An update on MNT for pressure injuries

Poor nutrition status is a major predictor of skin breakdown. And for those who are already dealing with a skin injury, nutrition plays an important role in the healing process. Here’s what you need to know to offer the best treatment for your patients and residents with pressure injuries.

Staging

 You’ve likely seen terminology in the medical record related to the staging of pressure injuries. When treating a patient or resident with skin breakdown, it’s important to know what you’re up against.

• Stage 1: non-blanchable redness; intact skin
• Stage 2: Partial-thickness skin loss with exposed dermis
• Stage 3: Full-thickness skin loss
• Stage 4: Full-thickness skin and tissue loss
• Unstageable: Stage 3-4 wound obscured by necrotic tissue
• Deep tissue: Intact or non-intact skin; persistent non-blanchable skin discoloration

Medical Nutrition Therapy (MNT) basics

• Calories: 30 to 35 kcal/kg generally recommended for individuals who are malnourished or at risk for malnutrition. Increase as needed to maintain weight and promote wound healing.
• Protein: minimum of 1.25 to 1.5 g/kg. Ensure adequate hydration with higher protein levels.
• Fluid: start with 1 ml/kcal. Increase with excessive fluid losses.

Supplementation

There is a role for oral nutrition supplements (ONS) to assist in meeting energy and protein needs, if an individual is unable to do so with diet alone. When ONS are used, they should ideally be high in calories and protein. Supplements fortified with arginine, zinc, and antioxidants may provide additional benefit, however the National Pressure Injury Advisory Panel does not specifically endorse these functional nutrients.

The National Pressure Injury Advisory Panel does not recommend routine vitamin and mineral supplementation to treat pressure injuries, unless a deficiency is documented or suspected. This may be contradictory to what may dietitians currently recommend or practice. To see the full discussion about vitamin and mineral supplementation, check out the Dietitians On Demand webinar, “Nutrition Management for Pressure Injuries.”

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References:

National Pressure Ulcer Advisory Panel. NPUAP pressure injury stages. http://www.npuap.org/resources/educational-and-clinical-resources/npuap- pressure-injury-stages/. Accessed August 5, 2018.

Munoz N, Posthauer ME, Cereda E, Schols JMGA, Haesler E. The Role of Nutrition for Pressure Injury Prevention and Healing: The 2019 International Clinical Practice Guideline Recommendations. Advances in Skin & Wound Care. 2020;33(3):123-136.