SkinHealth
              360™ 
          Nutrition & 
          Wound Healing
          Proper nutrition plays an important                                                           "During this new 
          role in successful wound healing. Yet, 
          in busy health care settings, other                                                           pandemic era, it is 
          demands of wound care such as                                                                 crucial to go back 
          high-tech support surfaces, surgeries,                                                        to the basics with 
          or specialized wound care treatments                                                          nutrition”
          and products can get in the way of 
          paying attention to the basic concepts 
          of nutrition.
          "During this new pandemic era, it is crucial to go back to the basics with nutrition, to give our patients 
          and residents the best chance at healing and recovery," said Shazi Khan, BSN RN WCC, a Senior Clinical 
          Consultant for Cardinal Health.
          Wound healing creates an intensified metabolic demand for nutrients by increasing cellular activity 
          during the three phases of wound healing: inflammatory, proliferative, and 
          remodeling. Malnourished patients are at risk for complications, such as 
          delayed healing, infection, increased length of hospital stays, and even death.
          To avoid these complications, health care providers must identify malnutrition 
          early and work to correct nutritional deficits to promote healing and the 
          individual's quality of life.
          Strategies to identify malnutrition                                                                                Featured expert:        
                                                                                                                             Shazi Khan, BSN RN WCC, 
          Health care providers should strive to achieve optimal nutrition for every                                         a Senior Clinical Consultant 
                                                                                                                             for Cardinal Health
          individual. However, malnutrition may be more likely to occur in older adults. 
        As many as 40% of hospitalized patients, and up to 85% of patients in care homes, suffer from malnutrition. 
        With the spotlight on achieving positive outcomes and controlling cost, health care organizations should 
        review their policies related to nutritional care.
        Upon admission to a healthcare setting, health care providers should offer a comprehensive nutritional 
        screening critical to identify individuals who are at nutritional risk. Patients suffering from undernutrition or 
        malnutrition should then be referred to a registered dietician, or other appropriate professional. Useful 
        screening steps include:
             Obtaining accurate height and weight, weighing patient at the same time of day, in the same clothes, 
             daily or weekly as needed.
             Lab work assessing serum protein levels and lymphocyte count, which can point to deficiencies 
             associated with gastrointestinal problems or other deficiencies.
             Assessing medications and supplements for side effects that can affect nutritional intake or cause a 
             state of malabsorption.
        Nutritional assessment is not a one-off analysis; it should be a systematic and continual process of obtaining, 
        verifying, and interpreting data. Decisions about causes and treatment should only be made after careful 
        consideration of this data. Be aware, too, not to rule out nutrition issues in obese patients. Even with exces-
        sive calorie intake, there can still be nutritional problems such as vitamin C deficiency that can affect wound 
        healing.
       Nutrients, their wound healing functions, and sources
        Understanding the role macronutrients and micronutri-
        ents play is key to helping patients improve their nutrition          "Refined sugar is 
        in order to heal more effectively. 
        For people that are vegan, vegetarian, and/or sensitive to            not our friend. It has 
        dairy, Shazi calls out sources for protein: "The three best           a profound negative 
        sources of plant-based protein that I've found come from              effect on our bodies 
        peas, quinoa, and pumpkin seeds. For example, according 
        to the USDA's nutritional database, one cup of roasted                and immune systems 
        (without salt) pumpkin seeds contains 285 calories, 11.9 
        grams of protein, 12.4 grams of fat, and 11.8 grams of                and greatly increases 
        dietary fiber. Additionally, they're packed with antioxi-
        dants and offer a variety of other health benefits."                    the risk of infection, 
        He also says "Refined sugar is not our friend. It has a                especially if a wound 
        profound negative effect on our bodies and immune                      is present.”
        systems and greatly increases the risk of infection, 
        especially if a wound is present."
          Nutrient             Function                                              Source
          Calories             Provide adequate energy, prevent weight loss,         Carbohydrates, protein, fat
                               and preserve lean body mass.
          Carbohydrates        Deliver energy, spare protein, and glucose            Grains, fruits, and vegetables 
                               necessary for cellular growth, fibroblastic            with complex carbohydrate 
                               mobility, and leukocyte activity.                     preferred
          Protein              Contains nitrogen which is essential for wound        Meats, fish, poultry, eggs, 
                               healing.                                              legumes, milk and dairy 
                               A component of the immune system.                     products. Lean sources 
                                                                                     of protein preferred.
                               Supplies collagen for skin, cartilage, and muscle.
          Fat                  Concentrated energy source that is essential for      Meat, eggs, dairy products, 
                               digestion absorption and transport of fat-soluble     and vegetable oils
                               vitamins (A, D, E).
                               Provides insulation under the skin and padding 
                               to bony prominences.
          Fluid                Solvent for vitamins, minerals, amino acids,          Water, juices, beverages,
                               and glucose.                                          fruits and vegetables contain 
                                                                                     approximately 95% water. 
                               Helps maintain body temperature and skin              Most supplements are 
                               integrity.                                            75% water.
                               Transports nutrients to cells and waste 
                               products from cells.
          Vitamin A            Stimulates epidermal turnover, strengthens scar       Cod liver oil, eggs, fortified 
                               tissue, increases the rate of re-epithelialization,   foods and beverages, and 
                               and restores epithelial structure.                    orange and yellow vegetables 
                                                                                     and fruits
          Vitamin C            Water-soluble, non-caloric organic nutrient           Citrus fruits and juices, 
                               essential for collagen synthesis and absorption       tomatoes, potatoes, broccoli
                               of iron.
          Zinc                 Co-factor for collagen synthesis, metabolizes         Meats, liver, eggs, seafood
                               protein, and assists in immune function.
       As many as 40% 
       of hospitalized 
       patients, and up to 
       85% of patients in 
       care homes, suffer                                            %                                 %
       from malnutrition.                                    40                               85
       Visually assess signs of malnutrition
       Lastly, there are a number of symptoms that a health care provider can visually assess as potential 
       signs of malnutrition:
            Dull, dry, thin, hair that is easy to pull out
            Yellow lumps around the patient's eyes
            Redness and fissures of the eyelid corners
            White rings around both eyes
            Lips that are red, inflamed, and cracking
            Gums that may be red, spongy, swollen, inflamed, or may bleed easily
            Tongue that is swollen, inflamed, or purplish
            Gray-brown spots on the teeth
            Paleness, hyperpigmentation, or scaling of the skin around the nostrils
            Thyroid gland enlargement
       Early identification of malnutrition or undernutrition is key to wound healing and patient quality of life.
       For more information on how to prevent, treat, and manage 
       wounds, please visit  www.cardinalhealth.com/skinmission
       SOURCES:
       1. Royall, Dawn. Educating registered nurses and healthcare support workers on nutrition and tissue viability. Nutrition. July 2019. Pages 529-531.
       2. Leininger Hogan, Sue RN MSN. How to Help Wounds Heal. www.rnweb.com. August 2004.
       3. Posthauer, Mary Ellen, RD, LD, CD. Nutrition Strategies for Wound Healing. Journal of Legal Nurse Consulting. Spring 2012. Volume 23, Number 1, Pages 15-23.