BMI

Normal weight:

BMI 18.5 to 24.9

BMI

Overweight:

BMI 25 to 29.9

BMI

• Obesity:

BMI ≥ 30

What does PEM stand for?

protein-energy malnutrition

What happens when there's a Lean Body Mass Loss of 20%?

The body uses protein stores for both wound healing and restoring lean body mass

What happens in the body when there's a Lean Body Mass Loss of 30%?

The body prioritizes protein stores to restore lean body mass, leaving insufficient protein for wound healing

If the loss is less than ___ of lean body mass, healing continues, but greater losses divert protein to restore body mass, slowing the healing process.

10 %

Biochemical Markers

Offer insights into nutritional and immune status. Key measurements include (Downer et al., 2023): Albumin & Prealbumin ; Total Lymphocyte Count (TLC), Anemia

Not the best indicators of visceral protein due to variability. Hydration, inflammation, and liver function can affect their reliability.

Albumin & Prealbumin

This reflects immune system status. Stress and infection can influence TLC.

Total Lymphocyte Count (TLC)

Managing ______ is key to improving healing and recovery.

Anemia

The below are signs of what?

• Thirst
• Cracked Lips
• Sunken Eyes
• Dark or Strong-Smelling Urine
• Poor Skin Turgor
• Confusion

Dehydration can complicate wound healing.

Key signs and symptoms of dehydration are (Academy of Nutrition and Dietetics, n.d.):

Types of Dehydration

There are three types of dehydration – ___ ___ and ___. Each one affects cell tonicity differently. What are those 3 types?

hypertonic, isotonic, and hypotonic

• Commonly caused by excessive sweating and/or fevers
• More water loss than sodium
• Requires water replacement

Hypertonic

Last image

• Commonly caused by vomiting and/or diarrhea
• Equal loss of water and sodium
• Requires replacement of both

Isotonic

• Commonly caused by diuretic use and/or kidney disease.
• More sodium lost than water
• Requires both water and electrolyte replacement

Hypotonic

Middle image above.

_________ damages tissues through increased protein degradation, decreased collagen formation, and slow healing.

Hyperglycemia

The American Diabetes Association (2023) recommends the following ranges for blood sugar: Fasting Blood Sugar

80 to 130 mg/dL

The American Diabetes Association (2023) recommends the following ranges for blood sugar: Non-Fasting Blood Sugar for peak postprandial

< 180 mg/dL

Hemoglobin A1c reflects average glucose over the past __ to __ weeks.

8 , 12

Higher values indicate a higher risk of diabetic complications, including ___ _____.

slowed healing

Normal hemoglobin A1c for adults is ___.

< 5.7%

The target range for people with diabetes is ___.

6 to 8%

What is the primary purpose of nutrition screening in healthcare settings?

To provide detailed dietary plans for the person

To identify those at risk of malnutrition and decide on the best interventions

To measure the exact caloric intake of each person

To ensure everyone receives the same nutritional supplements

To identify those at risk of malnutrition and decide on the best interventions

* The primary purpose of nutrition screening is to identify those who may have nutritional problems and determine the appropriate interventions. The primary purpose of nutrition screening is not to provide detailed dietary plans, measure exact caloric intake, or ensure everyone receives the same nutritional supplements.

True or False

Nutrition is vital for wound healing; nutrient deficiencies can delay or impair normal healing processes.

True

Aim for __ _ ___kilocalories per kilogram of body weight daily, adjusting for age, comorbidities, activity level, healing stage, wound severity, and the number of wounds. Monitoring and adjusting calorie intake will enhance the healing process.

30 to 35

____ are essential for collagen production, new cells, and blood vessels. Insufficient dietary ____ will delay healing. Proteins also support surgical wound repair, skin health, fluid and electrolyte balance, and immune function.

Proteins

With a heavily exudating wound, the body can lose up to ___ ___ of protein a day, making it important to adjust protein intake to compensate for protein loss through exudate.

100 grams

The body breaks down protein into ___ ___, which contain _______.

amino acids, nitrogen

These amino acids are the building blocks of proteins and are crucial for ____ ___ and ____ ____.

tissue repair ; collagen synthesis.

Amino acids like ___ and _____ are particularly important for speeding up the healing process

arginine ; glutamine

Neither arginine nor glutamine can be adequately metabolized ___ ___, making supplementation important during the body's healing phases.

during stress

Arginine is a building block of protein, supports immune response, and is essential to collagen formation. Its role in healing is:

• Essential during stress and catabolic states when the body’s ability to produce arginine internally is insufficient.
• Important during inflammatory and proliferative phases.
• Supplementing arginine helps support protein formation in cell.

