A.Nutrition is an essential component in the healing of any wounds. Protein, carbohydrates, fats, vitamins, minerals, and amino acid needs are increased for tissue repair. Table 7.2 summarizes the recommended amount of protein intake needed under different circumstances for tissue repair:
1.Consult with a dietitian for medical nutrition therapy (MNT).
2.Evaluate protein intake.
3.Evaluate the patient’s weight:
a.Serial weights—use same scales.
b.Diet diary or 24-hour recall.
c.The dietary and weight history is used to determine additional needs.
d.Excessive protein potentially leads to dehydration.
4.Lab testing:
a.Complete blood count (CBC).
b.Basic metabolic panel (BMP).
c.Protein: Albumin, total protein.
d.Renal: Blood urea nitrogen (BUN) and creatinine.
5.Evaluate wound stage/healing.
TABLE 7.2 Recommended Protein Needs Per Day for Wound Healing
6.Supplemental protein supplement may be required:
a.Sources of protein:
i.Whole eggs are considered the gold standard
protein.
ii.Meat: Red and white meat.
iii.Fish.
iv.Liver.
v.Dairy: Milk, cheese, yogurt.
vi.Soybeans.
vii.Legumes.
viii.Seeds.
ix.Nuts.
x.Grains.
b.Encourage meals and snacking, double portions of meat and eggs, commercial supplements, and fluids:
i.Eat five to six smaller meals throughout the day.
ii.Keep ready-to-eat meals and snacks.
iii.Drink shake-type beverages that contain protein, vitamins, and minerals.
iv.Add protein powder to drinks.
c.Consider appetite stimulants.
d.Enteral nutrition should be considered if oral food and fluid intake is not adequate.
Other Considerations
A.The elderly have multiple risk factors for intake of insufficient protein for wound healing:
1.Financial:
a.Expense of high-protein foods.
b.Expense of oral supplemental nutrition drinks.
2.Difficulty chewing:
a.Dental problems.
b.Loose-fitting dentures.
c.Edentulous.
3.Assistive needs:
a.Inability to prepare foods.
b.Need to have a caregiver feed the elderly person.
c.Given inadequate time to consume food if being fed.
4.Dysphagia.
5.Anorexia.
6.Fatigue.
7.Psychosocial:
a.Depression.
b.Loneliness.
B.Consultation with a dietitian for MNT, wound care specialist, social worker, occupational therapist, and behavioral health evaluations is advised.