MNT for Pressure Ulcers

The recommendations relating to the Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline have recently undergone their third revision by the European Pressure Ulcer Advisory Panel (EPUAP), the National Pressure Injury Advisory Panel (NPIAP), and the Pan Pacific Pressure Injury Alliance (PPPIA).

This collaborative and international effort resulted in the development of 115 evidence-based recommendations rated on the level of evidence that was available. In the case of nutrition-related standards, all of the research reviewed indicated there was sufficient evidence to support implementation in practice.

The EPUAP/ NPIAP/PPPIA guideline is meant to be individualized based on the patient's overall health, personal preferences and cultural needs. As with any provision of medical nutrition therapy, good clinical judgment by the registered dietitian nutritionist (RDN) is warranted when conducting a nutrition assessment.

Nutrition screening is advised for people who have a pressure ulcer or are at risk of developing one, or are at risk of malnutrition. The nutrition assessment should include an evaluation of the patient's weight history compared to current weight status, ability to eat without assistance, and an estimation of calories, protein, and fluid from all sources, so that an individualized nutrition care plan may be devised.

Increased protein and calorie needs are recommended for individuals who are recovering from a pressure injury and who are malnourished or at risk of malnutrition. When inadequate dietary intake has been identified, a multivitamin or mineral supplement may be beneficial to the healing process; however, the use of supplements when intake is adequate has not been supported. Depending on the staging of the pressure ulcer and the patient's risk of malnutrition, the provision of additional nutrients, such as zinc or arginine, may be considered. Although, the strength of the evidence and recommendation for supplementation is not as strong, according to the EPUAP/NPIAP/PPPIA guideline.

The overall goals of the RDN and members of the health care team for nutrition intervention in treating patients at risk of pressure ulcer development are as follows:

• Maintain adequate nutritional status by providing optimal nutrient and fluid levels.
• Identify and treat causes of poor nutritional intake.
• Monitor weight status routinely to detect unexpected or unintentional weight loss.
• Select nutrition interventions to improve or maintain nutritional status, including the use of oral supplements or nutrition support, if warranted.

Educational goals include increasing the patient's knowledge as to what nutrients aid in wound healing and the risk factors associated with pressure ulcer development.

References

• European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, and Pan Pacific Pressure Injury Alliance website. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline, 3rd Edition. Accessed June 3, 2020.
• European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Quick Reference Guide. Emily Haesler (Ed.). EPUAP/NPIAP/PPPIA: 2019. Accessed June 3, 2020.
• Academy of Nutrition and Dietetics. Nutrition Care Manual^®. Pressure Ulcers. Accessed June 3, 2020.