Chapter 21: Wound Healing
What are the 2 roles of vitamin E in wound healing? A) Antioxidant; modulates collagen synthesis B) Immune system support; enzyme production C) Protein co-factor; oxygen transport D) Stimulates fibroblasts; fights infection
A) Antioxidant; modulates collagen synthesis 1. antioxidant, when combined in a high calorie ONS enriched with arginine, zinc and other antioxidants promotes healing 2. inhibits collagen synthesis, decreases tensile strength of wounds
What is the evidence for arginine supplementation in wound healing? A) Enhances wound strength, collagen deposition, and synergistic effect of promoting the transport of amino acids into the tissues and synthesis of cellular protein. B) Lowers inflammatory factors at the wound site, reduces risk of infection C) It is a conditionally essential amino acid that the body can't make during inflammatory states such as wound healing D) As a branch-chained amino acid, it helps with protein sparing from cell tissues during the increased protein demand of wound healing.
A) Enhances wound strength, collagen deposition, and synergistic effect of promoting the transport of amino acids into the tissues and synthesis of cellular protein. Studies have shown that arginine supplementation will enhance wound strength and collagen deposition in artificial incisional wounds. Arginine promotes the transport of amino acids into the tissues, supports the synthesis of cellular protein, stimulates insulin secretion and is a precursor of nitric acid formation. Supplementing with additional energy, protein, arginine and micronutrients promotes healing both in well-nourished and malnourished individuals when done in addition to standard wound treatment. Studies suggest that the efficacy of these nutrients in wound healing is likely synergistic since there is no evidence supporting an independent effect when supplemented nutrients are given alone. Multiple organizations recommend supplements enriched with protein, arginine and micronutrients for adults with stage III-IV wounds or multiple pressure injuries/ulcers when traditional high-calorie, high protein supplements do not meet nutrition requirements and facilitate wound healing. No research examining the use of arginine alone as a supplement to promote wound healing has demonstrated efficacy.
What is the NPIAP definition of an unstageable pressure injury? A) Full Thickness skin and tissue loss, but cannot see the bottom of the wound. Usually later reveals a stage III or IV wound B) Intact-serum filled blister, or loss of top layer of skin with a pink or red, moist, viable wound bed showing skin tissue only C) Open wound with full thickness skin loss , in which adipose is visible in the ulcer and granulation tissue and epibole (rolled wound edges) are often present. D) Full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle tendon, ligament, cartilage or bone in the ulcer.
A) Full thickness skin and tissue loss, but can't see the bottom of the wound. Usually later reveals a stage III or IV wound. The extent of tissue damage within the ulcer cannot be confirmed because it is obscured by slough or eschar. If slough or eschar is removed, usually a stage III or stage IV pressure injury will be revealed. Of note, stable eschar (dry adherent, intact without erythema or fluctuance) on the heel or ischemic limb should not be softened or removed.
What is the NPIAP definition for stage 1 pressure injury? A) Intact, non-blanchable redness B) Intact-serum filled blister, or loss of top layer of skin with a pink or red, moist, viable wound bed showing skin tissue only C) Open wound with full thickness skin loss , in which adipose is visible in the ulcer and granulation tissue and epibole (rolled wound edges) are often present. D) Full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle tendon, ligament, cartilage or bone in the ulcer.
A) Intact, non-blanchable redness Intact skin with a localized area of non-blanchable erythema, which may appear differently in darkly pigmented skin. Presence of blanchable erythema or changes in sensation, temperature or firmness may precede visual changes. Color changes do not include purple or maroon discoloration, these may indicate deep tissue pressure injury.
What is the impact of vitamin E deficiency on wound healing? A) No clinically significant effects of vitamin E deficiency on wound healing are known B) Higher risk of wound infection C) Excessive clotting which impairs nutrient delivery D) Alopecia (hair loss)
A) No clinically significant effects of vitamin E deficiency on wound healing are known
What is the most current term to describe wounds formerly known as 'pressure ulcers'? A) Pressure Injury B) Pressure Sore C) Erosion wound D) Pressure Ulcer, there has been no change in this wound terminology since 1986 at the first meeting of the NPUAP.
