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Pressure ulcer is a localized injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure, or pressure in combination with shear.
Stage I-IV
Stage 1: Nonblanchable Erythema
Stage II: Partial Thickness Skin Loss
Stage III: Full Thickness Skin Loss
Stage IV: Full Thickness Tissue Loss
Unstageable: Depth Unknown
Normal Nutritional Status
At The Risk of Malnutrition
Malnutrition
1. Provide individualized energy intake based on underlying medical condition and level of activity.
2. Provide 30-35 kcal/kg body weight for adults at risk of a PrU/with a PrU who are assessed as being at risk of malnutrition.
3. Adjust energy intake based on weight change or level of obesity.
4. Modify dietary restrictions when limitations result in decreased food and fluid intake.
5. Offer fortified foods and/or high-calorie, high-protein oral nutritional supplements between meals if nutritional requirements cannot be achieved by dietary intake.
6. Consider enteral or parenteral nutritional support when oral intake is inadequate.
1. Provide adequate protein for positive nitrogen balance for adults assessed to be at risk of a PrU/with a PrU.
2. Offer 1.25-1.5 g protein/kg body weight daily for adults at risk of a PrU/with an existing PrU who are assessed to be at risk of malnutrition.
3. Offer high-calorie, high-protein nutritional supplements in addition to the usual diet to adults with nutritional risk and PrU risk, if nutritional requirements cannot be achieved by dietary intake. E.g. Resource 2.0
4. Assess renal function to ensure that high levels of protein are appropriate for the individual.
5. Supplement with high protein, arginine, and micronutrients for adults with a PrU.
1. Provide/encourage individuals assessed to be at risk of PrU/with a PrU to consume a balanced diet that includes good sources of vitamins and minerals.
2. Provide/encourage an individual assessed to be at risk of a PrU/ with a PrU to take vitamin and mineral supplements when dietary intake is poor or deficiencies are confirmed or suspected.
Vitamin C is an antioxidant and is necessary for collagen formation.
No solid evidence proved that VitaminC supplement affect on the PrU healing.
Vitamin C at physiological doses should be considered when dietary deficiency is diagnosed.
Zinc is a cofactor for collagen formation, an antioxidant, and is important for the synthesis of protein, DNA and RNA, and proliferation of inflammatory cells and epithelial cells.
Deficiency of zinc may be the result of wounds with increased drainage.
Copper deficiency may be harmful as copper is essential for collagen cross-linking.
1. Provide and encourage adequate daily fluid intake for hydration for an individual assessed to be at risk of / with a PrU. This must be consistent with the individual’s comorbid conditions and goals.
2. Monitor individuals for signs and symptoms of dehydration including change in weight, skin turgor, urine output, elevated serum sodium, and/or calculated serum osmolality.
3. Provide additional fluid for individuals with dehydration, elevated temperature, vomiting, profuse sweating, diarrhea, or heavily exuding wounds.
Healthcare practitioners assess the risks versus benefits of overly restrictive therapeutic diets, especially for older adults.
The type and amount of food and fluid ingested daily should be reviewed periodically to ensure that the individual actually consumes the number of calories estimated to meet nutrient needs.
Nutrition care plans need to optimize nutrition for healing of wounds while supporting other goals of medical care.
1. Posthauer M.E, Banks M, Dorner B & Schols. Jos M. G. A. The Role of Nutrition for Pressure Ulcer Management: National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance White Paper. Wolters Kluwer Health; 2015. (Available at PEN)
2. Becky Dorner & Associates. Nutrition Guidelines for Pressure Ulcer Prevention and Treatment. Dietitian of Canada. 2015. (Video)
3. National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers. Available onine: http://www.npuap.org/wp-content/uploads/2014/08/Quick-Reference-Guide-DIGITAL-NPUAP-EPUAP-PPPIA-Jan2016.pdf (accessed Feb 2018)(Available at PEN)