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0 , d" P d" d" 3 ^ . d" : KEY WOUND HEALING INDICATOR NUTRIENTS & LABS
LABREFERENCE VALUEFREQUENCY OF MONITORING AFTER INITIAL TESTING IMPORTANCE/KEY FACTS RELATED TO WOUND HEALINGOTHERA1C<6%every 3 monthsLong-term glucose control.Albumin3.5-5.5 g/dl
3-3.5 = mild deficiency
2.5-3.0 = moderate deficiency
<2.5 = severe deficiencyevery 3-4 wksGross indicator for nutritional & fluid status (long-term nutritional deficiencies). Needed for tissue synthesis & fighting infection/building blocks of all cells & body tissues (along with globulin & total protein).Alka phos90-130 U/LmonthlyPart of the LFTs.Alanine amino (ALT)10-40 U/LmonthlyHealthy liver to process protein (albumin); high levels = low protein production.Aspartate amino (AST)10-40 U/LmonthlyHealthy liver to process protein (albumin); high levels = low protein production.Arginine40-100 mol/LCollagen synthesis.BUN8-25 mg/dlweeklyByproduct of protein metabolism; elevated levels associated with delayed wound healing. Calcium9-11 mg/dlmonthlyProtein & albumin are bound to Ca for transport. Strengthens capillary membranes. Cholesterol100-200 mg/dlweeklyIf high, indicates a risk factor for PVD; increased & decreased values associated with malnutrition.Copper70-140 g/dlweeklyAngiogenesis & matrix remodeling.CPK22-198 U/LIf elevated, high risk for DTI.Creatinine0.6-1.4 mg/dlweeklyByproduct of muscle catabolism; if high indicates muscle breakdown (if renal status ok).CRP2.6-7.6 g/dldaily once tx initiatedAcute inflammation/infection. ElectrolytesMg: 1.5-2.5 mEq/L
Na: 135-147 mEq/L
K: 3.5-5.5 mEq/L
Ca: 9-11 mg/dl
Cl: 95-107 mEq/L
Phos: 2.5-4.5 mg/dlmonthlyEssential for normal cellular function.ESR<10 mm/hrdaily after tx initiatedInfection/inflammation/osteomyelitis.Folate3-16 ng/mlweeklyNormal function of RBCs & WBCs. Aids in synthesis of RNA & DNA, protein metabolism, & formation of heme.Glucose70-120 mg/dlprior to meals if diabeticOverall glucose hemostasis; chronically elevated levels lead to decreased healing by inhibiting O2 & nutrient perfusion via microvascular damage.Hematocrit42-52% male
37-48% femonthlyConcentration of red cells in blood.Hemoglobin13-18 g/dl male
12-16 g/dl femonthlyBinds and transports O2 to tissues; low levels are risk factor for PrU.Iron50-150 g/dlmonthlyTransports O2.Magnesium1.5-2.5 mEq/LmonthlyActivates enzymes involved in carb & protein metabolism & aids in DNA synthesis.Prealbumin (transthyretin)16-40 mg/dl
10-15 = mild deficiency
5-9 = moderate deficiency
<5 = severe deficiencyweeklySensitive indicator of protein deficiency & not greatly affected by mild liver disease.TIBC240-450 micrograms/dlmonthlyMeasures the amount of iron that can bind to transferrin for transport.Total protein5-9 g/dlmonthlyNeeded for tissue synthesis & fighting infection/building blocks of all cells & body tissues (along with albumin & globulin). Pts with wounds should be placed on a diet that offers 1.25 to 1.5 g protein/kg/day to promote wound healing.Total lymphocyte countNL 2000 cells/microL
1500-1800 = mild deficiency
900-1500 = moderate deficiency
<900 = severe deficiencymonthlyLow levels = immune competence; vicious cycle of malnutrition & infection.TransferrinNL is 200-400 mg/dl
150-200 = mild deficiency
100-150 =moderate deficiency
<1 severe deficiencyevery 2-4 weeksTo export iron; high in Fe deficiency & low in high catabolic states. Can reflect nutritional & protein status; with protein malnutrition transferrin levels decrease rapidly. Also reflects infection/inflammation; an increase leads to concomitant decrease in the production of other proteins produced by liver.Triglycerides100-200 mg/dlweeklyIf high, indicates a risk factor for PVD; increased and decreased values associated with malnutrition.UrinalysisCan use typical valuesmonthlyOverall, abnormal urinalysis results can indicate status of metabolic state related to wound healing capacity.Urine: 24-hourCan use typical valuesmonthlyCreatinine-used to estimate the amount of skeletal muscle mass lost because of catabolism present in the hypermetabolic state of wound healing. If creat. of the pt is compared with nl creat. & the % is less than 60%, it is indicative of protein/muscle wasting.
Nitrogen balance can determine the nutritional status of the pt and whether there is excess protein loss.
The more severe the renal dysfunction, the more impaired the wound healing ability.Vita A30-95 g/dlweeklyCollagen deposition & offset effects of glucocorticoids.Vita B110-60 ng/mlweeklyAids in metabolism of carbs,proteins, & fats & in synthesis of RNA & DNA.Vita B65-30 ng/mlweeklyHeme synthesis & folacin metabolism. Coenzyme for amino acid & protein metabolism.Vita B12200-900 pg/mlweeklyRBC maturation.Vita C>2 mg/dlweeklyCollagen deposition.Vita E5-20 g/mlweeklyEnhances immune response.Zinc60-150 g/dlweeklyCellular proliferation & synthesis.
NUTRIENT NEEDS FOR PRESSURE ULCERS
Individual nutrient needsPREVENTIONSTAGE 1STAGE 2STAGE 3STAGE 4 / UNSTAGEABLECal/kg body wt28-30
30-35 if additional cal. needed30-3530-3535-4035-40Protein, g/kg body wt1.0
1.2-1.5 if additional protein needed (increase fluids/monitor renal function)
1.2
1.5 if additional protein needed (increase fluids/monitor renal function)1.2-1.5 if additional protein needed (increase fluids/monitor renal function)1.2-1.5 if additional protein needed (increase fluids/monitor renal function)1.2-1.5 if additional protein needed (increase fluids/monitor renal function)Fluids, cc/kg body wt3030-3330-3330-3330-33Vits/minerals if deficiencies are confirmed or suspected:
multivit & mineral supple.
elemental zinc, 25-50 mg/d
daily
NA
daily
NA
daily
NA
daily
re-eval in 10-14 days
daily
re- eval in 10-14 days
FROM: Lori Fuhrer RN CWOCN CFCN
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