CD, LD, FAND

Last month, I discussed the results of the NPUAP's 2014 "Unavoidable Pressure Injury: State of the Science and Consensus Outcomes" conference and their goal to establish a pressure ulcer registry for clinicians.

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By Mary Ellen Posthauer RDN, CD, LD, FAND

In 2010, experts at a consensus conference convened by the National Pressure Ulcer Advisory Panel (NPUAP):

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By Mary Ellen Posthauer RDN, CD, LD, FAND

During the past year, I have had the opportunity to collaborate with Dr. Steven Gale and a group of wound care specialists on the development of a standardized approach for treating chronic wounds, often considered the new global epidemic. The January 2014 issue of WOUNDS featured the strategy that organizes wound care using "wound warrior wisdom" to assist clinicians to dominate-wounds" . The idea is to train "wound warriors" who will use this approach to treat and manage wounds in any setting, acute care, long-term care, wound clinics or home care.

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By Mary Ellen Posthauer RDN, CD, LD, FAND

Today an increasing number of individuals follow a vegetarian diet either by personal choice or for religious or cultural beliefs. Some research indicates that those who follow a plant-based vegetarian diet (50% of all protein in the diet) tend to be healthier than those who do not. There are several variations of the vegetarian diet from a semi-vegetarian or flexitarian to a strictly vegan diet. Years ago, dietitians were taught that it was critical to combine complementary protein sources using an exact pattern within a meal to achieve the required amount of amino acids. However, current research indicates that as long as the daily requirements are met, the body is able to combine amino acids as needed. The challenge is achieving requirements for individuals with wounds who are consuming vegetarian diets.

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By Janis E. Harrison, RN, BSN, CWOCN, CFCN

My Path to Becoming a Wound, Ostomy and Continence Nurse

"What did I get myself into?" There were several times over the first 10 years of my 20 year marriage to a person with an ostomy that I had to ask myself that question. Then came the revelation of the old saying "if you can't beat 'em…. join 'em." I decided that after major problems my spouse had with several surgeries – which included ostomy revisions, fistulae, abscesses, and surgical wounds – I would need to learn much, much more if I was going to spend the rest of my life with my husband, Daryl, and his maladies.

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by Mary Ellen Posthauer, RDN, CD, LD, FAND

Several years ago when my nutrition blog began, I discussed the issue of relying on laboratory values – in particular albumin, pre-albumin and transthyretin – as markers of nutritional status. Recently, during a discussion of nutrition and wound care, a dietitian expressed her frustration with a surgeon who kept postponing corrective abdominal surgery until a patient's nutritional status improved, as evidenced by the albumin being in the normal range. However, the patient was receiving adequate calories per enteral feeding and had gained weight. The albumin level was not reflective of the nutritional status. This discussion prompted me to revisit the issue of serum proteins as markers of nutritional status.

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By Mary Ellen Posthauer, RDN, CD, LD, FAND

Lindsay Andronaco's blog, "How Can Wound Care Nurses Provide Culturally Sensitive Care" prompted me to reflect on similar situations that I have encountered in the nutrition arena. In particular, when individuals with non-healing wounds are either not ingesting or unable to ingest adequate calories to promote healing, the interdisciplinary team meets with the individual and/or caregiver or surrogate to discuss the consideration of enteral nutrition. While the burden and benefit of enteral nutrition is discussed, the team is often challenged by both the cultural and religious beliefs that impact the final decision. Consider this case study.

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