litrevulcer

Literature Review 2003 - 2009
Reference
Hyrdation
Kcalories or CHO
Protein
Fats Lipds
Arginine
Glutamine
A IU
C mg
Mang
Cu
Zinc
Fe
1 American Dietetic Association. Nutrition In the elderly, pro greater than NPUAP 35 to 40 kcal for
AHCPR -agressive plan with
No
If def
If def ZnSo4
Care Manual @.Wound Care:pressure
1.5 - 2.0g/kg may be a risk
UW or losing wt AHCPR
Inadeq diet 1 - 1.2 for elderly
conclusion
suspected or
220mg or
ulcer nutrition intervention.
factor for dehydration.
30-35 kcal/g
Those @ risk 1.5 to 2.0
more research
confirmed a
50mg
http://nutritioncaremanual.org/content.cfm
EPUAP 1 to 1.50 gm/kg
needed
Vit/min tab
elemental
?ncm_content_id=79647 Accessed July
to meet DRI
BID 2-3 Zn
23, 2010.
hinders CU in
GI
2 Aronld, M., and Barbul, A. 2006.
Major source of fuel for
Pure pro def are rare, most pt
Demand for
Arg is needed Most abundant 25,000 IU/d x
x
x
x
Fe def is
Nutrition and Wound Healing. Plast.
body thus for healing
exhibit combinded pro-energy or
EFA increases
for collagen
AA in body. in severe
common in
Reconstr. Surg . 117 (suppl.): 42-58S.
process mainly collagen
pro-calorie malnutrition.
after injury.
synthesis
Efficacy of
injury.
the clinical
synthesis. Protein synthesis
supplemental Larger no
setting.
requires .9kcal/g and a 3cm
glutamine
improve
Correct def is
x1mm thick section of
admin has not excessive
easily done.
granulation tissue contains
proved to have intake -
10 mg collagen.
any noticeable toxic.E not
effect .
shown to
improve
healing. Vit
K def -
hematoma.
3 *Bergstrom N, Bennett MA, Carlson CE,
1.25 to 1.5 g/kg
EFA def=
deficiency
H20 Sol
et al. Treatment of Pressure Ulcers.
Protein markers: alb < 3.5 and
flaking
signs of A, C, 10XRD
Clinical Practice Guideline, No. 15.
TLC >1800
epidermis
Zinc, EFA, & A
Rockville, MD: U.S. DHHS. PHS,
Bs
AHCPR Publication No. 95-0652.
December 1994. Curious to read and
referenced in others.
4 Black, J. et al. 2009. National Pressure
Includes nonstageable & DTI, Earliest documentation
Revision of the unstageable ulcer
Ulcer Advisory Panel's Updated Pressure defines ulcer, NPUAP
from Hippocrates 400 BC. was to reduce occurrence of any
Ulcer Staging System. Dermatology
updated PU staging to
Paget clinical lectures on
ulcer with necrotic tissue as
Nursing, August, Vol. 19, No.4.
improve clincial accuracy,
bedsores in 1873.
unstageable when the depth of the
utlity & discrimination from
ulcer can be seen.
other dermal wounds.
Compiled by V. Elliott, PhD, RD.
1

