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NUTRITION: SETTING
THE LIMITS FOR WOUND
HEALING
ELIMINATING THE WEAKEST LINK
Laura King APD, AEP
Agenda and Objectives
Increase awareness of the ability of compromised nutrition status to compromise wound healing
Increase knowledge of broad range of nutrients that can play a nutritional role in wound healing physiology
Increase knowledge of active ways that you can positively influence the wound care outcomes for your residents
Wound Severity
Stage 1
Stage 11
Stage 111
Stage 1V In
cre
asin
g
se
ve
rity
Phases of Wound Healing- 4 R’s
Regeneration - Inflammatory phase
Repair- Proliferative phase
Revascularisation- Proliferative phase
Re-epithilialisation- Remodelling or maturation
phase
Let’s step through each of the phases and
check in with the nutrients that are valuable
during that phase.
You do not need to write each of them down- it
is important to get a feel for the variety of
nutrients that are utilised for vital steps in
wound recovery.
Phases of Wound Healing- 4 R’s
Regeneration- Inflammatory phase
Day 1-6
Key nutrient involvement
Vitamin K and Calcium contribute to blood clotting
Arginine and Vitamin C regulates nitric oxide
Glutamine and carbohydrates are utilised with
increased energy requirements
Glutamine is utilised as a DNA/ RNA precursor
Vitamin A stimulates immune response
Repair-Proliferative phase
Day 3 to Week 3
Key nutrient involvement
Arginine regulates fibroblast and macrophage
contributions to the repair phase
Zinc, Vitamin A, Vitamin C and Iron stabilise, or
contribute to the development of, collagen
structure
Revascularisation-Proliferative phase
Day 3 to Week 3
Key nutrient involvement
Vitamin C contributes to capillary formation
Protein (amino acids) provides the building blocks
for collagen synthesis
Protein (amino acids) are involve in making
enzymes required for vascularisation
Inadequate protein and fatty acids lead to
processes that interfere revascularisation
Re-epithilialisation-Remodelling or maturation phase
2 weeks to 2 years
Key nutrient involvement
Zinc is used for dozens of enzymes that
contribute to epithelialisation
Vitamin C, Magnesium and Zinc contribute to
ongoing stability of late stage wound
Nutrients involved in Wound Healing
Carbohydrate
Fat
Protein
Zinc
Vitamin C
Vitamin A
Copper
Arginine
Glutamine
Selenium
This broad
range of
nutrients
implicates
any resident
with low
nutrition
status
Good nutrition is a must!
The broad range of nutrients required means that residents who are:
At risk of poor nutrition
+
Have a wound
=
Recipe for poor healing
Nutrition Intervention
So... What can be done?
1. Adequate protein and energy
Well how do we measure this?
Unintended weight loss (>10% loss in 1-3/12)
Not receiving oral supplementation
Poor MMT score
Nutrition screening, using a validated tool for the appropriate
clinical setting, should be undertaken on all adults with pressure
injuries to identify those at risk of poor healing due to nutritional
problems.
NHMRC Grade of recommendation: B
Onward referral to Dietitian as indicated
2. Nutrient Supplementation
Zinc
Vitamin C
Vitamin A
Copper
*Supplementation is valuable ONLY
when serum levels are low*
NOTE: Supplementation of zinc or copper in normal serum is detrimental- it impacts on zinc/copper and iron metabolism- a delicate balance
3. Arginine supplementation
A conditionally essential amino acid
If deficient, may be the weakest link to
effective wound healing
In chronic wounds > stage 2; the benefit from
arginine supplementation will be seen in 2-3
weeks if going to be effective
Okay, so can be done?
Assess risk in regards to nutrient intake- identify weight change, loss of appetite and refer as necessary
Dietitian assessment and request of personalised measures to optimise oral protein and energy intake
Dietitian assessment may indicate opportunity to optimise serum levels- LMO request for serum
Replacement of inadequate nutrients as indicated by serum results
Dietitian may consider Arginine supplementation in specific cases
Okay, so can be done?
Assess risk in regards to nutrient intake- identify weight change, loss of appetite and refer as necessary
Dietitian assessment and request of personalised measures to optimise oral protein and energy intake
Dietitian assessment may indicate opportunity to optimise serum levels- LMO request for serum
Replacement of inadequate nutrients as indicated by serum results
Dietitian may consider Arginine supplementation in specific cases
Okay, so can be done?
Assess risk in regards to nutrient intake- identify weight change, loss of appetite and refer as necessary
Dietitian assessment and request of personalised measures to optimise oral protein and energy intake
Dietitian assessment may indicate opportunity to optimise serum levels-LMO request for serum
Replacement of inadequate nutrients as indicated by serum results
Dietitian may consider Arginine supplementation in specific cases
Okay, so can be done?
Assess risk in regards to nutrient intake- identify weight change, loss of appetite and refer as necessary
Dietitian assessment and request of personalised measures to optimise oral protein and energy intake
Dietitian assessment may indicate opportunity to optimise serum levels- LMO request for serum
Replacement of inadequate nutrients as indicated by serum results
Dietitian may consider Arginine supplementation in specific cases
Okay, so can be done?
Assess risk in regards to nutrient intake- identify weight change, loss of appetite and refer as necessary
Dietitian assessment and request of personalised measures to optimise oral protein and energy intake
Dietitian assessment may indicate opportunity to optimise serum levels- LMO request for serum
Replacement of inadequate nutrients as indicated by serum results
Dietitian may consider Argininesupplementation in specific cases
Assessable component
Okay! So now that you have learnt
about how nutrition can optimise
wound healing- put yourself to the
test...
Type your answers into a Word document
Assessable component
1. With regards to nutritional wound care management, nursing staff in residential aged care are responsible for: a. Commencing oral supplementation and referral to
Dietitian as indicated
b. Ordering blood tests and prescribing nutrient supplementation
c. Nutrition screening, communication and documentation, actioning referrals, assisting in compliance with supplementation
d. All of the above
e. A and C
Assessable component
2. In your own words describe why poor nutrition
can be considered the weakest link in
effective wound healing.
Assessable component
3. True or false:
Poor nutrition is always the cause of poor
wound healing.
(If false, provide brief list of other factors that
may need consideration)
Assessable component
Email your answers, along with any additional queries or questions, to:
I look forward to providing you with feedback, and further information as needed.
Thank you for completing this CPD activity!
NUTRITION: SETTING
THE LIMITS FOR WOUND
HEALING
ELIMINATING THE WEAKEST LINK
Laura King APD, AEP
