Becky Dorner

National Pressure Ulcer Advisory Panel's Updated Pressure Ulcer Staging System

The National Pressure Ulcer Advisory Panel has updated the definition of a pressure ulcer and the stages of pressure ulcers based on current research and expert opinion solicited from hundreds of clinicians, educators, and researchers across the country. The amount of anatomical tissue loss described with each stage has not changed. New definitions were drafted to achieve accuracy, clarity, succinctness, clinical utility, and discrimination between and among the definitions of other pressure ulcer stages and other types of wounds. Deep tissue injury was also added as a distinct pressure ulcer in this updated system.

The role of nutrition in pressure ulcer prevention and treatment: National Pressure Ulcer Advisory Panel white paper.

INTRODUCTIONThe purpose of this white paper is to review the available scientific evidence related to nutrition and hydration for pressure ulcer prevention and treatment in adults, introduce the nutrition recommendations from the new National Pressure Ulcer Advisory Panel (NPUAP)-European Pressure U

The role of nutrition for pressure ulcer management: national pressure ulcer advisory panel, European pressure ulcer advisory panel, and pan pacific pressure injury alliance white paper.

Nutrition and hydration play an important role in preserving skin and tissue viability and in supporting tissue repair for pressure ulcer (PrU) healing. The majority of research investigating the relationship between nutrition and wounds focuses on PrUs. This white paper reviews the 2014 National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance Nutrition Guidelines and discusses nutrition strategies for PrU management.

Nutrition: a critical component of wound healing.

PURPOSE To enhance the clinicians competence in using nutrition as an integral part of wound healing. TARGET AUDIENCE This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES After participating in this educational activity, the participant should be better able to: 1. Analyze the effects of specific nutritional deficiencies and patient parameters on wound healing capabilities. 2. Accurately interpret laboratory values related to nutritional status. 3. Apply evidence-based nutrition guidelines for improved wound healing.

Enteral Nutrition for Older Adults in Healthcare Communities

Older adults living in healthcare communities (HCCs) have multiple comorbidities and are at increased risk of malnutrition and unintended weight loss. Aging affects nearly every system as well as body composition and structure, causing physiological changes that can affect nutrition status. A significant percentage (56%) of residents who live in nursing facilities require extensive help to eat and have dental problems such as ill-fitting dentures, missing teeth, and swallowing problems, which can lead to inadequate caloric intake and unintended weight loss. Alzheimer disease or dementia is prevalent in both nursing facilities and in assisted living/residential care communities, where it affects 45% of older adults. In cognitively impaired residents, most tube feeding placements occur in the acute care setting and result in significant use of additional healthcare resources, along with high postinsertion mortality rates within 60 days of insertion. Nursing facilities receiving Medicare or Medicaid funding must abide by state and federal regulations and undergo rigorous surveys while balancing complex decisions related to initial placement of feeding tubes. Healthcare professionals must recognize the importance of establishing nutrition treatment goals that are resident centered and that respect the unique values and personal decisions of the older adult. Informed choice, resident-centered care decisions, and the review of living wills and/or advance directives are essential in the decision-making process. After enteral nutrition is started, healthcare practitioners must carefully review the physicians orders and administer and monitor the residents tolerance, checking for potential complications.

Position of the Academy of Nutrition and Dietetics: Individualized Nutrition Approaches for Older Adults: Long-Term Care, Post-Acute Care, and Other Settings

It is the position of the Academy of Nutrition and Dietetics that the quality of life and nutritional status of older adults in long-term care, post-acute care, and other settings can be enhanced by individualized nutrition approaches. The Academy advocates that as part of the interprofessional team, registered dietitian nutritionists assess, evaluate, and recommend appropriate nutrition interventions according to each individuals medical condition, desires, and rights to make health care choices. Nutrition and dietetic technicians, registered assist registered dietitian nutritionists in the implementation of individualized nutrition care, including the use of least restrictive diets. Health care practitioners must assess risks vs benefits of therapeutic diets, especially for frail older adults. Food is an essential component of quality of life; an unpalatable or unacceptable diet can lead to poor food and fluid intake, resulting in malnutrition and related negative health effects. Including older individuals in decisions about food can increase the desire to eat and improve quality of life.

Nutritional strategies for frail older adults.

The objectives of this continuing education article are to analyze the aging process and its effect on the nutritional status of frail older adults; determine how sarcopenia, anorexia, malnutrition, and Alzheimer disease increase the risk for pressure ulcer development and impact the healing process; and to apply evidence-based nutrition guidelines and implement practical solutions for wound healing.

Response to "Clinical Order Sets: Defining Laboratory Tests for Pressure Ulcers".

We readwith great interest theApril 2015Practice Points article, ‘‘Clinical Order Sets: Defining Laboratory Tests for Pressure Ulcers,’’ by Cathy Thomas Hess, BSN, RN, CWOCN. As thought and content experts in the field ofnutrition andwound healing, we would like to clarify the use of albumin as a basic screening tool for nutritional status and its perceived direct relationship to the severity of protein deficiency. In addition, we would like to comment on the common conflation about prealbumin as a ‘‘better indicator of acute nutritional status changes than albumin.’’ Current research indicates that using negative acute phase reactants, such as albumin and prealbumin, to measure nutritional status is no longer appropriate. Negative acute phase reactants are affected by the presence of inflammation, stress, hydration status, and renal function. Cytokine mediators, interleukin 1A, interleukin 6, and tissue necrosis factor, redirect the liver to synthesize positive acute phase reactants, such as C-reactive protein and ferritin, rather thannegative acute phase reactants. During this period of inflammation and/or stress, albumin is pulled from the extravascular space to the plasma and returned back to the extravascular space when inflammation declines. Albumin and prealbumin levels increase with dehydration and decrease with overhydration; this does not impact nutritional status. Studies support that the entire class of hepatic proteins is a better indicator of morbidity and mortality than it is of nutritional status. This makes these hepatic proteins useful as indicators of illness severity.Hepatic protein levels do not accurately measure nutrition repletion, thus making them poor markers of malnutrition. The Academy of Nutrition Dietetics and the American Society of Enteral andParenteralNutrition’s (ASPEN) 2012 article, ‘‘Characteristics recommended for the identification and documentation of adult malnutrition’’ defines an etiologybased approach to describe a standard set of diagnostic characteristics to define malnutrition. These characteristics include reduced energy intake, weight loss, and decline inmusclemass. The 2014 National Pressure Ulcer Advisory Panel, European PressureUlcerAdvisory Panel, and Pan Pacific Pressure Injury Alliance Guidelines for the Prevention and Treatment of Pressure Ulcers do not recommend the use of laboratory tests of acute phase reactants as indicators ofmalnutrition based on the lack of research. Registered dietitians are an integral part of the wound care team and can bring current information and research to light as the field is rapidly growing as more research is published. Registered dietitians are your best source of accurate and current nutrition information. Also featured in the April issue of Advances in Skin & Wound Care is the continuing education article, ‘‘The Role ofNutrition for PressureUlcerManagement: National Pressure Ulcer Advisor Panel, European Pressure Ulcer Advisory Panel, Pan Pacific Pressure Injury Alliance White Paper,’’ which provides additional information on this topic. This article offers a complete understanding of current nutritional recommendations for pressure ulcers.&