3.6

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Author:
efrain12
ID:
290853
Filename:
3.6
Updated:
2014-12-07 02:30:02
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Life Nutrition
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Description:
Nutrition & wound healing
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  1. Nutrition and wound healing are closely linked) nutritional deficiencies
    Impede the normal processes that allow progression through stages of healing
  2. Nutrition and wound healing are closely linked) malnutrition
    Has been related to decreased wound tensile strength and increased infection
  3. Nutrition and wound healing are closely linked) malnourished patients can develop..(3)
    -pressure ulcers

    -infections

    • -experience delayed wound healing
    • *chronic wounds
  4. Types of wounds ) acute wounds (3)
    -scrapes and lacerations

    -surgical wounds, intact, or dehisced

    -burns
  5. Types of wounds ) chronic wounds (4)
    -decubitus ulcers/pressure ulcers

    -diabetic foot ulcers

    -venous stasis wounds

    -arterial stasis wounds
  6. Why is obesity more of a risk for wound related problems than malnutrtiinion? 2
    -more inflammation all around

    -immobile
  7. Significance of chronic wounds: percent of diabetic foot ulcers unhealed?
    70%
  8. 4 stages of wound healing
    -hemostasis

    -inflammation

    -proliferation

    -remodeling
  9. Stages of wound healing) hemostasis
    -clot formation
  10. Stages of wound healing) inflammation (2)
    - ne/mO eliminate microbes, clear wound of damaged tissue

    -secrete cytokinesis/growth factors
  11. Stages of wound healing) proliferation (3)
    -epithelial cells migrate to cover the wound

    -endothelial cells participate in angiogenesis

    -fibroblasts contribute to ECM(collagen) depositions
  12. Stages of wound healing) remodeling: (2)
    -vessel regresison

    -reorganization of connective tissue into a scar
  13. Chronic wounds and stages of wound) inflammation
    prolongs the inflammatory phase
  14. Chronic wounds and stages of wound) proliferation (2)
    -Decreases fibroblast proliferation

    -altered collagen synthesis
  15. Aging effects on wound healing) 20-50 % fewer macrophages
    Leads to...

    -delayed cellular migration/proliferations

    -decreased rate of capillary growth in the wound
  16. Aging effects on wound healing) delayed cellular migration/proliferations-decreased rate of capillary growth in the wound : leads to
    Delayed wound closure
  17. Anatomical locations of pressure ulcers) supine position (40
    • -occiput
    • *back of head

    -scapula

    -sacrum

    -heels
  18. Anatomical locations of pressure ulcers) lateral position (7)
    -ear

    -acromion process

    -elbow

    -trochanter

    -medial&lateral condyle

    -medial&lateral malleolus

    -heels
  19. Anatomical locations of pressure ulcers) prone position (7)
    -elbow

    -ear, cheek, nose

    -breasts

    -genitalia

    -iliac crest

    -patella

    -toes
  20. Staging of pressure ulcers) stage 1
    Redness and warmth
  21. Staging of pressure ulcers) stage II
    Shallow ulcer with distinct edges
  22. Staging of pressure ulcers) stage III
    Full thickness loss of skin
  23. Staging of pressure ulcers) stage IV
    Involvement of fascia, CT, muscle and bone
  24. Staging of pressure ulcers) stage 1
    non-blanchable erythema
  25. Staging of pressure ulcers) stage 1
    -intact skin with non-blanchable redness of a localized area usually over a bony prominence
  26. Staging of pressure ulcers) stage 2
    Partial thickness
  27. Staging of pressure ulcers) stage 2
    Partial thickness loss of dermis presenting as a shallow open ulcer with red pink wound bed without slough
  28. Staging of pressure ulcers) stage 3 (5)
    -subcutaneous fat may be visible but bone, tendon, muscle are not exposed

    -slough may be present but does not obscure the depth of tissue loss

    -may include undermining and tunneling

    -depthvaires by location

    -bone tendon is not visible or palpable
  29. Staging of pressure ulcers) stage 4 (30
    -expose bone, tendon/muscle, slough, may be present

    -often includes undermining and tunneling

    -depot caries by location
  30. standard wound treatment ) debridement
    Removal of necrotic and infected tissues that interfere with wound healing
  31. standard wound treatment )  (30
    -debridement

    -selection of dressing to optimize wound moisture balance

    -treatment of infection if present
  32. Negative pressure wound therapy ) vacuum assisted closure therapy (6)
    -removal exudate from wounds

    -removal slough

    -potential decrease in wound bacterial burden

    -reduce edma

    -increase blood flow

    -promote contraction
  33. Ultrasound ) ?
    Delivers mechanical vibration via high freq sound waves which causes tissues to oscillate or vibrate
  34. Ultrasound ) what does it help with? (7)_
    -promotes wound edge contraction

