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.

Typically a nurse 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, hydration status, among other factors (2, 3).

Nutrition Interventions

Nutrition is an important aspect of a comprehensive care plan for prevention and treatment of pressure ulcers.

Adequate calories, protein, hydration and vitamins and minerals are necessary to support anabolism, positive nitrogen balance, tissue integrity and to prevent tissue breakdown.

Energy Intake

The 2014 National Pressure Ulcer Advisory/European Pressure Ulcer Advisory Panel/Pan Pacific Injury Alliance (NPUAP/EPUAP/PPPIA) Nutrition Guidelines recommend 30-35 calories per kg/day for individuals who have, or are at risk, for pressure ulcers (4).

Adjust this amount based on weight change or level of obesity. Those who have had significant and unintended weight loss may require more calories.

Protein

High intakes of protein are associated with improved healing rates. As such, the NPUAP/EPUAP/PPPIA guidelines recommend providing 1.25-1.5 g/kg/day of protein (4).

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 and supports the delivery of nutrients and oxygen to tissues. Current guidelines recommend 30 mL/kg/day or 1 mL per calorie consumed (4).

The guidelines also recommend multivitamin and mineral supplements for individuals with inadequate oral intake. In particular, vitamin C, zinc and copper play important roles in skin health and wound healing.

Strategies to Improve Nutritional Intake

For individuals with pressure ulcers who have difficulties achieving adequate dietary intakes, NPUAP/EPUAP/PPPIA 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

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.