Geriatric Quick Consult Pressure Ulcers Do #1
Many studies have linked pressure ulcers with malnutrition. The diet of the pressure ulcer patient must be adequate in order to allow healing.
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| The stage of the wound has been correlated with the severity of the nutritional deficits; particularly low protein intake or low serum albumin. Click here for more information.
If the serum albumin is less than 3.5 and/or the total lymphocyte count is less than 1800, nutritional intake should be assessed. Oral supplementals should be considered. If oral intake is inadequate, nutritional support (tube feeding, TPN) should be considered to place the patient into positive nitrogen balance. This generally requires about 30-35 cal/kg/d and 1.25-1.50 gm protein/kg/d. (Use of these interventions should be considered in the context of the overall treatment goals for the individual patient.) |
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| Attempt assisted feeding when assessment shows the patient to be undernourished.
The patient may simply lack adequate strength and coordination because of acute illness or may have visual acuity too poor to feed themselves in the hospital setting. Reassess the patient in 2-3 days to see if intake goals are met. If not, consider tube feeding. Remember: presence of a feeding tube does not necessarily mean a patient with a pressure ulcer is in optimum nutritional condition. |
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| There is some evidence that vitamin C and zinc may help healing if deficiencies are present.
Vitamin C is recommended in a dose of 500 mg/d. Studies of vitamin C supplementation in patients with pressure ulcers who were not severely deficient have had variable results1. This dose appears to be safe and reasonable. Zinc is recommended, based on data suggesting improved surgical wound healing. No studies have shown definite improved pressure ulcer healing in nondeficient patients. There is theoretical concern that high doses of zinc may inhibit white blood cell function and copper metabolism1. The FDA's recommended daily allowance is 15 mg. A daily multivitamin is recommended for patients suspected of having deficiencies. |
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- Spoelhof GD. Management of pressure ulcers in the nursing home. Annals of Long-Term Care 2000: 8(8): 69-77.
