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Advanced Medical Nutrition Therapy > MNT for Pressure Injuries > Flashcards

MNT for Pressure Injuries Flashcards

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USMLE® Step 1 flashcards
1
Q

What are other common names for a pressure injury?

A

-Pressure ulcer
-Decubitus ulcer
-Bed sore

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2
Q

Pressure injuries are localized damage to the skin and/or underlying tissue usually over a ___ ___, as a result of pressure or pressure in combination with shear and/or friction

A

Bony prominence

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3
Q

The tolerance of soft tissue for pressure and shear may also be affected by…

A

-Microclimate
-Nutrition
-Perfusion
-Comorbidities
-Condition of the soft tissue

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4
Q

Pressure injuries are among the most ____ conditions encountered in patients who are acutely hospitalized or in nursing homes

A

Common

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5
Q

It is estimated that there are ____ million pressure injury cases per year in the US

A

2.5

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6
Q

____ ulcers/injuries result from unrelieved pressure that occludes capillary blood flow, resulting in an inadequate supply of oxygen and nutrients to the epithelial and supportive tissue

A

Ischemic

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7
Q

Ischemic ulcers/injuries are usually located over ___ ___

A

Bony prominences

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8
Q

Common sites of ischemic ulcers/injuries:

A

-Sacrum
-Heels
-Hips
-Greater trochanters
-Ankles
-Elbow
-Shoulder
-Back of the head
-Inner knees

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9
Q

What are some primary risk factors for the development of pressure injuries?

A

-Unrelieved pressure over bony prominence
-Friction and shearing forces
-Moisture
-Immobility

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10
Q

What are some secondary risk factors for the development of pressure injuries?

A

-Malnutrition
-Body weight
-Fever
-Infection
-Anemia
-Vascular changes
-Neurological changes
-Decreased sensation
-Incontinence
-Iatrogenic factors (sedatives, restraints)

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11
Q

What two things occur as a body moves in a lateral plane?

A

-Frictional force between the skin and the surface
-Shear strain deep within the tissue

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12
Q

What are the stages of pressure injuries?

A

-Stage 1
-Stage 2
-Stage 3
-Stage 4
-Unstageable pressure injury
-Deep tissue pressure injury

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13
Q

What is a stage 1 pressure injury called?

A

Non-blanchable erythema of intact skin

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14
Q

Characteristics of a stage 1 pressure injury:

A

-Intact skin with non-blanchable redness of a localized area
-May be difficult to detect in those with darker skin tones
-Area may be painful and warm compared to adjacent tissue

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15
Q

What is a stage 2 pressure injury called?

A

Partial-thickness skin loss with exposed dermis

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16
Q

Characteristics of stage 2 pressure injury:

A

-Presents as a shallow, open ulcer with a red-pink wound bed without slough
-The wound bed is viable, pink or red, moist, and may also present as an intact or ruptured serum-filled blister

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17
Q

What is a stage 3 pressure injury called?

A

Full-thickness skin loss

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18
Q

Characteristics of a stage 3 pressure injury:

A

-Full-thickness skin loss involving damage or necrosis of subcutaneous tissue
-Subcutaneous fat may be visible but bone, tendon, and muscle are not exposed
-Presents as a deep crater
-Slough (grey/yellow dead tissue that is full of bacteria) and/or eschar (black dead tissue that does not contain bacteria) may be visible

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19
Q

What is a stage 4 pressure injury called?

A

Full-thickness skin and tissue loss

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20
Q

Characteristics of a stage 4 pressure injury:

A

-Full-thickness skin loss with exposed muscle, tendon, ligaments, or bone
-Slough and eschar may be present
-Epibole, undermining, and tunneling often occur
-Can extend into muscle, tendons, and joint capsule
-Can result in osteomyelitis

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21
Q

An ____ pressure injury is full-thickness skin and tissue loss in which the actual depth of the ulcer and extent of the tissue damage is obscured by slough and/or eschar in wound bed

A

Unstageable

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22
Q

The true depth, and therefore stage, cannot be determined until the slough/eschar are removed, but will then either be a stage ___ or ___

A

3 or 4

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23
Q

A ___ ___ pressure injury is a persistent non-blanchable deep red, maroon, or purple discoloration due to intense and/or prolonged pressure and shear forces at the bone-muscle interface

A

Deep tissue

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24
Q

Complications from pressure injuries:

