Pressure Ulcers and Malnutrition ACOVE

Malnutrition World Health Organization (WHO) Type of malnutrition Mild malnutrition Moderate malnutrition Severe malnutrition

Albumin 3.2 to 3.5 g/dL 2.5 to 3.1 g/dL < 2.5 g/dL  

Reversible causes of malnutrition:

 Dental status (dentition, gum health)  Food security (poverty)  Food-related functional status (ability to feed, prepare meals)  Appetite and intake (Rx, anorexia of aging) Swallowing ability Dietary restrictions • • •

Call a Nutrition Consult for patients at risk for malnutrition:

Weight loss Pressure ulcer Albumin <3.5 g/dL

Undernutrition vs. Malnutrition:

Malnutrition is a lack of proper nutrition secondary to either deficiency or excess. Undernutrition is protein energy and calorie deficiency. We use malnutrition and undernutrition interchangeably for this ACOVE. (Domer, B. et al. 2009 NPUAP)

Pressure Ulcers

Bed-bound individuals may form pressure ulcers in as little as 1 to 2 hours, whereas those who are confined to chairs and who cannot move voluntarily may form pressure ulcers in even less time because of the greater relative force on their skin (Bates Jensen, et al. JAGS 55:S409-416). There is a strong association between undernutrition and pressure ulcer formation and healing. (Reuben, D.B. JAGS (55): 5438-5442)

Common Characteristics of Pressure Ulcers www.npuap.org

Stage I: Skin Intact, non-blanchable redness over a bony prominence Stage II: Shallow open ulcer, reddish pink wound without slough Stage III: Tissue loss of full thickness. NO tendon or muscle exposed. Tunneling and undermining possible.

Stage IV: Bone, tendon or muscle exposed. Tunneling and undermining possible.

Unstageable: Base of ulcer is covered in slough and/or Eschar in the wound bed Deep Tissue Injury: Purple or Maroon area, localized skin intact or blood filled blister. Likely to become a stage III or IV.

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Braden Scale for Predicting Pressure Sore Risk www.bradenscale.com/images/bradenscale.pdf

Perform on patients with inability to reposition themselves • Sensory perception Moisture Activity Mobility Nutrition Friction & Shear