Transcript Nutrition for optimum wound healing

Nutrition for optimum wound
healing
作者：Alison A Shepherd
出處：Nursing Standard Vol 18(6)
October 2003
報告者：陳詩圓
• Nutritiote is crucial holistic approach to wound
healing.
• Nurse must to assessment of nutrition risk and
enable them to obtain more easily the necessary
support for patients to promote optimal wound
healing.
• Nutrition plays a key role in the pathology of
wound healing.
• Need into the different food type on aspects of
wound healing.
• Wound increase body metabolism.
• Wound left to progress can percipitate
weigh loss.
• Nutritional intervention should be provided
early to prevent this catabolic decline in
lean muscle mass, and impairing wound
healing.
• Nurses involved in wound management
need to understand the wound healing
process, this knowledge should underpin
their care plans.
• This is a complex process.
• Factors influencing poor wound healing:
poor nutrition, infection and impaired organ.
• Energy requlrements nutrition and wound
healing.
• Increased energy demands are made by both
inflammation and cellular activity.
• Glucose is the main substrate used by cells
to produce energy, and the main power
source
• Vit. B1 is an important cofactor for energy
production.
• The same is true manganese.
• This is identified that older people and this
is significant required for optimal wound
healing.
• Care for patients with DM , it is important
to be aware that hyperglycaemia has been
show to have severe pathophysiological
consequences in these individuals.
• Maintain stable blood sugar levels will
enhanced wound healing.
• Would seem prudent to advise people who have
diabetes to eat more complex carbohydrates.
• This physiological response is influenced by the
amount of carbohydrate that is present in foods.
• Foods such as oats, brown rice and wholemeal
bread, which are high in fibre and have a low
glycaemic index, lead to a slower and gentler rise
in corresponding blood glucose.
• Reduces file incidence of hyperglycaemia and
promotes effective wound healing.
• The inflammatory response is beneficial to wound
healing, as it brings nutrients to the area of the
wound, removes debris and bacteria and provides
stimuli for chemical wound repair .
• This pro-inflammatory cascade suppresses the
immune system .
• In individuals who are critically ill, where the
metabolic rate is high, this response becomes
imbalanced and has the potential to cause the
patient to develop septic shock which can progress
to multi-system organ failure
• Immunonutrition may be defined as the proess
whereby nutrients are used to modulate the
inflammatory process.
• That eicosanoids derived from the omega 3 series
tend to have less potent infiammatory and
immunological effects than those derived from
omega 6
• Other benefits of omega 3 fatty acids indude lower
post-operative infection rates and the enhancement
of collagen synthesis.
• Dietary protein is required for collagen
synthesis and might be used as source of
energy when fat and carbohydrate stores are
depleted.
• Protein deficiency contribues to poor
healing rates.
• A diet high in proliferative and remodelling
phases of wound healing.
• Arginine is the main amino add essntial for
collagen depoition.
• L-arginine supplementation in people with
DM enhances wound healing
• Glutamine plays an indirect role in wound
healing it is known to act as a source of fuel
for rapidly dividing cells, such as fibroblasts,
glutamine may also attenuate
immunosuppression and improve nitrogen
blance afterelective surgery.
• Iron is also required for the resistance of infection.
This emphasises its importance in wound healing.
• Would seem that the older generation is at risk of
poor wound healing, which affects their daily lives.
• would seem logical that anaemia would result in
tissue hypoxia and impaired wound healing.
• low haemoglobin per se does not have a
significant impact on wound healing, provided
that adequate tissue perfusion is maintained by
cardiac output and gaseous exchange
• Zinc has an important role in the econstruction of
the wound matrix.
• Low serum zinc levels have been associated with
impaired healing particularly in older women with
chronic leg ulcers.
• Although zinc supplementation has been
suggested as necessary in those with deficiency
when increased losses are present.
• as a result of metabolic stress, the process of
wound healing generates production of oxygen
molecules that are highly reactive and can impair
the process of wound healing.
• zinc acts as an antioxidant when applied topically
to me skin. It may protect against the formation of
free radicals, which are known to induce oxidative
stress.
• Nutritional screening is an important part of the
overall clinical assessment of patients. Nurses
based in hospitals and in the community have a
key role in the identification and monitoring of
patients who may be at nutritional risk, thus
requiring nutritional support.
• nutritional screening tool have been developed to
guide nurses in basic nutritional screening. Using
these tools may identify those patients at risk of
malnutrition and enable referral to a dietician for a
more detailed nutrition assessment and provision
of nutrition support.
• If the tools used in clinical practice are not tested
for validity, reliability, sensitivity and specificity
then this may compromise patient care.
• Screening should be carried out on admission and
then reassessed at regular intervals. This should be
dependent on the patient's circumstances as
individuals have differing nutritional requirements.
• Nutrition plays a key role in the pathology of
wound healing. Wound place a high metabolic
demand on patients so it is important that they
receive adequate calories to redress the balance
and prevent malnutrition.
• It is not the quantity of food that is important, but
the quality of what is being ingested.
• In particular, foods that are rich in omega 3, such
as oily fish, have been shown to promote less
inflammation and modulate immune function,
therebypromoting wound healing.
• High-protein diets are beneficial in the
proliferative and maturation phases of wound
healing.
• Use of the immune-enhancing amino acid
supplements such as glutamine and arginine,
especially in the critically ill, is needed.
• It is better that patients receive their nutrient
intake from ingestion of food with upplementation
drinks of fortified food.
• Nurses have a responsibility to patients to
carry out regular nutritional assessments
and work in conjunction with dieticians
where indicated. This will ensure the patient
receives a well-blanced diet, with the
nutrients required to promote good wound
healing .