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Literature Review 2003 - 2009
Reference
Hyrdation
Kcalories or CHO
Protein
Fats Lipds
Arginine
Glutamine
A IU
C mg
Mang
Cu
Zinc
Fe
5 Braden,B. and Bergstrom, N. 1988. The
Delinates nutrition status to
Braden Scale for Predicting Pressure Sore trigger further dietary consults
Risk.
http://www.bradenscale.com/bradenPDF.
Last accessed July 26, 2010. Permission
granted to include as a reference.
6 CareNotesTM System . YRMC Intranet
x 3 liters for Males
x
c
x
database, version 5.1. Wound Healing and
2.2 liters for Fem
your Diet. Thomson Reuters (Healthcare)
Inc. Accessed January 25, 2010.
7 Charney, P. Editor. (2009). ADA Pocket
Hypocalric feeding of obese
Adult Maintenace .8-1 g/kg
Guide to nutrition assessment. 2nd
patients w/o renal or hepatic
older adults 1g/kg
Edition. Chicago, IL: American Dietetic
dysf is 22 kcal/kg IBW
HD 1.2 - 1.3 upto 1.5 -1.8
Association.
page 172.
PD, CRRT > 1.5 -2.5 g/kg Obese
class I or II, trauma (ICU)=1.9
g/kg IBW with hypocaloric
feedings
8 Demling, R. (2009). Nutrition,
30 to 40 kcal/d
1.5 to 2g/kg ^ stress
Conditionally
500 mg .3 to .5
key if def 220
x
Anabolism, and the Wound Healing
glutamine:.3 g/kg/d for burn to 2
essential 2*
to 2g
mg
home
Zn SO4 mg
Process: An Overview. Eplasty, Vol 9, pp
g ^ HGH thus
trauma High
o
TID or 4 to
e9.
anabolism caution ^ amonia
dose ^ HGH but
stasis
10 u g
not clearly
levels Conditionally essential 2*
1-2
defined yet
trauma
mg
Compiled by V. Elliott, PhD, RD.
2

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Literature Review 2003 - 2009
Reference
Hyrdation
Kcalories or CHO
Protein
Fats Lipds
Arginine
Glutamine
A IU
C mg
Mang
Cu
Zinc
Fe
9 Dorner, B., Poshauer, M., and Thomas, D. 1 ml per 1kcalorie consumed
P
roviding adeq kcal
Chernoff:1.0 gram per kg,
insulin
citurs in
high pro
(2009).The Role of Nutrition in Pressure
high levels of pro may push
promotes anabolism,
Campbel et.al: 1 - 1.2
scretion
diet
foods like
Ulcer Prevention and Treatment:
for high fluids
n
it
ro
g
e
n
a
n
d

c
o
ll
a
g en
AHRQ:1.25 to 1.5 gram per kg,
controverial
meat. Liver,
NPUAPWhite Paper. Advances in Skin
19 to 28% of fluid comes
synthesis, and healing.
EPUAP:1.0 to 1.5
and shellfish.
and Wound Care, Vol. 22 No. 5, 212-221, from food
In
c
re
a
se
d

c
a
lories are
glutamine:fuel for fibroblasts safe
If def is
nut supp and EN are 75%
needed to overcome
max dose = .57 grams per kg
clinical then
water. Fluids serve as the
accelerated loss of E and
concluded range 1.25 to 1.5
40 mg
solvent for vit, min, gluc, and Pro due to
elemental
the transport medium for
hypermetabolism. Adjust
upper limit of
nutrients and waste products
for wt issues incl obesity.
DRI
10 Dorner, B., Poshauer, M., and Thomas, D.
The Role of Nutrition in Pressure
UlcerPrevention and Treatment:
Serum albumin is apoort inidcator
NPUAPWhite Paper.
of visceral protein status. This is
CHO in the form of glucose due to albumin's long half-life 12-
is the major fueld source for 12 days nad the multiple factors
callagen synthesis which is that dec alb even when pro intake
the building block of tissue. is adq (eg, infection, acute stress,
surgery, cortisone excess,
hydration status),
11 Escott-Stump, S. (2008). Nutrition and
DRI total water: 91 oz daily
Recommended 25-35
Follow the AHCPR (2006) 1 - 1.5
Multivit &
Diagnosis-Related Care. 6th edition.
for women, 125 oz for men
kcal/kg body weight; use
g pro/kg. Deep ulcers may require
min page
Phila, PA: Wolters Luwer.
inc. hot climates or w/
lower fro obese and higher 1.5/2g/kg.
113
activity. Drinking fluids with for underwt. Section 2, page
& btwn meals according to
112-114.
thirst is sufficient elderly may
lose their thirst awareness.
80% intake from beverages &
20% from food. Sec6,
Overview: Diet & Heart, page
319, 860.
Compiled by V. Elliott, PhD, RD.
3

