wounds and wound care - pressure ulcer staging - negative pressure wound therapy - supplementation...
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WOUNDS AND WOUND CARE- Pressure Ulcer Staging- Negative Pressure Wound
Therapy- Supplementation for wound
healing- Treatment Principles- [email protected]
PRESSURE ULCER STAGINGNational Pressure Ulcer Advisory Panel (NPUAP)Guidelines - Based on depth of tissue injury, not size
Typically over bony prominences, but can occur over any area excessive pressure is applied
STAGE 1Non-blanchable erythema
STAGE 2Skin only – excoriation, blister, shallow ulcer
STAGE 3Involves subcutaneous tissue
STAGE 4Involves structures below the subcutaneous tissue – muscle, tendon, fascia, bone
UNSTAGABLENecrotic tissue present which does not allow accurate staging
UNSTAGABLE - KENNEDY
DTIPurple or maroon discoloration of the skin
NEGATIVE PRESSURE WOUND THERAPY“WOUND VAC”
BENEFITSRemoves exudates, infectious material
Reduces edema
Promotes perfusion and angiogenesis
Promotes granulation tissue formation
NPWT / NWPTi
SMALL PORTABLE NPWTPICO – Smith & Nephew
SNaP - Spiracur
NPD 1000 – Kalypto Medical
NUTRITIONAL SUPPLEMENTATION FOR WOUND HEALING
The Dietician is my friend!
WOUNDS = HYPERMETABOLIC STATE
Calories30-35 Kcal/Kg
35-40 Kcal/Kg – underweight or loosing weight
Protein0.8-1.0 g/Kg – Adults
1.0-1.2 g/Kg – Elderly
1.0-1.5 g/Kg – At risk for pressure ulcers
1.2- 1.5 g/Kg – Promote wound healing
Adequate hydration 30-40 ml/Kg/day
1- 1.5 ml/Kcal
Increased requirements with wound drainage, fever
VITAMIN CWorks with the amino acids proline and lysine during collagen synthesis
Angiogenesis
Fibroblast and leucocyte function
500 mg twice daily
Renal failure – 250mg/day – avoid oxalate deposits
ZINCCofactor in collagen synthesis
Cellular proliferation and synthesis – enzyme and immune function
Can adversely affect copper status
ZnS04 220 mg (50 mg elemental) once daily for 2 - 3 weeks
IRON
Hemoglobin Synthesis and collagen formation
Iron (FESO4) - 325mg 1 to 3 times/day for iron deficiency
Vitamin C aids absorption
Can have adverse affects if excess leads to tissue deposition
VITAMIN ACollagen synthesis and cross linking
Stage I-II:
Replete only if deficient
10, 000 – 25,000 IU x 10 days
Stage III-IV:
5000 IU per 1000 kcal
Concomitant glucocorticoid use:
10,000-15,000 IU x 7 days
B VITAMINSCollagen linkage. Healthy immune system Protein and DNA synthesis. Formation of red blood cellsMultivitamin unless specific deficiency
OTHER CONSIDERATIONSGlycemic control
- proper cell function
Copper
- cofactor in connective tissue formation - collagen polymerization and cross link formation
Arginine
- conditionally essential amino acid
- increase collagen deposition and blood flow
Glutamine
- conditionally essential amino acid
- facilitates nitrogen metabolism
- supports protein synthesis
- critical substrate for the cellular immune
HMB (hydroxymethybutarate)
– metabolite of leucine
– promotes tissue building, increase in muscle mass
EFAs
WOUND HEALINGDressing choice and frequency depends on many factors
Maintain optimal moisture for wound healing – exceptions stable dry heel eschar and severe arterial disease
Control bacterial colonization and infection
Control inflammation
Promote tissue proliferation
Outpatient
- Patient convenience and ability
- Requirement for nursing assistance
Wound team follow up typically weekly unless longstanding or stable non-healing