Nutritional Supplements

Michael Miller's picture

By Michael Miller DO, FACOS, FAPWCA, WCC

As we enter this New Year, I have several resolutions which I hope will act as a sextant for my upcoming wound care voyages. I promise to be less critical of my colleagues who do horrendous, insipid, unprofessional, unethical, unintelligent, profit-motivated things to patients in the name of good care…OK, maybe not. I have promised to continue my Sinbad-like voyage to find my much sought after ball-laden juggler for whom to send my much needed debridements and IV port placements. I understand that surgeons prefer to evaluate patients before elective procedures to assure that they have no potential problems and that they are low risk candidates for the requested procedure. But asking a 300 lb. paraplegic to come in to a poorly accessible office to vet them and then schedule them days later rarely identifies a reason to defer on the procedure but moreover, places the patient, their family and others at high risk and considerable inconvenience. Can you not arrange to see them early and help them later the same day?

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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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

Fat-soluble vitamins A, E, and K dissolve in fat and are transported in the body attached to lipids and require pancreatic enzymes and bile for absorption. They are stored in the liver and fatty tissue, which is why an excess concentration of fat-soluble vitamins can be toxic. When blood concentrations of fat-soluble vitamins decline, the body simply retrieves them from storage. Individuals with pancreatic insufficiency, cirrhosis or malabsorption syndrome may have low concentrations of fat-soluble vitamins. Consuming sources of fat-soluble vitamins daily is not necessary, but average intake of these vitamins consumed over time is beneficial. The impact of these fat-soluble vitamins in the management of wounds and other conditions will be discussed.

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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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Mary Ellen Posthauer's picture

By Mary Ellen Posthauer RDN, CD, LD, FAND

In addition to providing calories and protein to promote wound healing, fluid intake is equally important. Achieving hydration needs and preventing dehydration, a risk factor for pressure ulcer development due to its effect on blood volume and skin turgor, is vital.

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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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