Table 1.

Nutrition guidelines for prevention and treatment of pressure ulcers

1. Screen and assess nutritional status for each individual with a pressure ulcer at admission and with each condition change—and/or when progress toward pressure ulcer closure is not observed. (Strength of Evidence=C)

• Refer all individuals with a pressure ulcer to the dietitian for early assessment of and intervention for nutritional problems. (Strength of Evidence=C)

• Assess weight status for each individual to determine weight history and significant weight loss from usual body weight (≥5% change in 30 days or≥10% in 180 days). (Strength of Evidence=C)

• Assess the individual's ability to eat independently. (Strength of Evidence=C)

• Assess the adequacy of total nutrient intake (food, fluid, oral supplements, enteral/parenteral feedings). (Strength of Evidence=C)

2. Provide sufficient calories. (Strength of Evidence=B)

• Provide 30–35 kcal/kg body weight for individuals under stress with a pressure ulcer. Adjust formula based on weight loss, weight gain, or level of obesity. Individuals who are underweight or who have had significant unintentional weight loss may need additional kcal to cease weight loss and/or regain lost weight. (Strength of Evidence=C)

• Revise and modify (liberalize) dietary restrictions when limitations result in decreased food and fluid intake. These adjustments are to be managed by a dietitian or medical professional. (Strength of Evidence=C)

• Provide enhanced foods and/or oral supplements between meals if needed. (Strength of Evidence=B)

• Consider nutritional support (enteral or parenteral nutrition) when oral intake is inadequate. This must be consistent with the individual's goals. (Strength of Evidence=C)

3. Provide adequate protein for positive nitrogen balance for an individual with a pressure ulcer. (Strength of Evidence=B)

• Offer 1.25–1.5 g protein/kg body weight daily for an individual with a pressure ulcer when compatible with goals of care, and reassess as condition changes. (Strength of Evidence=C)

• Assess renal function to ensure that high levels of protein are appropriate for the individual. (Strength of Evidence=C)

4. Provide and encourage adequate daily fluid intake for hydration. (Strength of Evidence=C)

• Monitor individuals for signs and symptoms of dehydration: changes in weight, skin turgor, urine output, elevated serum sodium, or calculated serum osmolality. (Strength of Evidence=C)

• Provide additional fluid for individuals with dehydration, elevated temperature, vomiting, profuse sweating, diarrhea, or heavily draining wounds. (Strength of Evidence=C)

5. Provide adequate vitamins and minerals. (Strength of Evidence=B)

• Encourage consumption of a balanced diet that includes good sources of vitamins and minerals. (Strength of Evidence=B)

• Offer vitamin and mineral supplements when dietary intake is poor or deficiencies are confirmed or suspected. (Strength of Evidence=B)

From National Guideline Clearing House, used with permission.²⁷