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Literature Review 2003 - 2009
Reference
Hyrdation
Kcalories or CHO
Protein
Fats Lipds
Arginine
Glutamine
A IU
C mg
Mang
Cu
Zinc
Fe
12 European Pressure Ulcer Advisory Panel ulcer stages defined.
30 -35 kcal/kg of wt
protein supplements 1.25 to 1.5 g
Balanced
Only if
and National Pressure Ulcer Advisory
Compatible with pt wishes &
per kg
diet. Unless
def are
Panel. Trt of Pressure Ulcers: Quick Ref conditions. Wt changes, urine
poor intake.
suspecte
Guide. Washington DC:NPUAP; 2009.
output, elevated serium
d/confir
sodium, or calculated serum
med.
osmolility.Add fluid if ^
temp. V or D , profuse
sweating or heavily draining.
13 *Ferguson, M. (2000). MedSurg Nursing
30 to 35 ml/kg w/
30 to 35 kcal/kg
1.25 to 1.50 gm/kg caution @ 1.5
daily vit &
August . Volume 9. Issue 4. page 163-176. airfluidized beds + 10 to 15
min
Curious to read and referenced in others.
ml fluid/kg 1 ml fluid/kcal in
EN
14 Gray, M. 2003. Does Oral Zinc
Diarrhea, GI Fistuale, Crohns, Dietary sources: beef, prk,
Inc Zn 11mg - m 9 Excess Zn
Supplementation Promote Healing of
SBS, sprue,
fortified cereals 100%
compe mg - f
may trigger
Chronic Wounds? J
RDA, yougurt, baked beans,
tes
Anemia
WOCN ; 30: 295-9.
sashews, and pecans?
15 Health East Care System POLICY AND
30 to 35 ml/kg
L
ists obese 14 - 31cal/kg
1 to 2 g g/kg
see h/o
PROCEDURE MANUAL Policy #: NP
(1500 ml min)
ABWt or 20 - 25 adjusted
7.0
Body wt. Adjusted body
Nutrition Services Department http\\:
wedight =(Acutal BW-ideal
www.mnhospitals.org/inc/data/tools/.../Nu
BW x(0.25 - 0.5) + IBW)
trition-Therapy-Policy.pdf Accessed July
2010
16 Institute for Clinical Systems
Nutrition based on patient's
Adeq nut and hydrat are
Albumin 3.5 to 5.5 g/dl, long half-
Improvement (ICSI). Pressure ulcer
age, sex, ht, wt, presence of
critical to wound healing.
life (18 to 20 days), affected by
treatment. Health care protocol.
wasting/obesity, current
Thorough assessment as
hdration status. Pre-
Bloomington (MN): Institute for Clinical disease, severity of illness &
initial
albumin 15 to 25 mg.dl, shorter
Systems Improvement (ICSI); 2008 Jan.
presence & severity of
half-life (two days reflects what
28 p. [36 references]
wounds. Recommends
has been absorbed and
collecting a baseline.
metabolized recently.
Compiled by V. Elliott, PhD, RD.
4

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Literature Review 2003 - 2009
Reference
Hyrdation
Kcalories or CHO
Protein
Fats Lipds
Arginine
Glutamine
A IU
C mg
Mang
Cu
Zinc
Fe
17 Intermountain Medical Center Nutrition
Gained permission from this
Calories are cited as 30 -
1 - 2.2 g/kg Achieve nitrogen
Omega 3 ?
safe dosage
For adults
not on crf
DRI, if
no
Support Team 06.23.09 and their authors Utah Support Team to adapt
35 but consider age,
balance.
still ?
.57gm/kg/d no
def 1000-
Linford, L., Furhman, M.P., and
their table found in ASPEN
malabsor, sedated etc. Stage
safe dosage
2000 mg
Thompson, C. to adapt their tables entitled guidelines.06.16.09 Revised
> 25
yet?
with III
or IV PU
"Nutrition and Pressure Sores Revised
edition of 2007 was emailed.
+research
January 2007" and "Reviewed 2009
30cc/kg with mimimum of
Oral/Enteral Nutrition Therapy for Adult 1500cc/d unless renal or
Patients with Pressure Ulcers" Used in
cardiac.
ASPEN curriculum.
18 Jones, K. (2003). Identifying Best
Since inclusion in health
x=mention
x
x
x
Practices for Pressure Ulcer Management. system acquired conidtions
JCOM 16, No. 8, 375-381.
with reduced reimbursement
(www.cms.hhs.gov/hospitalac
qcond) Best practices are
being sought. many
inconsistencies
19 Langer, G., Knerr, A. et al. (2009).
Elderly people recovering
Nutritional interventions for peventing
from acute illness appear to
and treating pressure ulcers. The
develop fewer pressure ulcer
Cochrane Library 2009, Issue 4.
when given 2 daily
supplement drinks
20 Linus Pauling Institute. Oregon State
University.Micronutrients for Older
Adults.
http://lpi.oregonstate.edu/infocenter/oldera
dults.html. @Linus Pauling Institute, 2008-
2010. Permission granted.
21 Mackay, D. and Miller, A.( 2003)
25,000
1 to 2 g
15 to 30 mg
Nutritional Support for Wound Healing.
Alternative Medicine Review, Volume, 8,
Number 4,
Compiled by V. Elliott, PhD, RD.
5

