Stephen Ratcliffe on the important link between nutrition and wound care and healing.
For many clients and their carers, the link between nutrition and wound care is not easily understood. But in the context of food as the building block of all cells in the body, including skin cells, this relationship becomes clearer. The role of nutrition is two-fold – to provide the raw materials to create new skin cells and to help the immune system to help fight off infection as wounds are healing.
Pressure areas and wounds: Elderly are at risk
The elderly are among the highest risk client groups for pressure areas and wounds. Age-related complications such as swallowing problems, reduced mobility, loss of appetite and subsequent weight loss can impact on a person’s likelihood for a pressure area or wound.
With weight loss comes a reduction in body fat stores – or the ‘cushions’ of the body around bony prominences such as the hips, sacrum, heels and shoulder blades. Prolonged pressure from lying in one position can cause a reduction in blood flow to the skin over a bony prominence and cause the skin layers to break down, resulting in a pressure ulcer.
Chronic medical conditions, such as diabetes and cardiovascular disease, which often progress with age, damage blood vessels. Heel ulcers are a particular concern for these clients as the blood vessel damage from their condition reduces the amount of oxygenated, nutrient-rich blood that reaches the extremities where it is needed to regenerate injured skin cells.
Pressure ulcers can worsen very quickly and can have serious health consequences if they become infected as they can introduce harmful bacteria into the body. The geography of a pressure area or wound impacts on the likelihood of infection too – a sacral pressure area has a high chance of infection, and in incontinent patients this can be a real issue.
Managing pressure ulcers
This involves a two-pronged approach:
* External treatment using appropriate dressings, ointments and creams and regular turning to reduce pressure over a bony prominence
* Internally through good nutrition.
Key nutrients in the diet and their role in wound healing:
This refers to the amount of calories or kilojoules that are obtained from food. When somebody has a pressure ulcer their metabolism (or the rate at which they use energy) increases. This is because energy is needed for normal daily functions, as well as extra energy for wound healing and fighting/preventing infection.
Collagen, a fibrous structural protein, is a key building block for skin cells in the body. The body increases collagen production in an attempt to heal itself as a result of a skin injury. When skin is damaged, the liquid that oozes from the wound is called exudate. This is high in protein and some minerals, including zinc and iron.
For wound healing, protein requirements increase to replace injured skin cells and the protein lost from wound exudate. If a person has multiple skin tears or wounds with exudate, the protein requirements of the diet can increase significantly.
Water in the body keeps skin hydrated and supple. If a person is dehydrated, their skin will be dry and more prone to damage from sheering forces.
Vitamins and minerals
* Zinc: This mineral is required for many cellular functions, including cell replication and generation of collagen.
* Vitamin C: Vitamin C has beneficial effects on the immune system and is required in the generation of collagen, the structural protein of skin.
* Vitamin A: This vitamin stimulates the immune system.
Translating nutrients into food
Dairy foods contain the ‘trifecta’ – energy, protein and fluid, as well as zinc. Regular fat (or full-cream) varieties are a good choice for people who are underweight and struggling to meet their energy requirements. Yoghurt, custard, mousse, milkshakes, ice cream and rice pudding with milk are examples of high-kilojoule dairy foods that supply energy, protein and fluid.
Vitamin C requirements are easily achieved with one to two glasses of fruit juice or two pieces of fruit per day – citrus or berry fruits such as oranges, grapefruit, strawberries, blueberries and kiwi fruits are good sources of vitamin C. Vegetables such as capsicum, broccoli and spinach also contain high levels of vitamin C, but cooking can degrade some of the vitamin C.
Zinc is common in red meat, salmon and dairy foods. Offal (such as liver) is particularly high in minerals, including zinc. Liver also contains high levels of vitamin A. Nuts also contain some zinc but are sometimes not appropriate in the elderly due to swallowing problems or difficulty chewing.
Similarly, meat consumption can decline in the elderly which may place them at risk of zinc deficiency and may require supplementation.
Wound care: The role of dietitians
Some settings employ Accredited Practising Dietitians (APDs) to provide medical nutrition therapy for clients with, or at risk of, pressure areas or wounds. This involves a detailed nutritional assessment, combined with an individualised nutrition care plan. An APD may also establish specific menus, and advise on ‘between meal’ foods, fluids and snacks.
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