“No Pressure…But I Need My Nutrition Please!” Come Visit the Clinical Nutrition Booth at The Carnival on Friday October 12 th, 2012 in the cafeteria Topic: Pressure Ulcer Treatment and Prevention: Skin, Wounds, and Nutrition Value of Therapeutic Nutritional Drinks/Foods Oral Nutrition Support Products *Free Samples For Everyone!*

No Pressure….But I Need My Nutrition Please! Why is Nutrition So Important? What Role Does Nutrition Have in Wound Care? What Can we do to Encourage Oral Nutritional Supplementation?

Objectives  Identify how much PU and wounds are affected by nutrition  Explore how a patients length of stay can affect their nutrition  Discuss the relationship between Lean Body Mass (LBM) loss and health complications  Why nutrition should be especially emphasized in the clinical setting  Therapeutic nutritional drinks/foods supplements  What can we do better as a medical team to help prevent and treat pressure ulcers?

What is a Pressure Ulcer? Who Gets Them?  A pressure ulcer (PU) is an injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction.  People who are immobile for extended periods Older adults Paralyzed Comatose Malnourished Low LBM

Pressure Ulcer Stage I: Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area.

Pressure Ulcer Stage II: Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound, without slough. May also present as an intact or open/ruptured serum-filled blister.

Pressure Ulcer Stage III: Full thickness tissue loss. Subcutaneous fat may not be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling.

Pressure Ulcer Stage IV: Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on parts of the wound bed. Often include undermining and tunneling.

 The body has to compete for the same nutrients that help heal wounds and used to maintain or gain weight. This results in lean body mass loss, which can slow the healthy process.  Lean Body Mass (LBM) loss and malnutrition start prior to admission and accelerate each day in the hospital  30-50% of patients are malnourished upon admission  37% of patients lose LBM in 1-2 days of hospital stay  27% of patients experience a nutritional decline Why is Nutrition So Important?

What Complications Increase with LBM Loss and Poor Nutrition? 10% Impaired immunity, increased infection, mortality increased by 10% 20% Decreased healing, weakness, increased infection, thinning of the skin, mortality increased by 30% 30% Too weak to sit, new pressure ulcers develop, pneumonia, wound healing ceases, mortality increased by 50% 40% Death, usually from pneumonia

Oral Nutrition Supplements and Wound Healing  Poor nutrition is a clinically proven contributing factor of a pressure ulcer  Many patients with wounds will develop will develop protein calorie malnutrition  Malnourished patients are at % higher risk for pressure ulcers  Most patients do not have adequate intake in results in patients who don’t get the nutrition they need to maintain and rebuild LBM  We can fill the nutritional gap with oral nutrition supplements

Nutrition has been proven to reduce facility-acquired pressure ulcers as part of a comprehensive program!  So, What’s the problem?! Most nutrition recommendations are not followed We need to monitor patient nutrition, carry out nutrition orders, and record supplement and meal intake Encourage water intake! If the patient does not like the supplements- what supplements can we give instead? Work as a team! Communication!

What Supplements Can We Recommend? Unjury- Why Unjury?  1 serving has 20 grams of protein  Highest quality protein  Easy to make and serve! Juven- Why Juven?  Proven to support building new tissue at the wound site -Revigor CaHmb, arginine, and glutamine  Build lean muscle mass and promote collagen formation, which is an important step in healing  Easy to make and serving!

Additional Oral Supplements  Facilitates nutritional gaps where there is a poor oral intake  Promotes optimal wound healing  Types and Flavors:  Boost Pudding  Boost Glucose Control  Body Quest Ice Cream  Boost/Boost Plus  Beneprotein  Resource Breeze  Arganaid

Bottom Line :  Wound healing requires adequate nutrition for optimal outcomes.  Adequate nutrition is a key element in wound healing  Patients who experience protein-energy malnutrition and involuntary weight loss are at risk for delayed wound healing  We can work together to promote healthy outcomes  Provide supplements as ordered- don’t let them stack up in the room!