A) Pressure Injury In 2016, the National Pressure Injury Advisory Panel (formerly National Pressure Ulcer Advisory Panel) replaced the term pressure ulcers with pressure injury to more accurately describe pressure injuries in both intact skin and ulcerated skin. The staging system remains the same as the previous staging system. For example, stage I and DTI are described as injured intact skin, whereas the other stages describe open ulcers. Older vocabulary led to confusion because definitions for each of the stages referred to all types of pressure injuries as pressure ulcers.
What are 3 roles of zinc in wound healing? A) enzyme system component; immune function; metalloproteinase production B) immune function; blood sugar homeostasis; enzyme production C) modulates inflammation; enzyme system component; enhances oxygen delivery to cells D) conditional antioxidant; enhances protein transport; supports gut health
A) enzyme system component, immune function, metalloproteinase production. In wound healing, the role of zinc is: 1. component of many enzyme systems 2. affects multiple aspects of immune function 3. production of metalloproteinases is zinc dependent
What are 2 consequences of iron deficiency in wound healing? A) low hemoglobin and tissue hypoxia; may contribute to impaired immune response B) accelerated tissue breakdown; hyperglycemia C) excessive antioxidant activity; anemia D) excessive fibroblast linking; higher risk of thrombosis
A) low hemoglobin and tissue hypoxia; may contribute to impaired immune response. 1. Low hemoglobin due to iron-deficiency anemia may be a factor in tissue hypoxia. This can impair wound healing if compensatory mechanisms cannot maintain adequate tissue perfusion 2. May contribute to impaired immune response (T cell and phagocytic function)
What are the 3 roles of vitamin C in wound healing? (pick 3) A) fibroblast maturation and collagen synthesis B) dampens inflammatory response C) immune system support D) required for angiogenesis
A, C, and D. 1. required for fibroblast maturation as well as hydroxylation of proline and lysine in collagen synthesis 2. affects immune function (leukocyte function and complement production) 3. required for angiogenesis (development of new blood vessels)
What kind of wound most often leads to lower leg amputation? A) Venous stasis ulcer B) Diabetic foot ulcer C) Infected foot wound D) Compartment syndrome wound
B) Diabetic foot ulcer. Healing of wounds is impaired in individuals with diabetes. Patients with diabetes are at risk for developing nonhealing diabetic foot ulcers, a significant complication of diabetes. It can result in lower leg amputation. Treatment of a diabetic foot ulcer requires adequate nutrition to stabilize blood glucose levels, proper wound care, prevention and treatment of inflammation and infection, and off-loading pressure.
What is the NPIAP definition for stage II pressure injury? A) Intact, non-blanchable redness B) Intact-serum filled blister, or loss of top layer of skin with a pink or red, moist, viable wound bed showing skin tissue only C) Open wound with full thickness skin loss , in which adipose is visible in the ulcer and granulation tissue and epibole (rolled wound edges) are often present. D) Full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle tendon, ligament, cartilage or bone in the ulcer.
B) May be an intact serum-filled blister, or loss of the top layer of skin, with a pink or red, moist, viable wound bed showing skin tissue only. Partial-thickness loss of skin with exposed dermis. Wound bed is viable, pink or red, and moist. May also present as an intact or ruptured serum-filled blister. Adipose is not visible, and deeper tissues are not visible. Granulation tissue, slough, and eschar are not present. Injuries commonly result from adverse microclimate and shear in the skin over the pelvis and shear in the heel. Stage should not be used to describe moisture-associated skin damage (MASD) including incontinence associated dermatitis (IAD), intertriginous dermatitis (ITD), medical adhesive-related skin injury (MARSI) or traumatic wounds (skin tears, burns, abrasions).
