The important nutrients for wound healing are proteins, albumin, fats ,carbohydrates, Vitamins A,C,K,Zinc, Copper, Pyridoxine,riboflavin , thiamine and iron.Follow your hospital policy and procedures.
PROTEINS: I am Protein and I help with wound healing.
I am required for the structure,
function of the body.
If you don’t have me you are losing.
Because I can repair wound.
Regulating the body cells, the organs.
I am clotting factor production.
Epithelial cell proliferation.
Do you know me?.
Protein in the white blood cell production.
Cell mediated phagocytosis.
Composed of large molecules chain of amino acid.
I come in a special orders as coded by DNA.
Sequence of the nucleotides in the protein DNA.
I help with wound healing.
WHEN I AM DEFICIENT YOU GET.
Delayed and poor wound healing.
That is wound will not heal well.
Impaired cellular immunity.
No protection against infection.
Edema, that is abnormal swelling.
ALBUMIN is my name.
I control Osmotic equilibrium.
Without Albumin there will be generalized edema.
My name is CARBOHYDRATES the supplier of cellular energy to spare the protein.
If I am deficient as carbohydrate.
Body will use visceral and muscle as protein for energy.
Copper: I am collagen cross linkage.
Fats : I provide essential fatty acids.
I also Provide cellular energy.
I am VITAMIN A Collagen synthesis and epitheliazation
If I am not around poor healing process .
I am VITAMIN C ,membrane integrity.
If I am missing you have fragile capillaries,
Resulting in poor wound healing
because I am vitamin C.
Vitamin K you know me coagulation is my job.
Without Mr K increase risk of bleeding.
I am pyridoxine,riboflavin and thiamine for,
Antibody and WBC formation
and promote enzyme activity.
The Cofactor in Cellular development.
Without me- decreased resistance to infection.
ZINC: For cell proliferation.Without me you got alteration in taste and slow healing.
I am IRON: Enhances leukocytic bacteria activity. Without me you have
Anemia and impairment of tensile strength.
LABORATORY STUDIES/ LEVELS.
A1C less than 7% or 7.(glycated Hemoglobin)
Glucose 70 to 110mg/dL.
Albumin 3.5g/dl to 5.5g/dl.
(Half- life of 18 to 20days)
Prealbumin 16 to 40mg/dL.
Total Protein 5 to 9g/dL
BUN 8 to 20mg/dL(Byproduct of protein metabolism)
Creatinine 0.8 to 1.2mg/dL
Cholesterol 100 to 200mg/dL.
Transferrin 200 to 400mg/dL.
Total lymphocyte count 2000cells/mm3
Hemoglobin 14 to 18g/dL men.
Hemoglobin 12 to 16g/dL women.
Hematocrit 42% to 54% men.
Hematocrit 38% to 46% women.
Is the patient eating well?.Is the patient intake > 80%?. Total lymphocyte count > 1800.Enough for wound healing.
Is there a weight loss or weight gain.
If there is poor intake. What are the physical and psychological condition that affects adequate intake?.Lack of appetite?.Do not want hospital food?.
Is the gut functioning?.
If the gut is not functioning then patient should be placed on TPN.(Total Parental Nutrition)
Hospice patients.(Comfort care)not candidate for TPN.Patient needs periodic reassessment.
If gut is working assist patient with feeding.
If patient is not getting enough nutrients. Place patient on tube feeding. ( per doctor orders)
If your patient cannot meet up with nutritional needs by normal ingestion of food.Patients can be given liquid supplements, different types of snacks to eat by mouth. If this did not work tube feeding will be the next alternative.
This can be through ngt feeding ( usually temporary) or peg tube feeding. With this the GI tract must be working. Some patients when they are on tube feeding, the doctor usually orders lactobacilli 2packets per tube feeding tid x3 doses.
Patients with lactose intolerance , free lactose diet are ordered. Patient insufficient fiber ,tube feeding with high fiber supplements are given.Patients with more than three loose stools, samples sent to the lab and Lomotil given. Monitor for constipation because of the lomotil. If the GI tract is not working, then the nutrients will be given through the venous system and that will be TPN(Total parenteral nutrition)This will go like this ,doctor orders nutrition consult.Registered Dietitian make recommendations, the doctor approve recommendation and orders for TPN.Pharmacist prepared the TPN and delivers it.You( the Registered Nurse) will review doctor orders ,and the TPN bag and give it.While patient is on TPN monitor blood sugar every 6hours. That is the policy. But please follow your facility policy and procedures. There are special tubings for TPN infusion, and you need a pic line or central line. For PPN 20guarge,18g or 16g are all good. The reason why you need a big size needle gauge is because of the Viscosity of TPN.
