Malnutrition
This cycle will probably continue to spiral downward if good nutritional care is not implemented. Chronic wounds are more likely to occur in the elderly and chronically ill, who are also more likely to suffer from malnutrition.
How can nurses identify individuals who are malnourished or at risk of malnutrition?
It’s not that easy! The majority of nutritionally distressed, or even malnourished, patients don’t look that way So it is important to ask a few questions, such as: Have they experienced any recent unintentional weight loss? Have they experienced any recent decrease in food intake? If individuals answer yes to these questions, they are at high risk of malnutrition and should be referred to an accredited practising dietician for a full nutritional assessment and, if necessary, an intervention.
Individuals who are overweight or even obese may still be clinically malnourished due to recent poor nutritional intake and unintentional weight loss. Malnutrition in overweight individuals is just as detrimental as for people who are not overweight, as losses are usually related to body protein stores, not just fat.
There are a few nutrition risk screening tools that have been developed and validated. The Malnutrition Screening Tool (MST) was developed in Australia for use in acute hospitalised patients, but can also be used for residential aged-care clients.
A score of two or more indicates a risk of malnutrition and the need for a full assessment and/or intervention.
The nutrients of healing
Healing s complex, Put simply, it’s the process of replacing the injured tissue with new tissue, which requires energy (calories) and particular nutrients, but especially
Nurses are in the best position to assist patients regarding wound management and nutrition.
protein. Here are the key ingredients the body requires to heal. Protein is necessary in all stages of wound healing. Reviews of studies have found there may be enhanced healing with high-protein nutritional supplements.
Protein requirements may vary depending on an individual’s nutritional status and the size of a wound, but generally 1.5g protein! Kg/day is required.
Good sources of protein are meat, fish, eggs, dairy products (milk, cheese, yoghurt), nuts and legumes. Adequate energy (or calories) is also required to support healing. If adequate energy is not consumed, further protein is broken down for energy. Vitamin C plays an important role in collagen synthesis and supporting the immune system. It also increases the absorption of iron. However, high doses of Vitamin C are not required. Recommended supplementation for deficient patients is 60-200mg daily. This nutrient is found mostly in fresh fruit and vegetables. Vitamin A increases the inflammatory response in wounds, stimulating collagen synthesis. Low Vitamin A levels can result in delayed healing. However, supplementation with Vitamin A requires caution. It is found in milk, cheese, eggs, fish and dark green and orange fruit and vegetables. Vitamin E may reduce injury to the wound but there is limited evidence that it helps decrease scar formation. Supplementation of Vitamin E also requires caution.
Zinc plays a large role in tissue growth and healing. Deficiency in this mineral has been associated with delayed healing, but supplementation in people who are not zinc deficient generally has no benefit.
Dietary sources of zinc include red meat, fish and shellfish, poultry, milk products and eggs.
If nutritional supplementation is required, it is best to use a mixed product containing all of the above nutrients.
The role of nurses
Nurses are in the best position to assist patients regarding wound management and nutrition. They are the best people to ask questions regarding risk and to observe and monitor food and fluid intake. If patients have chronic wounds and/or are identified as at risk or malnourished, nurses are the best people to encourage eating and to help with it.