    -decreases periwound edema

    -stimulates granulation tissue in undermining and tunneling

    -induce inflammatory stage

    -increase cell membrane permeability

    -stimulate fibroblast migration and collagen synthesis

    -increase scar strength & elasticity
  35. Hyperbaric oxygen therapy ) what happens?
    inhales o2 inside chamber that is delivered systematically in a pressurized environment of almost twice atmosphere
  36. Hyperbaric oxygen therapy ) mechanism of action (2)
    -doubling the pressure of o2 doubles the amount that dissolves in the plasma

    -may diffuse to tissue that are hypoxic or not well perfused
  37. Risk factors for impaired wound healing) (4)
    -significant weight loss

    -inadequate protein intake

    -inadequate nutrient intake

    • -extreme BMI
    • *low or High
  38. Risk factors for impaired wound healing) vulnerable patients include: (2)
    -advanced age with stroke, DM, dementia

    -immobiled , wheelchair, poor sensation
  39. Braden scale for predicting pressure sore risk) what is it?>
    Scoring system to evaluate a patients risk of developing a pressure ulcver
  40. Braden scale for predicting pressure sore risk) 6 categories it consist of
    -sensory perception

    -mositure

    -activity

    -mobility

    -nutrition

    -friction
  41. Braden scale for predicting pressure sore risk) range of 6 to 23 , lower meaning
    Higher risk
  42. objective of nutrition therapy) (7)
    -resotre nutrient intake

    -monitor branden scale scores

    -heal ulcer and prevent further breakdown

    -improve infection, fever, diarrhea, vomitting

    -assess intake using calorie counts

    -support immune system

    -maintain skin integrity once healed
  43. objective of nutrition therapy) energy: (4)
    -necessary for anabolism

    -nitrogen synthesis

    • -collagen formation
    • -wound healing
  44. objective of nutrition therapy) energy:

    ASPEN : kcal/kg/d?
    30-35 kcal/kg/d
  45. objective of nutrition therapy) energy: if underweight or losing weight , increase to
    35-40 kcal/g/d
  46. objective of nutrition therapy) protein: necessary ? (3)
    Synthesis of enzymes involved in healing

    Proliferation of cells and collagen

    -formation of CT
  47. objective of nutrition therapy) protein: severe protein depletion results in (2)
    -decrease wound breaking strength

    -increased infection rates
  48. objective of nutrition therapy) protein: how much g/kg/d?
    1.25-1.5
  49. objective of nutrition therapy) protein: stage III or IV ulcer may require
    1.5-2 g/kg/d
  50. objective of nutrition therapy) amino acids: Arginine ; substrate for (30
    -protein synthesis

    -collagen deposition

    -cell growth
  51. objective of nutrition therapy) amino acids: glutamine : critical for? (4)
    -Synthesis of nucleotides in cells


    -essential for gluconeogensesis

    Involved in immune function and simulate inflammatory response

    -shown to enhance immune function after major surgery
  52. objective of nutrition therapy) fat: role in wound healing?
    Not extensively studied
  53. objective of nutrition therapy) fat need for essential fatty acids
    Increases with injury
  54. objective of nutrition therapy) fat: why does need for fatty acids increase with injury?
    Prostaglandins play major roles in cell metabolism and inflammation
  55. objective of nutrition therapy) water:
    Adequate intake necessary for tissue perfusion and oxygenation
  56. objective of nutrition therapy) water: why increased demands? (2)
    With high protein intake and major fluid loss from wounds
  57. objective of nutrition therapy) water recommendations
    30 mL/kg or 1-1.5 ml/kcal consumed
  58. objective of nutrition therapy) vita a involved in?
    Normal inflammatory response
  59. objective of nutrition therapy) vita A: IU/d
    10,000 - 50,000
  60. objective of nutrition therapy) vita A: can reverse
    anit inflammatory effects of corticosteroids on wound healing
  61. objective of nutrition therapy) vita c: acerbic acid is cofactor in
    Collagen synthesis
  62. objective of nutrition therapy) vita c : poor wound healing is ymptom of
    scurvy
  63. objective of nutrition therapy) vita c: may be problematic with
    pts with hsitry of kidney stones
  64. objective of nutrition therapy) vita c: recommendations (2)
    -stage 1 & 2: 100-200 mg

    Stage 3 & 4: 1000-2000 mg
  65. objective of nutrition therapy) zinc (4
    Plays role in immune function

    -DNA synthesis

    -protein and collagen synthesisw

    -cell proliferation
  66. objective of nutrition therapy) zinc: excess of this
    Interferes with iron and copper absorption and can lead to deficiency of these minerals
  67. Normal serum zinc
    .66 to 1.50 mcg

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