What are 3 factors that can contribute to wound chronicity? A) Wound depth, blood pressure control, and unstable weight status B) Prolonged inflammatory state, inadequate nutrient intake, and increased bioburden C) Wound location, age of the subject, and presence of a neurological disease D) Excessive nutrient intake, anaerobic environment, and uncontrolled blood glucose
B) Prolonged inflammatory state, inadequate nutrient intake, and increased bioburden 1. prolonged inflammatory state 2. reduced availability of growth factors 3. increased bioburden 4. underlying disease (diabetes) 5. prolonged bleeding during the inflammatory phase 6. inadequate availability of nutrients and blood supply 7. prescription drugs 8. hypoxemia 9. inadequate nutrient intake
What are 2 impacts of zinc deficiency on wound healing? A) decreased production of neurotransmitters needed in healing, impaired blood sugar control B) impaired wound strength and depressed immunity C) excessive antioxidant activity, anemia D) excessive fibroblast linking, excessive wound bed debris and slough
B) impaired wound strength and depressed immunity. 1. impaired wound strength (decreased fibroblast proliferation, collagen synthesis and rate of epithelialization) 2. depressed immunity is seen even in mild deficiency, susceptibility to a variety of pathogens is increased
What are the 3 roles of iron in wound healing A) immune function, blood sugar homeostasis, enzyme production B) oxygen transport, enzyme component, cofactor in collagen synthesis C) modulates inflammatory response, essential in clotting activity, impairs bacterial growth D) lymphatic function, reduces free radical activity, dilates capillaries
B) oxygen transport, enzyme component, cofactor in collagen synthesis 1. oxygen transport to wounded tissues 2. component of many enzymes (required in oxidative burst of phagocytosis) 3. cofactor in hydroxylation of lysine and proline for collagen synthesis (impaired hydroxylation of collagen due to iron deficiency is rarely seen in clinical practice)
What kind of amino-acid enhanced protein supplement should be provided to patients with multiple stage III or IV pressure injuries? A) protein supplement with methionine B) protein supplement with arginine C) protein supplement with carnitine D) protein supplement with leucine
B) protein supplement with arginine. According to the 2014 National Pressure ulcer/injury advisory panel recommendations, evidence with strength level B ("probably do it") to: Supplement with high protein, arginine and micronutrients for adults with a pressure ulcer category/stage III or IV or multiple pressure ulcers when nutritional requirements cannot be met with traditional high-calorie and protein supplements.
What are 3 impacts of vitamin C deficiency on wound healing? A) impaired red blood cell production; increased oxidation; renal dysfunction B) reduced wound tensile strength; bleeding; and tissue fragility/breakdown C) excessive fibroblast linking; higher risk of thrombosis; hyperglycemia D) impaired immune response; decreased macrophage activity; inflammation due to scurvy
B) reduced wound tensile strength, bleeding, and tissue fragility/breakdown. 1. reduced wound tensile strength, and increased wound dehiscence, due to impaired fibroblast and collagen maturation 2. bleeding - may contribute to increased capillary fragility and angiogenesis with increased wound hemorrhage 3. tissue fragility/breakdown - old wounds may breakdown in very severe deficiency
When should EN be started in ICU burn patients? A) enteral nutrition support started within 24-48 hours of ICU admission B) after the patient is hemodynamically stabilized, usually after the ebb phase response is completed, 3-5 days after burn insult C) enteral nutrition support should be initiated whenever possible within 4 to 6 hours following ICU admission D) when failure to achieve adequate intakes orally over 5-7 days is evident
C) EN should be initiated whenever possible within 4 to 6 hours following ICU admission for burn patients.
What is the NPIAP definition of Deep Tissue Pressure Injury? A) Full Thickness skin and tissue loss, but cannot see the bottom of the wound. Usually later reveals a stage III or IV wound B) Intact-serum filled blister, or loss of top layer of skin with a pink or red, moist, viable wound bed showing skin tissue only C) Intact or nonintact skin with localized area of persistent non-blanchable deep red, marron, or purple discoloration or epidermal separation revealing a dark wound bed or blood filled blister D) Full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle tendon, ligament, cartilage or bone in the ulcer.
C) Intact or nonintact skin with localized area of persistent non-blanchable deep red, maroon or purple discoloration or epidermal separation revealing a dark wound bed or blood-filled blister. These wounds may resolve without tissue loss, OR can rapidly evolve/deteriorate to reveal deep tissue damage. Pain and temperature change often precede skin color changes. Discoloration may appear differently in darkly pigmented skin. Injury results from intense and/or prolonged pressure and shear forces at the bone-muscle interface. If necrotic tissue, subcutaneous tissue, granulation tissue, fascia, muscle or other underlying structures are visible, this indicates a full thickness pressure injury (unstageable, stage III or stage IV). Do not use deep tissue pressure injury to describe vascular, traumatic, neuropathic or dermatologic conditions.