Glutamine is necessary for building proteins in the body. Its role in healing is:

• Promoting cell proliferation.
• Exerting cytoprotective effects in response to nutrient deprivation, stress, and immune challenges.

Achieving a positive nitrogen balance is necessary for new tissue synthesis. This occurs when nitrogen intake exceeds nitrogen excretion, enabling the body to build and repair tissues effectively. Insufficient protein intake leads to a negative nitrogen balance, causing tissue breakdown instead of repair.

Nitrogen Balance

For effective wound healing, aim for ____grams of protein per kilogram of body weight.

1.5 grams

For effective wound healing, aim for ___ ___ of protein per kilogram of body weight for severe wounds or burns.

2.0 grams

Sources of high-quality protein include -

Lean meats, fish, eggs, and legumes.

Patients with ___ _____ must be careful about how much protein they take. Always consult the patient’s nephrologist and dietitian to recommend appropriate diets and supplements!

renal failure

Key Points

__ ___ like arginine and glutamine are vital for _______ __ the healing process.

Amino acids ; speeding up

A person’s daily protein requirements might look like this: Typical adults:

0.8 grams per kilogram of body weight

A person’s daily protein requirements might look like this: During wound healing:

1.2 to 1.5 grams per kilogram

A person’s daily protein requirements might look like this: Severe wounds or burns:

Up to 2.0 grams per kilogram

Fats and Fatty Acids

Fats and fatty acids normally constitute ___ to ____of total daily calories and should come from healthy sources. Fats and fatty acids play a significant role in wound healing

20 ; 35%

Fats and fatty acids play a significant role in wound healing by:

• Providing energy.
• Aiding in the absorption of fat-soluble vitamins needed for wound healing.

• Important for reducing inflammation and supporting cell membrane integrity.
• From sources like fish, nuts, seeds.

Healthy fats are

• Anti-inflammatory
• Support tissue regeneration
• Found in fish, flaxseeds, chia seeds, walnuts, and hemp seeds

Omega-3 fatty acids are a type of healthy fat essential for wound healing. Key functions in healing are

• Omega Six Fatty Acids Omega-6 fatty acids are another type of healthy fat necessary for cellular function. Important to note:

• Small quantities are necessary for immune response.
• Excessive amounts of Omega 6 are pro-inflammatory.
• These come from corn, soybean, and sunflower oils, nuts, and seeds.

Both omega-3 and omega-6 are essential, but maintaining a proper balance is crucial. The typical Western diet is often too high in ____and too low in ___, which can lead to excessive inflammation.

Aim for a balanced intake to support optimal wound healing and overall health.

omega-6 ; omega-3

T/F

By burning carbohydrates for energy, the body preserves protein for its role in healing

TRUE

Glucose, a form of carbohydrate, is used for __production and is needed in phagocytosis and collagen development.

ATP (Adenosine Triphosphate)

* In nutrition and biology, it is widely known as the "energy currency" of the cells

What is needed for Phagocytosis and collagen development in wound care?

Glucose which is used for Adenosine Triphosphate (Caloric Energy).

Vitamins and minerals

_____ and ______ are the unsung heroes of wound healing. They orchestrate the repair of damaged tissue and restoration of skin integrity during these phases.

Hemostasis, inflammation, proliferation, and remodeling are what in wound healing?

The four phases of wound healing

Hemostasis

The body's natural, life-saving process that stops bleeding after a blood vessel is injured.

Primary Hemostasis (Stopping the Flow)

* Vasoconstriction: Immediately after an injury, the damaged blood vessel narrows to reduce blood flow to the area.

* Platelet Plug Formation: Tiny cell fragments in the blood called platelets rush to the injury site. They adhere to exposed collagen, activate, and clump together to form a temporary, fragile seal.

Inflmmation

The critical second stage of wound healing (following hemostasis). It serves as the body’s natural defense system, cleaning the wound of debris and preventing infection before tissue repair

Inflammation begins within ___ of injury and lasts between 2 to 5 days.

24hrs

* In severe or chronic wounds, this phase can last significantly

Because of increased blood flow and chemical activity at the injury site, the inflammatory phase is characterized by four distinct physical symptoms:

• Redness (Rubor): Due to dilated blood vessels rushing blood to the area.
• Warmth (Calor): Caused by the increased blood supply and active metabolic processes.
• Swelling (Tumor): Fluid leakage and immune cells gathering in the tissue.
• Pain (Dolor): Resulting from swelling pressing on nerve endings and the release of inflammatory chemicals.

