Thursday, June 15, 2017

Shadowing a Wound Nurse


Nutrition plays a key role in healing wounds, and during my long term care rotation at Villa Rosa Nursing and Rehabilitation Center, I spent a morning peeking over a wound nurse’s shoulder as she assessed patients’ wounds. Although my time shadowing the nurse was short, I was able to watch her change the dressing of three different wounds: a sacral pressure injury, a heel pressure injury, and a scrape. It was my first time seeing a pressure injury in real life! We reviewed medications pertinent to wound healing such as “calcium alginate” dressings, which create moist healing environments for wounds, and “santyl” ointment which works to remove dead skin surrounding a wound. I also learned that wounds heal best at normal body temperature. Of course, we didn’t forget to talk about the importance of good nutrition to promote wound healing!
Here are a couple of nutritional components that I learned which aid wound healing:

  1. Increased Protein needs
It is recommended that healthy adults get 0.8-1.0 grams of protein/kg/day, while the elderly get 1.0-1.2 grams of protein/kg/day. However, in patients who have wounds or pressure injuries, or are at risk for acquiring them, protein recommendations can go up to 1.5-2.0 grams/kg/day in order to make up for any protein lost in wound exudate and to help synthesize new skin tissue. In the long term care facility where I rotated, protein supplements were often ordered for patients who had inadequate nutrient intake, in order for them to reach their increased protein needs. This need for increased protein can also be accomplished through eating foods high in protein, such as meat or eggs.

  1. Vitamins and Minerals
Getting enough vitamins and minerals can usually be accomplished through a balanced diet, however, a healing wound can often benefit from supplementation of certain vitamins and minerals. Specific nutrients that my preceptor at the long term care facility often recommended in patients with wounds were Zinc and Vitamin C. Zinc helps wounds because it plays a role in collagen and protein synthesis, cell proliferation, and immune function. It is important to note that Zinc supplementation should be recommended with caution because too much zinc can interrupt iron and copper absorption. Vitamin C is beneficial for collagen formation and its antioxidant functions.

  1. Blood Sugar Control
Sometimes patients have non-healing wounds due to elevated blood sugar, which is a concern in patients with uncontrolled diabetes. High blood sugar causes small blood vessels to become rigid, resulting in poor blood circulation. This prevents wounds from receiving the oxygen, nutrients and immune cells they need for skin repair. The healing process can take months due to this and can even lead to dangerous infections, which sometimes require amputations. Controlling blood sugar is an especially important task for anyone with diabetes and a wound.

As a dietetic intern, it was a great opportunity to see several wounds first hand! I now have a better understanding how good nutrition promotes wound healing.  

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