Nutr in Wounds

•

•Lean losses compromise body functions:

–10% loss = increased infection,
impaired immunity

–20% loss = decreased healing, weakness, infections,
thinning of skin

–30% loss = cannot sit up, pressure sores
develop, pneumonia is common,
no healing occurs

–40% loss = Death

We know that as the body loses this type of tissue, its function becomes impaired. Let’s take a reference 170 pound man who may have around 130 pounds of lean tissues, including water, muscle, organs, bones, collagen, and the like. At a loss of around 12-13 pounds, his immune function will be impaired and he is more likely to have an infection. At a loss of around 25 pounds, the body tries to maintain an equilibrium between survival and healing. He simply cannot properly heal and will experience significant weakness, infections, and a thinning of the skin. At around 38 pounds of weight loss from baseline, the body abandons efforts to heal in pursuit of survival. He can no longer sit up, has difficulty swallowing and breathing, develops pressure sores that won’t heal. In fact, at this level of loss the body swings into full preservation and survival mode and stops any healing process altogether. At 40% loss the body can no longer function and death will ensue, usually as a result of pneumonia.

If a person starts out with protein-energy malnutrition or PEM, we can usually predict that healing will not occur quickly and completely unless aggressive efforts are made to restore nutritional status to a level where healing can be prioritized by the body.

Nutrient Needs During Healing

•Increased needs:

–Fluids

–Calories

–Protein

–Micronutrients

•Vitamins

•Minerals

This leads us to what the body needs during healing. Wounds generate heat and sometimes drain, increasing losses of fluids and the need to replace fluids. Because of the hypermetabolism, the body will require more than the usual amount of energy or calories. Because of catabolism, the body will require more than the usual amount of protein to reduce the erosion of the body’s protein stores. Wounds that drain fluids may also cause additional losses of protein that should be compensated for through dietary intake. And, in order for all of those processes to proceed, the body will require greater amounts of some vitamins and minerals as both catalysts and substrate for wound healing to successfully occur.

Nutrition Assessment

•Factors to consider:

–Baseline nutritional status
factors that affect
nutritional status

–Wound: location, type,
severity and stage

–Presence of diabetes
and other complicating
conditions

–Dietary intake

But first, we should find out about the individual patient’s nutritional risk. While there are many things to consider in assessing a patient, baseline and changes in nutritional status are key factors in determining the types of compromise that the patient may be experiencing. Weight, weight changes, body mass index, and indicators of the severity of the acute phase process, such as laboratory values of albumin, white blood cell counts, and others may be helpful to determine the need to feed the acute phase and maintain or restore body tissues.

Any pre-existing condition that can compromise nutritional intake will be especially important to consider during wound healing. The acute phase response that occurs with significant wounds can lead to a reduced appetite, which can further compromise nutritional status at a time when nutrient needs are higher.