FALL2000 JOINT
PROVIDER/SURVEYOR TRAINING
WHAT IS NUTRITIONAL
ASSESSMENT?
Determining the body’s ability to convert food
into body components.
When the body can no longer convert food
into body components we get skin
breakdown.
FALL2000 JOINT
PROVIDER/SURVEYOR TRAINING
WHAT IS NUTRITIONAL
ASSESSMENT?
Your residents need sufficient amounts
of carbohydrates, vitamins/minerals,and
proteins in their diet to facilitate wound
healing.
FALL2000 JOINT
PROVIDER/SURVEYOR TRAINING
HOW DOES STRESS RESPONSE
CHANGE METABOLIC PROCESSES?
Residents in long term care facilities
experience physical and emotional stressors.
The body’s response to this stress can result
in:
Energy depletion
Loss of protein
Increase risk for skin breakdown
Muscle wasting
Decrease in energy needed for wound healing
FALL2000 JOINT
PROVIDER/SURVEYOR TRAINING
GOAL-PREVENTION OF PROTEIN - CALORIE
MALNUTRITION & PRESSURE ULCERS
How does protein-
calorie malnutrition
impact wound
healing?
FALL2000 JOINT
PROVIDER/SURVEYOR TRAINING
WOUND HEALING PROCESS AND
NUTRITION
INFLAMATION
Cellular proliferation Adequate energy&protein
Connective tissue Adequate energy&protein
formation
Wound contraction Adequate energy&protein
Wound remodeling Adequate energy&protein
You have to have adequate
nutrition or this does not
occur.
FALL2000 JOINT
PROVIDER/SURVEYOR TRAINING
ACTION!!!
FALL2000 JOINT
PROVIDER/SURVEYOR TRAINING
NUTRITIONAL ASSESSMENT FOR PATIENTS
AT RISK FOR SKIN BREAKDOWN
Anthropometric ( i.e. weight/height)
Physical assessment
Biochemical indexes
Dietary intake
FALL2000 JOINT
PROVIDER/SURVEYOR TRAINING
ANTHROPOMETRIC ASSESSMENT
Unusual weight loss over a short period of
time
Downward trend in weight
Low body mass index 130% ideal body weight calculate an
adjusted fluid need:
1500 + (patient’s weight-20 kg) X 15 ml
* If greater than 100years old give 20cc/kg body
wt
FALL2000 JOINT
PROVIDER/SURVEYOR TRAINING
HOW DO NUTRIENT NEEDS CHANGE
WITH SKIN BREAKDOWN?
FALL2000 JOINT
PROVIDER/SURVEYOR TRAINING
CHANGES WITH A PRESSURE
ULCER
Calorie needs increase from 1.2-2.0 times
basal energy expenditure
Protein needs increase from 1.2-2.5gm/kg
body weight
Fluid needs increase if fluid losses from ulcer
are significant
FALL2000 JOINT
PROVIDER/SURVEYOR TRAINING
NUTRIENTS NEEDED FOR WOUND
HEALING IN THE ELDERLY
55% Carbohydrates
30% Fat (There is a decreased risk for heart disease
with age so fat is not as much of a concern)
1.5-2.0 Protein/kg (If renal or liver status is poor can
not tolerate 2.0 gm Protein)
10-20gm/d Glutamine (most prominent amino acid
found in the body and the first one lost)
10-20gm/d Arginine (Important amino acid due to it’s
tendency to facilitate wound healing faster)
Arginine and Glutamine used for stage 3&4 ulcers
FALL2000 JOINT
PROVIDER/SURVEYOR TRAINING
SUPPLEMENTS USED TO
ENHANCE HEALING
Multivitamin/mineral supplement (Can use baby
vitamins)
500 mg Vitamin C(Females 75mg/daily/Males 90mg
daily) If kidney stones/ kidney problems may want to
use just multi-vitamins.
50 mg elemental Zinc (Zinc competes with Iron and
Copper. Too much can effect absorption of Iron and
Copper resulting in increase skin breakdown. Stop
Zinc when you have wound closure. Don’t exceed
50mg/day FALL2000 JOINT
PROVIDER/SURVEYOR TRAINING
HOW DO YOU GET ANOREXIC
RESIDENTS WITH WOUNDS TO EAT?
FALL2000 JOINT
PROVIDER/SURVEYOR TRAINING
STRATEGIES FOR WEIGHT GAIN AND
WOUND HEALING
Small frequent amounts of food (use
small bowl/plates presenting only small
amount of food at a time).
Favorite foods (Can liberalize diet as
long as there are no adverse effects).
Foods that are easy to chew & swallow
Use fortified foods
FALL2000 JOINT
PROVIDER/SURVEYOR TRAINING
STRATEGIES FOR WEIGHT GAIN AND
WOUND HEALING
Nutrient dense beverages for medication pass
Vitamin/mineral supplements
Pharmacological intervention
Appetite stimulants (Can be very expensive)
Anabolic steroids (Promotes protein build up and
weight gain)
FALL2000 JOINT
PROVIDER/SURVEYOR TRAINING
PUTTING THE PUZZLE TOGETHER
TAKES:
Total patient
assessment
Long-range vision
Communication
FALL2000 JOINT
PROVIDER/SURVEYOR TRAINING