Optimizing nutritional status is an important strategy both in the prevention and treatment of pressure ulcers.
Pressure ulcers — also called bedsores and decubitus ulcers — are injuries to the skin or underlying tissue resulting from unrelieved pressure on the skin.
The constant pressure reduces blood flow to parts of the body and damages the skin by depriving it of oxygen and nutrients.
They most often form on bony parts of the body such as the shoulders, elbows, hips, buttocks, ankle bones and heels (1).
Pressure-ulcer management requires an evidenced-based comprehensive nutritional care plan.
This article identifies the elements you need to address the nutritional needs of an individual with pressure ulcers.
Implement nutrition screening
A nutrition screen identifies those who require a more detailed nutritional assessment based on the identified nutritional factors.
Upon admission to a health care setting and with each significant change of clinical condition, the individual should undergo a nutritional screening using a validated screening tool, such as the Mini Nutrition Assessment (MNA) for older adults or the Malnutrition Screening Tool (MST).
Typically a nurse or performs the nutrition screening and refers individuals who are at risk of malnutrition and individuals with an existing pressure ulcer to a registered dietitian for a comprehensive nutritional assessment.
Comprehensive nutritional assessment
A nutrition assessment for pressure ulcers should assess the individual’s:
- Weight status to determine weight history and identify any significant, unintended weight loss
- Ability to eat independently
- Adequacy of nutrient intake
Serum albumin and prealbumin levels do not reliably determine nutritional status. These values can be influenced by inflammation, renal or hepatic function, and hydration status, among other factors (2, 3).
Nutrition is an important aspect of a comprehensive care plan for prevention and treatment of pressure ulcers.
Adequate calories, protein, vitamins and minerals as well as hydration are necessary to support anabolism, positive nitrogen balance, tissue integrity and for preventing tissue breakdown.
The 2019 International Clinical Practice Guideline for the prevention and treatment of pressure ulcers recommend 30-35 calories per kilogram of bodyweight per day for individuals who have, or are at risk for pressure ulcers (4).
Adjust this amount based on the presence of medical diseases and conditions, weight change, and body mass index (BMI). Those who have had significant and unintended weight loss may require more calories.
Assess renal function to determine whether high protein intakes are appropriate for the individual.
Spread this amount equally between breakfast, lunch and dinner, making sure to provide 30-40 grams of protein at each meal.
Hydration, vitamins and minerals
Sufficient fluid intake maintains skin turgor, supports the delivery of nutrients to tissues, and helps transport waste from cells.
Current guidelines recommend 30 mL per kilogram of bodyweight per day or 1 mL per calorie consumed. Individuals with renal or heart failure typically require fluid restrictions. (4).
The guidelines also recommend nutritional supplements for pressure ulcers, including high-protein, high-calorie nutritional supplements as well as vitamins, minerals, and individual amino acids.
Vitamins C and E, zinc and copper as well as L-arginine and L-glutamine have important roles in the healing of pressure ulcer.
Strategies to improve nutritional intake
For individuals with pressure ulcers who have difficulties achieving adequate dietary intakes, the guidelines recommend these strategies to improve overall nutritional status:
- Liberalize therapeutic diets if those restrictions lead to inadequate nutritional intake.
- Offer high-calorie, high-protein nutritional supplements between meals.
- Consider nutrition support with consideration of the individual’s goals and plan of care.
Other factors that can negatively affect appetite or nutritional status can be identified with the comprehensive nutritional assessment.
Nutrition interventions for improving nutritional status should focus on solving the underlying cause of the identified factor.
When this is not possible — as with physiological and metabolic changes — the nutrition intervention should aim to minimize the signs and symptoms of the nutritional problem.
Malnutrition is a risk factor for pressure ulcers and can delay the healing of pressure ulcers in people with pressure ulcers and who are malnourished.
The bottom line
Nutrition plays an important role in preserving skin integrity and supporting the necessary processes for pressure ulcer healing.
A comprehensive nutritional plan based on evidenced-based guidelines for nutrition interventions can improve health outcomes for individuals who have pressure ulcers or are at risk of developing them.