A

-Pain
-Infection: abscess, cellulitis, bacteremia, osteomyelitis
-Associated with decreased quality of life, prolonged hospital stay, increased health care costs, and increased mortality

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25
Q

____ is the goal with pressure injuries

A

Prevention

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26
Q

All patients should be ____ for pressure injury risk on admission to any health care agency and periodically reassessed

A

Screened

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27
Q

The Braden Scale for Predicting Pressure Sore Risk examines…

A

-Sensory perception
-Moisture
-Activity
-Mobility
-Nutrition status
-Friction/shear

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28
Q

A Braden Scale for Predicting Pressure Sore Risk score of___ or less indicates high risk for developing pressure injuries

A

12

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29
Q

For those determined to be at risk of pressure injuries, they should have a ____ skin assessment

A

Daily

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30
Q

The best way to prevent pressure injuries is to relieve ____

A

Pressure

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31
Q

To relieve pressure in a bed-bound person, they should be repositioned at least once every ____ hours

A

2

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32
Q

To relieve pressure in a chair-bound person, they should be repositioned every ____

A

Hour

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33
Q

People who are able should shift weight every…

A

15 minutes

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34
Q

What are some other ways to relieve pressure?

A

-Pressure-relieving mattress
-Pillows and foam wedges under or between bony prominences
-Increase activity/movement

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35
Q

Another way to prevent pressure injuries is to avoid friction and shearing by…

A

-Using lifting devices
-Maintaining HOB <30 degree angle (if appropriate with medical condition) for those on bed rest

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36
Q

What are some important ways to keep skin in good quality to avoid pressure injuries?

A

-Keep skin clean
-Avoid excessive moisture
-Avoid excessive dryness (using moisturizers as needed)

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37
Q

What are other methods to prevent pressure injuries?

A

-Bowel and bladder programs for incontinence
-Adequate hydration
-Maintain/replete nutrition stores

38
Q

Treatment/management of pressure injuries:

A

-Interdisciplinary approach
-Improve tissue perfusion by eliminating pressure
-Wound cleansing and dressing
-Debridement of necrotic tissue
-Monitoring for and treatment of infections
-Operative repair: debridement, skin grafts
-Medical nutrition therapy

39
Q

We can evaluate healing or lack of healing using the National Pressure Injury Advisory Panel’s ___ ____ ___ ___ ___

A

Pressure Ulcer Scale for Healing

40
Q

Factors that interfere with wound healing:

A

-Malnutrition
-Infection
-Ischemia
-Smoking
-Disease/conditions: atherosclerosis, CHF, obesity, ischemia, immune deficiencies, diabetes, hyperglycemia
-Medications: immunosuppressant drugs, corticosteroids

41
Q

____ is a risk for pressure injuries and inadequate calories, protein dehydration, and certain micronutrient deficiencies increase the risk of skin breakdown

A

Malnutrition

42
Q

What should be included in the nutrition assessment for those with pressure injuries?

A

-Appetite
-Current weight and weight history (under- or overweight increases risk; unintentional weight loss)
-Adequacy of total nutrient intake: current and PTA
-Current medical status and PMHx
-Medications
-Functional status
-Ability to eat independently
-Chewing/swallowing
-GI status
-NFPE (muscle wasting, vitamin/mineral deficiencies, wound analysis-> number of injuries, staging and size, drainage)

43
Q

What labs would give us an indication of someone’s hydration status?

A

-Serum Na
-BUN
-Osmolality

44
Q

We should look at blood sugar because ____ can delay wound healing

A

Hyperglycemia

45
Q

Wound healing requires energy for synthesis of…

A

-Collagen
-Cell metabolism
-Angiogenesis

46
Q

____ impairs wound healing

A

Underfeeding

47
Q

Energy requirements for someone with a pressure injury who is malnourished or at risk for malnutrition:

A

30-35 kcal/kg

48
Q

We should individualize energy requirements based on what three things?

A

-Medical conditions
-Level of activity
-Intentional weight gain/loss

49
Q

Sufficient protein is needed for…

A

-Cell synthesis
-Collagen and connective tissue formation
-Immune function

50
Q

Protein can be lost in wound ___ and ____

A

Exudate and drainage

51
Q

Protein ____ delays wound healing

A

Deficiency

52
Q

The goal is to provide adequate protein for ____ nitrogen balance

A

Positive

53
Q

We should provide ___-___ g/protein per kg for adults with pressure injury who are malnourished or at risk of malnutrition

A

1.25-1.5

54
Q

Patients should consume ___-___ grams of high-quality protein at each meal to increase protein synthesis

A

25-30

55
Q

____ is a conditionally essential amino acid during periods of acute metabolic stress and injury

A

Arginine

56
Q

Arginine promotes the transport of ___ ____ into tissue cells

A

Amino acids

57
Q

Arginine can enhance ___ ___ and ___ ___

A

Wound strength and collagen deposition

58
Q

Arginine stimulates the release of what two things that improve wound healing?

