Nutrition and Wound Healing Flashcards
Malnutrition
the cellular imbalance between supply of nutrients and energy and the body’s demand for them to ensure growth, maintenance, and specific functions
Nitrogen balance
The difference between the amount of nitrogen taken in by the body and that excreted
Most nitrogen is in the form of protein
Proteins metabolism results in nitrogen exertion
Essential amino acids
Need to supplement
Non-essential amino acids
Produced by the body
Conditional or semi essential amino acids
May require supplements at various times (growth spurts)
Fat soluble vitamin
Primarily stored in adipose tissue and liver, not easily removed from the body, stays stored until used, can develop toxicity
Water soluble vitamin
Easily removed from body, little to no storage by the body
Nutrition goals - wound healing
Provide energy for wound healing Maintain appropriate nitrogen balance Maintain optimal hydration for adequate tissue perfusion Maintain glycemic control Monitor nutritional status
Nutritional risk factors
Weight loss 5% in 30 days, 10% in 180 days BMI less than 21 (with weight loss) Hypoalbuminemia Lymphopenia Diminished ability to intake food
Loss of 10% lean body mass
Complications
Mortality
Impaired immunity, increased infection
10%
20% loss of lean body mass
Complications
Mortality
Decreased healing, weakness, infection
20%
30% loss of lean body mass
Complications
Mortality
Too weak to sit, pressure ulcers develop, pneumonia, no healing
50%
40% loss of lean body mass
Complications
Mortality
Death, usually from pneumonia
100%
Calories - goal
Basic energy needs
Prevent weight loss
Calories - normal
25-35 kcal/kg body weight
Calories - intermediate
35-40 kcal/kg body weight
Calories - hypermetabolic
40-60 kcal/kg body weight
Calories needed for healing - injury factor: post op with no complications
1-1.05
Calories needed for healing - injury factor: wound healing
1.2-1.6
Calories needed for healing - injury factor: 40% BSA burn
1.5-1.85
Calories needed for healing - injury factor: severe infection
1.3-1.55
Calories needed for healing - injury factor: more than 40% BSA burn
1.85-2.05
Albumin - risk level and normal
Risk level = less than 3.5 with normal hydration
Normal = 3.5-5
Prealbumin - risk level and normal
Risk level = less than 16
Normal = 15-36
Hemoglobin - risk level and normal
Less than 12 = risk
Normal = 12-16
Hematocrit - risk level and normal
Risk level = less than 33%
Norm = 36-49%
Cholesterol - risk level and normal
Risk = less than 160 Normal = less than 200
Total lymphocyte count - risk level and normal
Risk = less than 1800 Normal = 3000-3500
Serum osmalality measures what? Risk level? Norm?
Measure of hydration
Risk - more than 295
Norm - 280 - 303
Water
Oxygen perfusion
Wound hydration
Solvent for a variety of components to allow cell diffusion
Aids in maintaining body temperature
Hydration - osmalality - normal and dehydration
Normal = 280-303 Dehydration = more than 303
Hydration - serum sodium - normal and dehydration and overhydration
Normal = 135-145 De = more than 145 Over = less than 130
Hydration - BUN - normal and dehydration and overhydration
Normal = 7-20 De = over 35 Over = less than 7
Hydration - Urine specific gravity - normal, dehydration, overhydration
Normal = 1.002-1.008 De = more than 1.028 Over = less than 1.002
Hydration - normal adult requriement is
30-40 mL/kg
Minimum of 1.5L
Usually need to replace electrolytes along with fluid
Hydration - inc risk patients
Air fluidized beds increased need for hydration
CHF and renal failure - need to be careful because do not want to overtax the heart with fluids, but need them to be hydrated
Proteins
Major source of energy collagen synthesis epithelial cell production immune response (WBC production) Angiogenesis
Proteins - daily protein requirement
Pt weight divided by 2
Protein - albumin
Protein within the vascular spaces which also controls osmotic equilibrium (think edema)
Late indicator of malnutrition
Protein - prealbumin
More sensitive indicator of malnutrition
Transport protein and NOT a precursor of albumin
Serum albumin - half life
Abundant, 20 day half life
Carrier for variety of diff substrates
Serum albumin - synthesized where
Synthesized in the liver
Serum albumin - if dec
Dec in amino acids will lead to dec in albumin
Will lead to decrease of lean body mass as shift in energy metabolism occurs
Serum pre-albumin - half life
2 to 3 days
Carrier for variety of diff substrates
Serum pre-albumin - eliminated by
kidney
Kidney issues may impact levels!
Renal failure = increase in pre albumin
Fatty acids
Collagen production/strength
Cell membrane integrity
Role is controversial
Polysaturated fatty acids (omega 3) may slow wound healing
Cholesterol - bile and hormone production, cell membrane fornation
Vit A
fat soluble
inflammation and epithelialization
Vit B
water soluble
collagen cross links
Vit C
water soluble
leukocyte activation, blood vessel stability via cell membrane integrity
Vit E
fat soluble
people tend to have too much - liver toxicity
Vit K
fat soluble
coagulation
Minerals
Ca, Mg, Phosphorus
skeletal system integrity
Zinc
collagen formation
protein synthesis
WBC function
Fibroblast function
Copper
Collagen crosslinks
Involved in angiogenesis
Arginine
Amino acid Improves nitrogen balance Precursor needed for collagen production Improved immune system responses Primarily surgical/traumatic wound healing Effects are still being debated
Glutamine
Amino acid
Nitrogen transfer function
Oxidizes and becomes fuel for macrophage, lymphocyte and fibroblast activation
Minimizes muscle wasting