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Literature Review 2003 - 2009
Reference
Hyrdation
Kcalories or CHO
Protein
Fats Lipds
Arginine
Glutamine
A IU
C mg
Mang
Cu
Zinc
Fe
22 Mathus-Vliegen, E. (2004). Old Age,
35 kcal/kg/d
1.5g/kg
mention
B is mentioned
mention
Malnutrition and Pressure Sores: An Ill-
Fated Alliance. Journal of
Gerontology:Medical Sciences,. Vol. 59A.
No. 4. 355-360.
23 McClave, S. A., Martindale, R.G., Vanek,
C5. In critically ill obese, C5. Pro range > or + 2.0 g/kg IBW
deficiency
V. W., McCarthy, M., Roberts, P.,
Permissive underfeeding or for Class I and II (BMI= 30-40)
signs
Taylor, B. et. al, and the A.S.P.E.N.
hypocaloric feeding is
For Class III (BMI > 40) pro range
Board of Directors & American College of
recommended. Obese > 30. recommended > or + 2.5 g/kg
Critical Care Medicine. (2009).
EN goal 11-14 kcal/kg of IBW Rational: steady wt loss,
Guidelines for the Provision and
ABW or 22-25 kcal/kg
while infusing pro should meet
Assessment of Nutrition Support Therapy
IBW daily.
needs, neutral nitrogen balance
in the Adult Critically Ill Patient: Society
thus allowing for healing.
of Critical Care Medicine (SCCM) and
American Society for Parenteral and
Enteral Nutrition (A.S.P.E.N.)
JPEN J Parenter Enteral Nutr MAY-
JUNE 2009 33 : 277-316.
24 National Academy of Science's Institute
Dietary Reference Intakes
of Medicine.
(DRIs) represent the most
http://fnic.nal.usda.gov/interactive DRI/
current scientific knowledge
"NAL, ARS, USDA." Accessed March
on nutrient needs
2010.
25 National Policy and Resource Center on
Table delineating the newest 51-70 M 2204 kcal
56 g
Nutrition and Aging, Florida International categories 51-70 and then 70+
University. National Resource Center on
for both male and female
Nutrition, Physical Activity & Aging.
Plus also indicatesAcceptable
http://fnic.nal.usda.gov/nal_display/index. Macronutrient Distribution
php?info_center=4&tax_level=3&tax_sub Ranges (AMDRs) as a % of
ject=256&topic_id=1342&level3_id=514 total calories.
0 accessed July 26 2010.
Compiled by V. Elliott, PhD, RD.
6

