PRESSURE ULCERATION IN NUTRITION INTERVENTION

Pressure Ulceration in Nutrition Intervention

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Table of Contents

Introduction3

Discussion5

Prevalence, Incidence and Costs5

Pressure Ulcers in Ireland6

Impact on Individual7

Pathophysiology and Risk Factors8

MUST Nutritional Screening Tool9

Nutrition Risk Score13

Pressure Ulcer Grading and Risk Assessment Tools Usefulness14

Nutritional Interventions for Healing16

Effect of Nutritional Status on Development of Pressure Ulcer17

Relevance of Nutrition in Wound Healing19

Role of Macronutrients and Micronutrients in Wound Healing20

Conclusion21

References22

Appendix26

Critical Issues in the Assessment and Management of Individual with Pressure Ulceration in Nutrition intervention

Introduction

Pressure ulcer is one of the common and prevailing problems in most healthcare settings. Prevalence and incidence of pressure ulcer are studied by several researchers; however, according to Thomas (2006) statistics quoted depict prevalence rates ranged from 3-10% to 3-23% and based on the setting.

EPUAP/NPUAP defined pressure ulcer as localised injury to the underlying tissue/or to the skin over a prominence of bony, because of pressure, or pressure in combination with shear. Several confounding or contributing factors are also related with pressure ulcer. EPUAP/NPUAP classify pressure ulcer into four stages - non-blanchable redness of intact skin, partial thickness skin blister or loss, fat visible, and bone/muscle visible (EPUAP & NPUAP, 2009).

Shear, friction and pressure are believed to be extrinsic factors, which impose upon the skin surface (Thompson & Furhrman, 2005). Additionally, a number of intrinsic factors may add to the development of pressure ulcer (Dharmarajan & Ugalino, 2002). These factors alter the blood supply to and structural components of the tissues or lessen the sensation or mechanism of perception responses; for instance, diabetic neuropathy in which a patient cannot sense the stimulus position change at the time pressure is applied. Poor status of nutrition is often quoted as the intrinsic factors (Reddy, Gill & Rochon, 2006; Whitne, Phillips, Aslam et al. 2006). Even though, the precise mechanism through which it adds to the development of pressure ulcer is feebly understood (Moore & Cowman, 2011).

Few researches of sound methodological quality have been conducted, which are related to the pressure ulcer and malnutrition (Bluestein & Javaheri, 2008; Wells & Dumbrell, 2006). Nonetheless, providers of healthcare usually relate poor nutrition with the pressure ulcer development, along with poor preventative measures that helps pressure ulcer to grow. According to Hisashige & Ohura (2012), malnutrition is often found in such patient, and equipped to 50 percent of older persons are determined to be malnourished while admitted to hospitals. Assessment of risk is a precursor to the prevention measures planning, intended at lessening the incidence and prevalence of pressure ulcers by identifying appropriate interventions like nutritional intervention should be introduced (Hisashige & Ohura, 2012). Therefore, assessment of risk is an essential concept in this context (Wells & Dumbrell, 2006).

Wells & Dumbrell (2006) reported that pressure ulcer increases the strain on resources for the service regarding health yet they are debatably 95 percent preventable. Moreover, pressure ulcers increase the human cost with regards to suffering and pain, reduced life quality, and furthermore pressure ulcers can contribute to mortality (Ahmed & Haboubi, 2010). The precise pathophysiology is pressure ...