Manual of Clinical Nutrition

Pressure Ulcers

Manual of Clinical Nutrition Management III- 109 Copyright © 2013 Compass Group, Inc.

For patients who are underweight (body mass index < 20) and have challenges meeting nutritional
requirements, oral intake of medical nutrition supplements is very effective in promoting intake and weight
gain and improving functional status (6). Medical nutritional supplements provide a better source of energy,
protein, and micronutrients than food snacks and do not inhibit meal intake (6,18). If the patient is tube fed,
the feeding should provide a minimum of 100% of the patient’s energy, protein, and RDAs (DRIs) for vitamins
and minerals (2). Because the effectiveness of specialized enteral formulas for wound healing has not been
validated, further study is needed before the routine use of wound healing formulas can be recommended (3).

Amino acids: The amino acids arginine and glutamine have been studied for their possible role in enhancing
wound healing. However, the literature does not provide evidence to support the supplementation of the diet
with these amino acids (3).

Evaluation and Monitoring
Treatment of pressure ulcers should always be provided by a multidisciplinary team (2). Nutrition
intervention is part of a multidisciplinary approach that also includes nursing intervention (reduction of
pressure and shearing, skin and wound care, feeding assistance, and a bowel and bladder care program),
medical intervention (treatment of infection and other medical conditions), and physical and occupational
therapy (promotion of increased activity and feeding ability).

References

1. National Pressure Ulcer Advisory Panel. Updated Staging System. 2007. Available at: http://www.npuap.org/pr2.htm. Accessed
   November 5, 2007.


2. Pressure Ulcer Treatment Clinical Practice Guidelines. Rockville, Md: US Dept of Health and Human Services, Public Health Service,
   Agency for Health Care Policy and Research; 1994. Quick Reference No. 15, AHCPR publication 95-0650.


3. Stechmiller JK, Cowan L, Johns P. Wound healing. In: Gottschlich MM, ed. The A.S.P.E.N. Nutrition Support Core Curriculum: A Case-
   Based Approach—The Adult Patient. Silver Spring, Md: American Society of Enteral and Parenteral Nutrition; 2007:405-423.


4. Skin integrity. In: Neidert KC, ed. Nutrition Care of the Older Adult. Chicago, Ill: Consulting Dietitians in Health Care Facilities, A
   Practice Group of the Academy of Nutrition and Dietetics; 1998.


5. Braden BJ, Bergstrom N. Predictive validity of the Braden Scale for pressure sore risk in a nursing home population. Res Nurs
   Health. 1994; 17:459-470.


6. Pressure ulcers. In: Nutrition Care Manual. Academy of Nutrition and Dietetics; 2007. Available at: nutritioncaremanual.org. Accessed
   November 5, 2007.


7. Clark M, Schols JM, Benati G, Jackson P, Engfer M, Langer G, Kerry B, Colin D. Pressure ulcers and nutrition: a new European guideline.
   J Wound Care. 2004;13:267- 272.


8. Thomas DR. Improving outcome of pressure ulcers with nutrition interventions: a review of the evidence. Nutrition. 2001;17:121-
   125.


9. Bergstrom N, Horn SD, Smout RJ, Bender SA, Ferguson ML, Taler G, Sauier AC, Sharkey SS, Voss AC. The National Pressure Ulcer
   Long-term Care Study: outcomes of pressure ulcer treatments in long-term care. J Am Geriatr Soc. 2005;53:1721-1729.


10. Cereda E, Klersy C, Rondanelli M, Caccialanza R. Energy balance in patients with pressure ulcers: A systematic review and meta-
    analysis of observational studies. J Am Diet Assoc. 2011;111:1868-1876.


11. Ayello EA, Thomas DR, Litchford MA. Nutrition aspects of wound healing. Home Healthc Nurse. 1999;17:719-729.


12. Breslow RA. Nutrition and air-fluidized beds: a literature review. Adv Wound Care. 1994;7:57-62.


13. Williams JZ, Barbul A. Nutrition and wound healing. Surg Clin North Am. 2003;83:571-596.


14. Gray M. Does oral zinc supplementation promote healing of chronic wounds? J Wound Ostomy Continence Nurs. 2003;30:295-299.


15. Haggard J, Houston MS, Williford JH, Meserve LA, Shewokis P. Retrospective study of the effects of zinc supplementation in an
    elderly institutionalized population with decubitus ulcers. J Am Diet Assoc. 1999;99:A-11. Abstract.


16. Fuhrman MP. Wound healing and nutrition. Top Clin Nutr. 2003;18:100-110.


17. Thompson C, Fuhrman MP. Nutrients and wound healing: still searching for the magic bullet. Nutr Clin Pract. 2005;20:331-347.


18. Stratton RJ, Boywer G, Elia M. Greater total energy and protein intakes with liquid supplements than food snacks in patients at risk
    of malnutrition. Poster presented at: European Society of Parenteral and Enteral Nutrition; October 21, 2006; Istanbul, Turkey.