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Literature Review 2003 - 2009
Reference
Hyrdation
Kcalories or CHO
Protein
Fats Lipds
Arginine
Glutamine
A IU
C mg
Mang
Cu
Zinc
Fe
26 Russell, M.K., and Mueller, C. (2007).
Ch 9. lists def signs
Nutrition Screening and Assessment. In
ASPEN Board of Directors (Ed.) .The
A.S.P.E.N. Nutrition Support Core
Curriculum: A Case-Based
Approach--The Adult (pp. 164-184).
Silverspring, MD:ASPEN.
27 Stechmiller, J., Cowan, L., and Johns, P.
wound defined. Adequate
30 to 40 kcal/d caution to 1.25 to 1.5 g/kg Stage III - IV ^
17 to 24.8
oral-10 to
only def
5 to 10
only def
x
(2007). Wound Healing, In ASPEN Board
hydration. a-30 ml/kg use 40kcl w/ some See next
2.0 w/ max of 2.2 g/kg (if
free grams
50,000 1000-2000 times
clients
mg/d -
of Directors (Ed.) .The A.S.P.E.N.
b-1 to 1.5 ml/kcal
ref
medically approp) eve
Semi-
IV-10,000
RDA/DR
Zn Sulfate
Stage I&II
Nutrition Support Core Curriculum: A
supplements suggested
essential (?)
limit to 10
I til PCM
1000 -2000
220 mg x 2
Case-Based Approach--The Adult
resolve
(pp.
controversial
days contra if - III&IV
daily
406-420). Silverspring, MD:ASPEN.
steroid or ^
s tress,
PN 2.5 to 4
smokers,
glucocorticoi
mg of zn in
^injury
d
contra 4
noncat
renal
4.5 to 6 mg
for ^injury
28 Takahashi. P. et.Al. (2004). Wound Care four types of ulcers: Pressure,
Nutrition maintains skin
cites indicator
multvit
for Elderly Patients: Advances and
ischemic, venous,
architecture Optimal metabolic
of malnutrition
Clinical Applications for Practicing
neutropathic.
response pro supple 1-1.5 G/KG
in elderly is a
Physicians. Mayo Clin Proc.79 : 260-267. CORRECT to inc appetite
15% decrease
in wt from
and maintain tissue health
baseline. 4.5 kg
loss x 12 mths
29 Thompson, C. and Fuhrman, M.P.
30-40 mL/kg
all kcalories 30-35
1.25-1.5 up tp 2 excess
mention no
glutamine:
(2005).Nutritents and Wound Healing:
kcal/kg/d
pro may tax renal or hepatic
amts
.57g/kg/d
Still Searching for the Magic Bullet.
function w/o adeq fluid may
Nutrition in Clinical Practice. 20 :331-
cause dehyrdation
347.
30 Thompson, C. and Furhman, M.P. (2003).
see h/o
LDS Hospital NST, Salt Lake City, UT.
31 Whitney, J. et.al. (2006). Guidelines for
Adequate to support the
Wt upon entry.
Prealbumin = recent protein
the Treatment of pressure ulcers. Wound growth of granulation tissue.
consumption and serum albumin =
Repair and Regeneration, 14: 663-679.
LT pro consumption.
Compiled by V. Elliott, PhD, RD.
7

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Literature Review 2003 - 2009
Reference
Hyrdation
Kcalories or CHO
Protein
Fats Lipds
Arginine
Glutamine
A IU
C mg
Mang
Cu
Zinc
Fe
32 Williams, D. and Harding, K. (2003).
x
x
x
x
x
x
x
x
Healing response of skin and muscle in
critical illness. Crit Care Med .
33 Wooley, J., and Frankenfield, D. (2007) .
ch 2
only if def
only if
only if def
Energy. In ASPEN Board of Directors
def
(Ed.) .The A.S.P.E.N. Nutrition Support
Core Curriculum: A Case-Based
Approach--The Adult (pp. 20 -29).
Silverspring, MD:ASPEN.
34 Wound, Ostomy, and Continence Nurses Defines based on Medicare:
History
NPUAP four
Society. (2009). Position Paper on
stages to
Avoidable versus unavoidable Pressure
include
Ulcers. Journal of Wound, Ostomy,
unstageable and
DTI deep tissue
andContinence Nursing. Jul-Aug.
injury.
36(4) :378-81,
35
YRMC Form
MUST Malnutrition Universal Screening
Tool. British Association of Parenteral
and Enteral Nutrition (BAPEN), 2003.
Compiled by V. Elliott, PhD, RD.
8

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