Week 1 | Role of Nutrition and Wound Healing (17180)

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Topics

Nutritional needs for wound healing

  • Types of physiologic processes requiring nutrients

Impact of malnutrition on healing

  • Delays in important healing processes, tissue synthesis
  • Prolongation of inflammatory phase
  • Reduces wound strength
  • Increased risk in some patients for pressure ulcers

Patients at risk for malnutrition

  • Specific populations at risk
  • By clinical site or type of illness/health condition

Nutrients required for healing and role in healing

  • Protein
  • Carbohydrates
  • Fats

Protein

  • Needed for all stages of healing
  • RDA for healthy adults is 0.8g/kg/day
  • Older adults 1.0g/kg/day
  • For healing 1.25-1.5g/kg/day (chronic wounds)
  • Needs may increase for multiple wounds or severe wounds →→ consult nutritionist

Arginine and Glutamine

  • Arginine
    • Wound breaking strength; immune function, protein precursor
  • Contained in standard enteral formulas; wound healing may require higher levels
  • Glutamine 
    • Primary fuel in gut mucosa; utilized by fibroblasts, lymphocytes, epithelial cells, stimulates HGH release

Carbohydrates (CHO)

  • CHO convert to glucose
  • Energy supplier for repair: phagocytosis and collagen synthesis
  • Normal glucose levels are important for repair
  • Adequate CHO and glucose prevent protein breakdown

Fats

  • Injury increases need for fats
  • Needed in inflammatory responses to injury
  • Fatty acids are important in both inflammation and anti-inflammatory responses
  • Omega 3 fatty acids and omega 6 fatty acids have different effects
  • Omega 3- improved immune fx, less infection (Burns)

Specific Nutrients: Vitamins

  • Vitamin C - Ascorbic Acid
    • Proline and lysine hydroxylation
    • Maintenance of wound integrity
    • Leukocyte/Fibroblast function
  • Stores deplete quickly after acute injury
  • Deficiency, minor wounds: 100-200mg/day
  • Complex wounds: 1,000 -2,000mg/d
  • Specific Nutrients: Vitamins

Vitamin A

  • Inflammation
  • Epithelialization
  • Collagen
  • Wound Closure
  • Counteractive Effects: Glucocorticoids by improved immune/inflammatory responses
  • Daily recommended intake for healthy adults: 2310-3333 IU/day
  • 10,000-50,000IU/day for 10 days (severe injury)
  • 10,000-15,000IU/day for 10 days (chronic steroid) 

Trace Elements and Minerals

  • Magnesium
    • Enzyme cofactor
  • Zinc
    • Metalloenzymes, protein synthesis; deficiency impairs healing
  • Iron
    • Proline and lysine hydroxylation; oxygen transport
  • Copper
    • Metalloenzymes; collagen cross-linking

Assessing for Nutritional Needs

  • History
  • General Health Status
  • Height/weight, BMI (kg/M2)
  • Anthropometric Measures
  • Weight
  • Mid arm circumference
  • Skin fold measure
  • Nutritional Screen
  • Malnutrition Screening Tool
  • Short Nutritional Assessment Questionnaire

Nutritional Assessment

  • Physical appearance
  • Skin, hair, muscle strength
  • Laboratory
    • Protein Stores
  • Albumin <3.5g/dl (3.5-5.0 g/dl)
  • Pre albumin <19.5 g/dl (19.5-35.8 g/dl)
    • Immune Competence

Timing of Nutrition

  • Surgical patients
  • Early postoperative enteral immunonutrition
  • Immunonutrition reduces SSI and complications
  • High risk non-surgical patients
  • Oral nutrition supplements reduced pressure ulcers in high risk patients (elderly and LTC)

Nutritional Therapies: Timing and Route

  • Timing of Nutritional Support
    • Delays in feeding associated with decreased wound strength
    • Preoperative and early postoperative repletion are beneficial 

Route of Nutritional Support

  • Enteral versus parenteral
  • If the gut works, use it!

Special Populations: Pressure Ulcers A population at risk:

  • Weight loss, low BMI, inadequate intake
  • Early assessment
  • Admission and with condition change
  • Further evaluation as indicated
  • Other steps
  • Calories and macronutrients, fluids, supplements
  • Micronutrients-IF deficient

Objectives for Learning Outcomes

After completing this session, you will be able to:

  1. Identify specific nutrients that are important for normal healing. 
  2. Discuss how malnutrition influences healing. 
  3. Describe patients who are at high risk for nutritional deficits. 
  4. List four factors that can be assessed to identify nutrition problems. 
  5. Discuss nutritional care for people at risk for pressure ulcers.
Course summary
Available: 
04/07/2017
Expires: 
07/02/2018

JoAnne Whitney, PhD, RN, CWCN, FAAN
Associate Dean for Research and Professor, Department of Biobehavioral Nursing and Health Systems, University of Washington School of Nursing; Harborview Medical Center Research Scientist and Endowed Professor in Critical Care Nursing, Seattle, WA

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