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Wound Care Means First Wound Prevention

Nutritional Aspects in the Management of Skin Ulcers

Muscaritoli M, Gioia, Esposito M
Rome, Italy

Abstract
  Although the pathogenesis of skin ulcers (SU) varies largely depending on the reason that caused them, their ability to heal or, to the contrary, their tendency to become chronic or delayed healing depends on the combined effect of several common factors that can significantly influence the prognosis of the wound and the patient. Among these, the most common are represented by care of the wound, hygiene, and nutritional condition. It is widely recognized that protein-calorie malnutrition acts as a factor that favors the onset of SU and at the same time slows healing. The nutritional condition can in fact significantly influence the phases of the wound repair process, namely inflammation, proliferation (anabolic phase), and tissue remodeling. The pivot of nutritional support in the multidisciplinary care of skin wounds is based on an adequate intake of fluids, calories, and proteins. However, very often the diet, even when integrated with specific nutritional supplements, is not able to maintain an optimal state of nutrition and hydration to favor wound repair. In addition, the dietary intake of certain nutrients that are particularly useful in the wound healing process may be sub-optimal. This makes exogenous supplementation necessary, in order to promote and accelerate the healing process, thereby giving way to a pharmaco-nutritional approach for the prevention and cure of SU.

Prevention of Pressure Ulcers in Children: Lessons Learned

Quigley S
Massachusetts, US

Abstract
  Maintaining skin integrity in acutely ill and immobilized hospitalized patients is a priority for nurses. Whether all pressure ulcers are preventable remains controversial. No individual clinician working alone, regardless of how talented, can prevent all pressure ulcers from developing. Rather, pressure ulcer prevention requires activities among many individuals, including the multiple disciplines and individual team members involved in developing and implementing the care plan.

  Furthermore, clinical practice does not change through didactic lectures alone; it changes through building a change team and gathering administrative support, collaboration of all team members, and data collection with performance reporting that will heighten awareness throughout the organization.

  The success of a pressure ulcer prevention program is based upon:

    1. Establishing a Pressure Ulcer Prevention Policy

    2. Use of a risk assessment scale in combination with a comprehensive daily skin assessment

    3. Early identification of skin alterations and prevention protocols based upon individual risk sub-scores

    4. Documentation and communication of patient risk and consistent use of evidence-based interventions

    5.