Prevention & Treatment of Pressure Ulcers

First aid kit

NUTRITION IN PRESSURE ULCERS

PREVENTION AND TREATMENT

Below are some nutritional recommendations for the treatment of patients with pressure ulcers. It is an excerpt from Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. It was developed by the National Pressure Ulcer Advisory Panel, the European Pressure Ulcer Advisory Panel and the Pan Pacific Pressure Injury Alliance.

Nutritional Screening

Screen nutritional status for each individual at risk of or with a pressure ulcer:

• at admission to a health care setting;

• with each significant change of clinical condition; and/or

• when progress toward pressure ulcer closure is not observed.

Refer individuals screened to be at risk of malnutrition and individuals with an existing pressure ulcer to a registered dietitian or an interprofessional nutrition team for a comprehensive nutrition assessment.

Care Planning 

Develop an individualized nutrition care plan for individuals with or at risk of a pressure ulcer.

A registered dietitian, in consultation with the interprofessional team (including, but not limited to, a physician, nurse, speech pathologist, occupational therapist, physical therapist and dentist) should develop and document an individualized nutrition intervention plan based on the individual’s nutritional needs, feeding route and goals of care, as determined by the nutrition assessment.

Energy Intake

Provide 30 to 35 kcalories/kg body weight for adults with a pressure ulcer who are assessed as being at risk of malnutrition.

Adjust energy intake based on weight change or level of obesity. Adults who are underweight or who have had significant unintended weight loss may need additional energy intake.

Consider enteral or parenteral nutritional support when oral intake is inadequate. This must be consistent with the individual’s goals. If oral intake is inadequate, enteral or parenteral nutrition may be recommended if consistent with the individual’s wishes. Enteral (tube) feeding is the preferred route if the gastrointestinal tract is functioning. The risks and benefits of nutrition support should be discussed with the individual and caregivers early on, and should reflect the individual’s preferences and goals for care.

Pressure Ulcers

Stage 1 Pressure Ulcers

Pressure Ulcers

Stage 2 Pressure Ulcers

Pressure Ulcers

Stage 3 Pressure Ulcers

Pressure Ulcers

Stage 4 Pressure Ulcers

Pressure Ulcers

Stage 5 Pressure Ulcers

Protein Intake

Offer 1.25 to 1.5 grams protein/kg body weight daily for adults with an existing pressure ulcer who are assessed to be at risk of malnutrition when compatible with goals of care, and reassess as condition changes.

Offer high calorie, high protein nutritional supplements in addition to the usual diet to adults with nutritional risk and pressure ulcer risk, if nutritional requirements cannot be achieved by dietary intake.

Hydration 

Provide and encourage adequate daily fluid intake for hydration for an individual assessed to be at risk of or with a pressure ulcer. This must be consistent with the individual’s comorbid conditions and goals.

Fluid serves as the solvent for vitamins, minerals, glucose and other nutrients and transports nutrients and waste products though the body. Health professionals should monitor individuals’ hydration status, checking for signs and symptoms of dehydration such as: changes in weight, skin turgor, urine output, elevated serum sodium, or calculated serum osmolality.

Vitamins and Minerals 

Provide/encourage an individual with a pressure ulcer to take vitamin and mineral supplements when dietary intake is poor or deficiencies are confirmed or suspected.


This Quick Reference Guide presents a summary of the recommendations and excerpts of the supporting evidence for pressure ulcer prevention and treatment. The more comprehensive Clinical Practice Guideline version of the guideline provides a detailed analysis and discussion of available research, critical evaluations of the assumptions and knowledge of the field, and description of the methodology used to develop guideline. This Quick Reference Guide is intended for busy health professionals who require a quick reference in caring for individuals in the clinical setting. Users should not rely on excerpts from the Quick Reference Guide alone. The goal of this guideline is to provide evidence based recommendations for the prevention and treatment of pressure ulcers that can be used by health professionals throughout the world. The purpose of the prevention recommendations is to guide evidence based care to prevent the development of pressure ulcers and the purpose of the treatment focused recommendations is to provide evidence-based guidance on the most effective strategies to promote pressure ulcer healing.

The full report can be read or downloaded here: Prevention & Treatment of Pressure Ulcers: Quick Reference Guide

 

Cited: National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. Emily Haesler (Ed.). Cambridge Media: Osborne Park, Western Australia; 2014.

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