With a good nutritional support you have placed your patient into positive nitrogen balance. The patient will maintain same amount of protein in the tissue every day. As long as patient is unable to chew or swallow tube feeding is usually recommended. I am sure that there are so many new recommendations out there as new findings and research becomes available with evidence based practice.
The importance of nutrition in the prevention of wound and treatment of wound cannot be overemphasized. And that includes all the nutrients listed above, assessment, periodically reassessment,nutritional screening, daily calories counts. Everything are factored in ,including weight, diseases,stages of disease, sedentary lifestyle.For example inadequate calorie intake and lack of protein intake will not help obese patients with wound healing.
Questions and answers.
(1) According to studies done in 1992 by Bergstrom and Braden a patient with low intake of ——- will develop pressure ulcer. There is no other nutritional variable that is significant in predicting pressure ulcer development.
(A) Iron .
(D) Vitamin A.
Correct answer C.
Rationale:Protein is used by the body for repair,production of enzymes, hormones,antibodies, growth. Excess protein is converted to fat and stored as adipose.Protein is broken by the body into amino acids which will recombined to form proteins. About eight or nine amino acids are considered very important for the body and cannot be made by the body. They must be supplied in the diet that we eat.
(2)What is the he most concentrated source of energy in the body ?.
(C )Mineral and vitamins.
Correct answer D.
Rationale: Fat provide 9 calories for every gram,protein and carbohydrates produce 4calories for every gram.Vitamins and minerals produce nutrients not energy.
(3)Nutrition markers associated with pressure ulcer risk on patients in a long term facilities are.
(A) Albumin of less than 3.5 and completely dependency on tube feeding.
(C) Albumin greater than 4.5.
(D) Overeating and smoking.
Correct answer A..
Rationale: Low albumin of less than 3.5g/dL will make patient vulnerable to developing pressure ulcer.
(4 )The nurse discuss weight reduction with her patient. She teaches the patient that 1lbs of body fat is equal to what?.
Correct answer A.
Rationale:One pound of body fat is equal to 3500cal.B,C,D are all wrong.
(5) How do you give Parenteral nutrition to your patient?.
(A) Nasal gastric tube.
(B) Jejunostomy tube.
(C)Peg tube route.
Correct answer D.
Rationale: Parenteral nutrition are TPN and PPN, they are given intravenously.
(6 )How does Protein help to regulate fluid balance?.
(A) Sodium intake.
(B) Fluid formation.
(C) Hydrostatic pressure
(D) Oncotic pressure.
Correct answer D.
Rationale:Serum protein are responsible for maintaining oncotic pressure or colloid osmotic pressure which exerts a pull pressure. A,B,C are all wrong.
(7 )What is anthropometric measurements?.
( A )It is a series of quantitative measurements of height, weight, body mass,body circumference and skin fold thickness.
(B)Measurement of intake and output.
(C) Measurement of mineral resources and water.
(D )Measurement of muscle weakness.
Correct answer A.
Rationale: An anthropometric measurement indicate body dimensions.The others are not related to the question.
(8)Patient is placed on nasogastric tube feeding. Advantages of using the stomach as a reservoir for food is that it will prevent?.
(B )Duodenal ulcer.
(C) Dumping syndrome.
(D) Hypertension and hyperglycemia.
Correct answer C.
Rationale: When the stomach is used as a reservoir, the formula is released at a controlled rate.Which will prevent the occurrence of dumping syndrome.
(9) Your patient refused to eat hospital food. What nursing action if taken will stimulate his appetite?.
(A )Encourage patient family to bring food from home.
(B) Patient should get respiratory treatment before eating his food.
(C) Give pain medication before feeding the patient.
(D) Reinforce the need for him to finish his meal.
Rationale:Food from home that the patient likes will stimulate his appetite .Pain medication should be given before meals. Do not force him rather stimulate his appetite.
NB: Patient should be allowed to finish eating before breathing treatment unless it is contrary indicated.Sometimes you will have one respiratory therapist that abruptly stops patient from eating their meal instead of letting the patient finish. Some patient will refuse to eat after RT treatment and complain that the food is cold.Even when offered to warm it ,they will just refuse.Please advocate for your patient and follow up with your doctor orders and your facility policy and procedures.
(10 )What are the fat soluble vitamins?
(A ) Vitamin C,and B12.
(B. )Vitamin K and thiamine.
(C )Vitamin E and albumin.
(D) Vitamin A,D,E,K.
Correct answer D.
Rationale: Fat soluble vitamins are A,D,E,K. Excess of these vitamins are not secreted. So these vitamins will remain in the fat tissues of the body until they are used .So if your patient is receiving supplements of these vitamins look for signs and symptoms of overdose toxicity.