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34 Visit us at NURSE.com • 2016


Opportunities for IP collaboration Te nurse’s role. Identifying malnutrition or malnutrition risk


is fundamental to the nurse’s role of optimizing wound healing. Malnourished patients often have higher rates of infections and pressure ulcers (and consequently require greater nursing care) and are less independent due to muscle loss, which also increases nursing care with longer lengths of hospital stay.32


phases of wound healing, it is prudent to consider vitamin and mineral supplements for patients with very poor dietary intakes, who have medical conditions that impair absorption and utiliza- tion of nutrients, or who take medications that promote increased losses or impair absorption or utilization. Also, patients with food insecurity due to socioeconomic conditions or health beliefs that severely limit food selection may benefit from vitamin and mineral supplements. A table online summarizes nutrients required during different phases of wound healing and identifies selected foods that are good sources of each key nutrient.25 Water requirement. Water is an essential nutrient that is found


in all body components. Water serves as the solvent for vitamins, minerals, glucose and other nutrients and transports nutrients and waste products through the body. Food accounts for about 20% of total water requirement. Oral nutritional supplements and tube feeding products provide about 1 kcal/cc and are about 75% to 80% water by volume. More dense products (i.e., 1.5 to 2.0 kcal/ cc) are about 60% water by volume. Refer to the nutrition label for specifics. Additional water is often needed to meet the water requirements of patients receiving tube feedings. Water requirements are estimated using various formulas


derived from clinical judgment rather than research studies. Tere are research studies on water requirements in healthy adults living in severe climates conducted by the military and for elite athletes during training and competitions. Data from these studies cannot be extrapolated to the seriously ill, patients with surgical or trauma wounds, or undernourished patients who are at risk for a pressure ulcer or who have a pressure ulcer. Water dysregulation is detrimental to wound healing. Disorders


of water balance (i.e., dehydration, volume depletion and overhy- dration) are common in hospitalized adults and long-term care residents. Dehydration contributes to skin fragility and suscepti- bility to skin breakdown. Moreover, dehydration impedes cellular migration during the proliferative phase of wound healing.26 Patients who are seriously ill and older adults tend to have a decreased thirst sensation due to confusion, an altered state of consciousness or severe depression. Disorders of water balance are identified primarily through physical assessment, unplanned changes in body weight and laboratory assessment.17 Te Prevention and Treatment of Pressure Ulcers: Clinical


Practice Guideline recommends 1 mL/kcal consumed daily. Patients with increased fluid losses from elevated temperature, vomiting, diaphoresis, diarrhea or heavily exuding wounds will likely require more water daily. Estimated water requirements should be based on individualized assessment and monitored for signs of water dysregulation.26


than 1,500 kcal per day will need more than 1 mL water per kcal consumed.


Patients who consume less


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