Fat-Soluble Vitamins

Fat-soluble vitamins are stored in the ____ and play crucial roles in collagen formation, immune response, and blood coagulation. Ensure adequate intake from dietary sources for wound healing.

Liver

Vitamins A, D, E, K

Fat-soluble vitamins

Function / Source: Vitamin A

F: Supports collagen formation and protein synthesis

S: Carrots, sweet potatoes, leafy green vegetables, liver, fish oils, milk, eggs

Function / Source: Vitamin D

F: Promotes calcium metabolism, bone health, and immune function

S: Fatty fish, fortified milk and cereals, egg yolks, sunlight

Function / Source: Vitamin E

F: Acts as an antioxidant aiding in collagen synthesis

S: Nuts and seeds, spinach, broccoli, vegetable oils

Function / Source: Vitamin K

F: Essential for blood coagulation

S: Leafy greens, brussels sprouts, vegetable oils

Two key water-soluble vitamins vital for wound healing are:

Vitamin C ; B Complex

Vitamin _____

• Antioxidant
• Supports the immune system
• Key for collagen synthesis required for new connective tissue formation
• 500 mg or more daily to support wound healing
• Found in citrus fruits, strawberries, and bell peppers

Vitamin C

B Complex

• B1:

Thiamine for energy production and nerve function

B Complex

• B2:

Riboflavin for cellular growth and repair

B Complex

B3:

Niacin for DNA repair and skin health

B Complex

B5:

Pantothenic acid key for energy production and fatty acid metabolism

B Complex

B6:

Pyridoxine for protein metabolism and hemoglobin synthesis

B Complex

B7:

Biotin promotes skin, hair, and nail health

B Complex

B9:

Folate for DNA repair and red blood cell production

B Complex

B12:

Cobalamin for red blood cell formation and neurological function

Name that vitamin:

Folate for DNA repair and red blood cell production

B9

Name that vitamin:

Pantothenic acid key for energy production and fatty acid metabolism

B5

Name that vitamin:

Niacin for DNA repair and skin health

B3

Conditions like pernicious anemia, gastric or ileal resections, Crohn's disease, and low stomach acid can___ vitamin B12 absorption, sometimes necessitating B vitamin injections.

impair

_____ are vital for DNA synthesis, oxygen transport, and inflammation reduction. Adequate intake from sources like meat, beans, shellfish, and fortified cereals is crucial for wound healing.

Minerals

Name the mineral:

• Tissue Repair
• Immune function
• Anti-inflammatory properties
• Liberates vitamin A from storage in the liver
• Depleted with wound drainage, excessive gastrointestinal fluid loss, or poor long-term dietary intake
• No supplement recommendations unless true deficiency
• High serum zinc levels may inhibit healing and interfere with copper metabolism

Zinc

Name that mineral:

• Oxygen transport to healing tissues
• Energy production
• Immune response

Iron

Name that mineral:

• Preserves strength of skin, blood vessels, epithelial and connective tissue
• The balance between copper and zinc levels is more clinically significant than their concentrations alone.

Copper

• Aids in hydration of wound sites and oxygen perfusion
• Solvent for minerals, vitamins, amino acids, glucose, and other small molecules
• Transports vital nutrients to cells and removes wastes from them

Vital functions of water are (Baranoski & Ayello, 2020):

Patients with excessive wound drainage are at a higher risk of dehydration. Additional risk factors for dehydration and conditions requiring extra fluids include:

• Emesis
• Diarrhea
• Elevated temperature
• Increased perspiration
• Use of air-fluidized beds

Prioritize ___ over other beverages, as some can negatively affect nutritional balance.

water

• Heart Failure
• Edema
• Fluid Overload
• Severe Renal Failure

Factors that may decrease fluid needs include

Amino acids play a significant role in tissue repair, what are amino acids considered the building block of?

Proteins

Vitamins

Fats

Carbohydrates

Proteins

Protein breaks down into ___ ___ , considered the building blocks of protein, which are needed for tissue repair and collagen synthesis. Amino acids are not considered the building blocks of vitamins, fats, and carbohydrates.

amino acids

Amino acids are needed for the following:

tissue repair and collagen synthesis

Proteins are crucial for collagen production and tissue repair; 1.2 to 2 grams per kilogram of body weight is the recommended amount of protein for wound healing.

• Proteins are crucial for collagen production and tissue repair; 1.2 to 2 grams per kilogram of body weight is the recommended amount of protein for wound healing.

Which strategy effectively enhances nutrition in a person with a reduced appetite?

Offer easy to chew food and smaller portions