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Pressure injuries or ulcers
Damage to the skin and underlying tissue caused by prolonged pressure on the skin.
Debridement
The removal of damaged tissue or foreign objects from a wound.
Blanchable
skin turns white when you press on it and then returns to its normal color when you release the pressure.
Non-blanchable skin
Non-blanchable skin does not turn white when you press on it, which indicates tissue damage.
Full-thickness skin loss
Loss of all layers of the skin, exposing underlying tissues such as fat, muscle, or bone.
Granulation tissue
New connective tissue and microscopic blood vessels that form on the surfaces of a wound during the healing process. Granulation tissue typically has a red, granular appearance.
Slough
Dead tissue that is typically yellow, tan, gray, green, or brown and may be stringy, thick, or loose. Slough must be removed for the wound to heal.
Exudate
Fluid that leaks out of blood vessels into nearby tissues. Exudate is often described as thin and watery, but it can also be thick and pus-like.
Undermining/tunneling
Undermining occurs when the tissue under the edges of the wound is damaged, creating a pocket or tunnel.
Braden scale
A tool used to assess a patient's risk of developing a pressure injury.
Diabetic ulcers
Open sores that can occur on the feet of people with diabetes.
Peripheral neuropathy
A condition that damages the nerves in the extremities, causing numbness, tingling, and pain.
Poor circulation
A condition in which there is not enough blood flow to a particular area of the body.
The most common locations for diabetic ulcers.
Feet/lower legs
Venous ulcers (stasis ulcers)
Sores that develop on the legs, usually near the ankles, due to poor blood flow in the veins.
Venous insufficiency
A condition in which the veins have trouble returning blood to the heart.
Gradual onset
Venous ulcers typically develop gradually over time.
Arterial ulcers
Sores that develop on the feet or toes due to poor blood flow in the arteries.
Peripheral artery disease (PAD)
A condition in which the arteries in the legs and feet become narrowed or blocked.
Surgical wounds
Cuts or incisions made in the skin during surgery.
Complication of surgery
Surgical wounds can become infected or fail to heal properly, leading to complications.
Immobility
A lack of movement, which can increase the risk of developing pressure injuries.
who is more likely to experience complications with wounds
People with underlying health conditions, such as diabetes or poor circulation
Nutritional Screening and Assessment for Pressure Injuries
An evaluation to identify individuals at risk for malnutrition or who are already malnourished. This is a crucial step in pressure injury management.
Early and frequent screening is essential to providing timely nutritional interventions.
Oral Nutrition Supplements for Pressure Injuries
Concentrated sources of calories, protein, vitamins, and minerals that are consumed in addition to the regular diet.
Supplements can help patients meet their increased nutritional needs when they cannot do so through diet alone. They are often recommended for individuals with pressure injuries who are at risk for or diagnosed with malnutrition.
Calorie Needs for Pressure Injury Healing
Recommendation → 30-35 kcals/kg of body weight per day.
Adults with pressure injuries who are malnourished or at risk for malnutrition.
Healthy fats, whole grains, dairy, lean protein, nutrient-dense snacks, smoothies, shakes, fortified foods, and nutritional supplements.
Protein Needs for Pressure Injury Healing
Recommendation → 1.25 to 1.5 g/kg of body weight per day.
Protein is essential for tissue repair and wound healing.
Sources - Lean meats, fish, dairy, eggs, plant-based proteins, and protein supplements/oral nutritional supplements.
Fluid Needs for Pressure Injury Healing
Recommendation → Start with 1 ml per kcal consumed per day.
Increase as needed based on individual fluid losses, such as from perspiration, diarrhea, or vomiting.
Role of Vitamin C in Wound Healing
Supports collagen synthesis, which is critical for wound strength and closure.
Sources → Citrus fruits, strawberries, kiwi, tomatoes, bell peppers, and broccoli.
Role of Vitamin A in Wound Healing
Supports the growth of epithelial cells, which are the cells that line the skin and other surfaces of the body. Vitamin A also helps to maintain the integrity of the skin.
Sources → Carrots, sweet potatoes, spinach, kale, apricots, and liver.
Role of Vitamin E in Wound Healing
Protects cells from oxidative damage and helps to reduce inflammation.
Sources → Almonds, hazelnuts, sunflower seeds, spinach, broccoli, and vegetable oil.
Role of Vitamin D in Wound Healing
Supports immune function and helps to reduce inflammation.
Sources → Fatty fish, fortified foods (dairy and cereal), egg yolks, and sunlight.
Role of Zinc in Wound Healing
Essential for collagen synthesis and immune function.
Sources → Beef, poultry, oysters, beans, nuts, and whole grains.
Role of Copper in Wound Healing
Necessary for the formation of new blood vessels.
Sources → Organ meats, shellfish, nuts, seeds, legumes, and whole grains.
Role of Iron in Wound Healing
Carries oxygen to the tissues, which is essential for wound healing. Iron also supports energy metabolism.
Sources → Red meat, poultry, beans, spinach, and fortified cereal.
Role of Magnesium in Wound Healing
Involved in energy production and protein synthesis.
Sources → Nuts, seeds, whole grains, leafy greens, and legumes.
Role of Arginine in Wound Healing
Promotes blood flow to the wound site.
Role of Glutamine in Wound Healing
Provides energy for cell proliferation and supports immune function.
Role of HMB in Wound Healing
Protects muscle tissue beneath the wound.
