Nutrition & Pressure Ulcers
According to "Wound Practice and Research," pressure ulcers, sometimes referred to as pressure sores, decubitis ulcers or bedsores, are defined as an area of localized damage to the skin and underlying tissue caused by pressure, shear force, friction, moisture or a combination of these. Nutrition plays an important role in the wound healing process.
Basics of Healing
The body's first line of defense is the skin. It forms a barrier between the external environment and the person. When the integrity of the skin is compromised, the risk for infection increases. In order for proper wound healing to occur, there must be adequate blood flow to the area to transport oxygen and nutrients.
Wound Healing Process
As noted in "RN," wound healing occurs in three overlapping phases. The inflammatory phase starts at the time of injury. During this phase the blood vessels constrict and the clotting process activates. White blood cells invade the area and attack bacteria and dead tissue. The next phase is the proliferative phase that begins about seven days after the injury. In this phase new blood vessels develop and granulation tissue forms a protective covering over the wound. The last phase is the remodeling phase which begins about three weeks after the injury. During this phase the wound edges are pulled inward and scar tissue forms.
When pressure is placed on bony prominences, such as the coccyx, buttocks, elbows or heels, blood flow is decreased to the area. When blood flow decreases, that area of skin and tissue is deprived of oxygen. Patients at greatest risk for pressure sores are those who are bedridden, the elderly and the malnourished. If friction or force occurs, intact skin can be disrupted. The combination of decreased blood flow and a disruption of skin increase the risk of pressure sores to develop. Moisture from urine, feces or sweat in the area of injury softens and decomposes the surrounding tissue.
Nutrition is important in pressure ulcers to help combat infection, facilitate the granulation of tissue and promote wound healing. Protein is necessary in the formation of collagen and elastin for wound healing, as well a major constituent of the immune system in fighting infection. Sources of protein include meat, eggs, dairy products and fish. The main carbohydrate needed is glucose, which aids in the removal of bacteria, dead tissue and promotes cellular growth. Sources of glucose include milk and dairy produce, nuts, sugar and honey. As noted in "Critical Care Quarterly Nursing," two vitamins are of particular importance to wound healing: vitamin A and vitamin C. Vitamin A increases the strength of scar tissue and vitamin C repairs collagen. Wholegrain breads, green vegetables and fresh fruit provide essential vitamin sources.
Patients with pressure sores and malnutrition are at a higher risk of developing infections. Without nutritional support, pressure ulcers can become chronic conditions leading to increased length of stay in hospitals, as well as increase morbidity and mortality rates..
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