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Pressure Sores and Nutrition Cheat Sheet (DRAFT) by [deleted]

Preventing and healing pressure sores

This is a draft cheat sheet. It is a work in progress and is not finished yet.

Introd­uction

Good nutrition is essential to preventing and treating pressure sore ulcers. For Geriatric patients with pressure sores (wounds) a care plan should be in place and followed to provide for the care and healing of the Pressure Sores.

Tips

Conduct a nutrit­ional assessment upon admiss­ion, with each condition change change and when a pressure ulcer is not healing. Refer all residents with pressure ulcers to the dietitian for early assessment and interv­ention.

Dete­rmine residents’ weigh history and identify any signif­icant weight loss from usual body weight (>5 percent change in 30 days or >10 percent in 180 days}

Assess the Ability to eat indepe­nde­ntly. Provide assistance and/or special feeding devices when resident is impaired.

Assess total nutrient intake (food, fluid, oral supple­ments, entera­l/p­are­nteral feedings).

Provide sufficient calori­es. In general; a person with a pressure ulcer requires 30 to 35 Kcalor­ies/kg body weight. Modify any dietary restri­ctions that are causing the resident to decrease food and fluid intake. Provide enhanced foods or oral supple­ments between meals if needed.

Provide enough protein. Offer 1.25 to 1.5 grams protein/kg body weight for residents with pressure ulcers (when compatible with goals of care) Assess renal function to ensure that high levels of protein are approp­riate.

Enco­urage Hydrat­ion Monitor residents for signs and symptoms of dehydr­ation, which include: Changes in weight, skin turgor, urine output, elevated serum sodium or calculated serum osmola­lity.

Residents with elevated temper­ature, vomiting, profuse sweating, diarrhea or heavily draining wounds need additional fluid.

Enco­urage a balanced diet that includes good sources of vitamins and minera­ls. Offer vitamin and mineral supple­ments when dietary intake is poor or defici­encies are suspected or confirmed.
 

Nutrition

Incr­eased Protein
As the body is healing, creating and replen­ishing protein becomes very important. The advisory panel recommends following a high-p­rotein diet, including between 1.25 grams and 1.5 grams of protein per kilogram of body weight. This means that a 150-pound man should get between 85 grams and 102 grams per day. It may be necessary to add protein powders to beverages and casseroles or to drink protein shakes to get enough protein. In a 2005 study published in the "­Journal of Clinical Nutrit­ion­," resear­chers found that when patients did not consume the recomm­ended amount of protein, their pressure ulcer healed more slowly than those patients who got adequate protein.

Vitamins A and C
Vitamin A deficiency can cause impaired wound healing and may weaken the immune system, resulting in an increased risk for wound infect­ions. The Academy of Nutrition and Dietetics Evidence Analysis Library documented that between 10,000 and 50,000 intern­ational units of vitamin A per day may provide enhanced wound healing in injured patients. Vitamin A supple­men­tation should be monitored by a doctor due to the potential for toxicity. Vitamin C deficiency is associated with delayed wound healing. The Agency for Health Care Research and Quality recommends 1,000 milligrams to 2,000 milligrams per day of vitamin C for stage-3 and stage-4 pressure ulcers.


Zinc and Arginine
Zinc is an important mineral that creates collagen and protein and aids in immune function. The Academy of Nutrition and Dietetics Evidence Analysis Library recommends 50 milligrams of elemental zinc twice per day. The amino acid arginine is needed in higher amounts when the body is under stress. Arginine aids in wound repair and can be found as a powdered drink supple­ment. In a 2005 study published in "­Cli­nical Nutrit­ion­," patients who received an arginine supplement had a signif­icant improv­ement in pressure ulcer healing than those who did not. Talk with a doctor about how much zinc and arginine you need.