Nutrition and Wound Healing Flashcards by Alex Stein

Malnutrition

the cellular imbalance between supply of nutrients and energy and the body’s demand for them to ensure growth, maintenance, and specific functions

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Nitrogen balance

The difference between the amount of nitrogen taken in by the body and that excreted
Most nitrogen is in the form of protein
Proteins metabolism results in nitrogen exertion

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Essential amino acids

Need to supplement

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Non-essential amino acids

Produced by the body

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Conditional or semi essential amino acids

May require supplements at various times (growth spurts)

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Fat soluble vitamin

Primarily stored in adipose tissue and liver, not easily removed from the body, stays stored until used, can develop toxicity

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Water soluble vitamin

Easily removed from body, little to no storage by the body

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Nutrition goals - wound healing

Provide energy for wound healing
Maintain appropriate nitrogen balance
Maintain optimal hydration for adequate tissue perfusion
Maintain glycemic control
Monitor nutritional status

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Nutritional risk factors

Weight loss 5% in 30 days, 10% in 180 days
BMI less than 21 (with weight loss)
Hypoalbuminemia
Lymphopenia 
Diminished ability to intake food

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Loss of 10% lean body mass
Complications
Mortality

Impaired immunity, increased infection

10%

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20% loss of lean body mass
Complications
Mortality

Decreased healing, weakness, infection

20%

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30% loss of lean body mass
Complications
Mortality

Too weak to sit, pressure ulcers develop, pneumonia, no healing
50%

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40% loss of lean body mass
Complications
Mortality

Death, usually from pneumonia

100%

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Calories - goal

Basic energy needs

Prevent weight loss

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Calories - normal

25-35 kcal/kg body weight

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Calories - intermediate

35-40 kcal/kg body weight

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Calories - hypermetabolic

40-60 kcal/kg body weight

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Calories needed for healing - injury factor: post op with no complications

1-1.05

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Calories needed for healing - injury factor: wound healing

1.2-1.6

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Calories needed for healing - injury factor: 40% BSA burn

1.5-1.85

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Calories needed for healing - injury factor: severe infection

1.3-1.55

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Calories needed for healing - injury factor: more than 40% BSA burn

1.85-2.05

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Albumin - risk level and normal

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Risk level = less than 3.5 with normal hydration

Normal = 3.5-5

Prealbumin - risk level and normal

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Risk level = less than 16

Normal = 15-36

Hemoglobin - risk level and normal

Less than 12 = risk | Normal = 12-16

Hematocrit - risk level and normal

Risk level = less than 33% | Norm = 36-49%

Cholesterol - risk level and normal

``` Risk = less than 160 Normal = less than 200 ```

Total lymphocyte count - risk level and normal

``` Risk = less than 1800 Normal = 3000-3500 ```

Serum osmalality measures what? Risk level? Norm?

Measure of hydration Risk - more than 295 Norm - 280 - 303

Water

Oxygen perfusion Wound hydration Solvent for a variety of components to allow cell diffusion Aids in maintaining body temperature

Hydration - osmalality - normal and dehydration

``` Normal = 280-303 Dehydration = more than 303 ```

Hydration - serum sodium - normal and dehydration and overhydration

``` Normal = 135-145 De = more than 145 Over = less than 130 ```

Hydration - BUN - normal and dehydration and overhydration

``` Normal = 7-20 De = over 35 Over = less than 7 ```

Hydration - Urine specific gravity - normal, dehydration, overhydration

``` Normal = 1.002-1.008 De = more than 1.028 Over = less than 1.002 ```

Hydration - normal adult requriement is

30-40 mL/kg Minimum of 1.5L Usually need to replace electrolytes along with fluid

Hydration - inc risk patients

Air fluidized beds increased need for hydration CHF and renal failure - need to be careful because do not want to overtax the heart with fluids, but need them to be hydrated

Proteins

``` Major source of energy collagen synthesis epithelial cell production immune response (WBC production) Angiogenesis ```

Proteins - daily protein requirement

Pt weight divided by 2

Protein - albumin

Protein within the vascular spaces which also controls osmotic equilibrium (think edema) Late indicator of malnutrition

Protein - prealbumin

More sensitive indicator of malnutrition | Transport protein and NOT a precursor of albumin

Serum albumin - half life

Abundant, 20 day half life | Carrier for variety of diff substrates

Serum albumin - synthesized where

Synthesized in the liver

Serum albumin - if dec

Dec in amino acids will lead to dec in albumin | Will lead to decrease of lean body mass as shift in energy metabolism occurs

Serum pre-albumin - half life

2 to 3 days | Carrier for variety of diff substrates

Serum pre-albumin - eliminated by

kidney Kidney issues may impact levels! Renal failure = increase in pre albumin

Fatty acids

Collagen production/strength Cell membrane integrity Role is controversial Polysaturated fatty acids (omega 3) may slow wound healing Cholesterol - bile and hormone production, cell membrane fornation

Vit A

fat soluble | inflammation and epithelialization

Vit B

water soluble | collagen cross links

Vit C

water soluble | leukocyte activation, blood vessel stability via cell membrane integrity

Vit E

fat soluble | people tend to have too much - liver toxicity

Vit K

fat soluble | coagulation

Minerals

Ca, Mg, Phosphorus | skeletal system integrity

Zinc

collagen formation protein synthesis WBC function Fibroblast function

Copper

Collagen crosslinks | Involved in angiogenesis

Arginine

``` Amino acid Improves nitrogen balance Precursor needed for collagen production Improved immune system responses Primarily surgical/traumatic wound healing Effects are still being debated ```

Glutamine

Amino acid Nitrogen transfer function Oxidizes and becomes fuel for macrophage, lymphocyte and fibroblast activation Minimizes muscle wasting

Nutrition and Wound Healing Flashcards

(56 cards)