A

-Growth hormone
-Insulin-like growth factor 1

59
Q

Arginine may promote wound ____

A

Repair

60
Q

Arginine may also improve ___ ___

A

Nitrogen balance

61
Q

Arginine can also enhance ____ function

A

Immune

62
Q

Clear and definitive ____ for arginine for safe and effective use have not yet been established

A

Guidelines

63
Q

Adequate ____ intake is needed for good perfusion and oxygenation of healthy tissue and wounds

A

Fluid

64
Q

We should monitor for signs of ____

A

Dehydration

65
Q

What formulas are commonly used to determine fluid needs for someone with a pressure injury?

A

-30 mL/kg
-1 mL/kcal

66
Q

We should provide additional fluid for those with…

A

-Heavily draining wounds
-Fever
-Dehydration
-Vomiting or diarrhea

67
Q

High ____ intake may require additional fluids

A

Protein

68
Q

Many ____ are necessary for optimal skin integrity and wound healing

A

Micronutrients

69
Q

Exact micronutrient requirements for patients with ___ are unknown due to lack of conclusive studies

A

Wounds

70
Q

Deficiencies in what 3 micronutrients can inhibit wound healing?

A

-Vitamin C
-Zinc
-Copper

71
Q

We should encourage patients to eat a ____ diet to include good sources of vitamins and minerals

A

Balanced

72
Q

We should provide/encourage vitamin and mineral supplementations only when dietary intake is ____ or ____ are confirmed or suspected

A

Inadequate; deficiencies

73
Q

Vitamin C aids in ____ synthesis

A

Collagen

74
Q

Vitamin C is also required for…

A

-Capillary formation
-Fibroblast formation
-Stimulation of neutrophil activity

75
Q

Vitamin C deficiency has been associated with…

A

-Delayed wound healing
-Increased risk of wound infection and dehiscence

76
Q

Since vitamin C is not readily stores in the body, deficiency can occur ____

A

Rapidly

77
Q

Who is at risk for vitamin C deficiency?

A

-Individuals with alcoholism
-Elderly
-Severely injured individuals
-Smokers
-Individuals who eat no fruit and vegetables

78
Q

In non-deficient individuals, vitamin C has not been proven to ____ wound healing

A

Enhance

79
Q

If someone is deficient in vitamin C, they should receive…

A

-100 mg three times per day for 1 month

80
Q

If someone is deficient in vitamin C and has renal failure, avoid supplementation over ____ mg/day due to the risk of renal oxalate stone formation

A

200

81
Q

Zinc is required for…

A

-Protein and DNA synthesis
-Collagen synthesis
-Cell replication and growth

82
Q

If someone has a zinc deficiency, they would have…

A

-Delayed wound healing
-Impaired immune function

83
Q

There is a lack of studies showing significant benefit of zinc supplementation of pressure injury healing in the absence of zinc ____

A

Deficiency

84
Q

What patients are at risk of zinc deficiency?

A

-Patients with diarrhea
-Patients with malabsoprtion
-Patients with metabolic stress
-The elderly

85
Q

For zinc deficiency, the optimal supplemental dose is ____

A

Unknown

86
Q

If clinical signs of zinc deficiency are present, provide…

A

25-40 mg/day of elemental zinc for 10 days

87
Q

Doses of zinc over ___ mg/day may inhibit wound healing by interfering with copper absorption

A

50

88
Q

We should provide high kcal and high protein fortified foods or oral nutrition supplements _____ meals

A

Between

89
Q

If needed and consistent with patient wishes, use of supplemental tube feeding may be done using what type of formula?

A

-High protein, nutritionally complete formula

90
Q

What should be included in an oral nutrition supplement or enteral nutrition formula for adults with a stage 2 or greater pressure injury who are malnourished or at risk of malnutrition?

A

-High kcal
-High protein
-Arginine
-Zinc
-Antioxidants

Advanced Medical Nutrition Therapy (14 decks)

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