Nutrition plays an important role in the management of wounds like diabetic ulcers or bedsores. Wounds of this type can require lengthy and ongoing treatment, lasting years, and some may never heal during the patient's lifetime. Adequate protein provides the essential building block of every cell in the body. Adequate calories provide the body with the energy it needs to work effectively. Certain vitamins and minerals affect healing, specifically vitamin C, vitamin A and zinc.
Benefits
Providing targeted nutrition for wound management provides the body with the raw materials it needs to accomplish healing. Proper nutrition helps maintain immune function and reduces the risk of infection, a serious concern in patients whose ability to heal and immune status may already be compromised. According to the Northern Health and Social Services Board (NHSSB), malnutrition is associated with both delays in wound healing and the development of complications.
Assessment
Any patient at risk for chronic wounds or pressure ulcers needs a nutritional assessment. A basic nutritional assessment includes laboratory tests for albumin, prealbumin, transferrin, electrolytes, white blood cells and hemoglobin levels, and determining intake of adequate calories, protein, fluids and vitamins and minerals. If laboratory tests indicate inadequate intake of vitamins and minerals, supplements are often prescribed including vitamin C (1000mg daily) and zinc (50mg daily). Any patient with chronic wounds, wounds that are slow to heal or arterial and venous leg ulcers should be screened for diabetes.
High Risk
There are several groups of patients at high risk for nutritional deficiencies that may compromise wound healing. According to NHSSB and Wound Care Canada, these groups include patients who have chronic infections, poor oral intake, a loss of 5 percent or more of their initial body weight, problems digesting and absorbing nutrition or who are on home enteral (tube) feeding. Patients who have recently had surgery, who are losing skin integrity, who are diabetic or who already have chronic ulcers, slow healing wounds or high exudate wounds are also at high risk. Patients who have diabetes are monitored for control of blood sugar levels; elevated blood sugar levels inhibit healing.
Identification
Nutritional intake needs vary based on the severity of the wound or the risk of developing a wound. Protein intake needs vary from .8 to 3g of protein daily per kilogram of body weight. Caloric intake needs vary from 30 to more than 40 calories daily per kilogram of body weight. Fluid intake needs vary from 30cc to 40ml daily per kilogram of body weight.
Theories/Speculation
Research involving optimal nutrition for wound healing is ongoing. Three studies, published in 2009, explored the roles of nutrition in wound healing. Researchers at Balmain Hospital in Australia published the results of their work, showing micronutrients may play an important role in wound healing. Researchers at Hospital das Clinicas in Brazil published the results of their work on the implications of improving nutritional intake before surgery to improve healing. Researchers at University of Milan, Italy published the results of their work, adding arginine to the nutritional supplements for patients with pressure ulcers.