What are the 3 roles of vitamin A in wound healing? A) Supports mucosal and epithelial surface integrity; antioxidant; glucose regulation B) Enzyme cofactor; cytokine conversion; insulin sensitivity C) Mucosal & epithelial surface integrity; collagen linking; counteracts negative effects of glucocorticoids D) Vitamin A does not play a prominent role in wound healing.
C) Mucosal & epithelial surface integrity; collagen linking; counteracts negative effects of glucocorticoids 1. Mucosal & epithelial surface integrity- maintains integrity of epithelial and mucosal surfaces 2. Collagen linking: stimulates fibroblasts, which increase collagen synthesis; cross linking and remodeling of collagen 3. Counteracts negative effects of glucocorticoids: antagonizes inhibitory effects of glucocorticoids
What is the NPIAP definition for stage III pressure injury? A) Intact, non-blanchable redness B) Intact-serum filled blister, or loss of top layer of skin with a pink or red, moist, viable wound bed showing skin tissue only C) Open wound with full thickness skin loss , in which adipose is visible in the ulcer and granulation tissue and epibole (rolled wound edges) are often present. D) Full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle tendon, ligament, cartilage or bone in the ulcer.
C) Open wound, with full-thickness loss of skin, in which adipose is visible in the ulcer and granulation tissue and epibole (rolled wound edges) are often present. Does NOT go down to fascia, muscle, bone, tendon, or cartilage. Slough and/or eschar may be visible. Depth of tissue damage varies by anatomical location, areas of significant adiposity can develop deep wounds. Undermining and tunneling may occur. Fascia, muscle, tendon, ligament, cartilage and/or bone are not exposed. If slough or eschar obscures the extent of tissue loss, this is an unstageable pressure injury.
What nutrients have increased needs during the initial inflammatory phase of wound healing? A) Energy, magnesium, Vitamin A, and fluid B) Energy, protein, fat, and pyridoxine C) Protein, selenium, energy, and Vitamin C D) Iodine, energy, protein, and arginine
C) Protein, selenium, energy, Vitamin C. There are over ten nutrients with increased needs during the initial inflammatory phase of wound healing, including: 1. energy 2. protein 3. vitamin C 4. vitamin E 5. vitamin K 6. iron 7. selenium 8. copper 9. zinc 10. vitamin A 11. vitamin D
Can zinc toxicity impair wound healing? A) no, the body can safely store excess zinc B) no, additional zinc further enhances the immune system and any excess is eliminated by the kidneys C) yes, zinc toxicity can impair the immune system by impairing neutrophil and lymphocyte function D) yes, zinc toxicity can lead to mineralized deposits in the wound bed that impair blood flow and nutrient delivery
C) Yes, zinc toxicity can have adverse effects on wound healing and the immune system including impaired neutrophil and lymphocyte function.
How much protein is considered adequate for adults with delayed healing of pressure injuries/ulcers? A. 0.8 g/kg/d B. 1.0-1.2 g/kg/d C. 1.25 to 1.5 g/kg/d D. 0.6 g/kg/d
C. 1.25 to 1.5 g/kg/d Goal for protein support for patients with pressure injuries/ulcers is 1.25 to 1.5 g protein per kg body weight per day
Which of the following should be offered to provide elemental zinc for pressure injuries/ulcers healing? A. Zinc sulfate 220 mg/d B. Zinc gluconate: 84 mg/d C. Daily multivitamin with minerals supplement D. Zinc chloride: 170 mg/d
C. Daily multivitamin with minerals supplement Zinc supplementation is recommended only for patients with confirmed zinc deficiencies, adequate levels can be achieved with a daily multivitamin with minerals supplement. For patients with normal levels of zinc, supplementation offers no benefit and may result in zinc toxicity.
Pre-existing malnutrition was a positive predictive variable for pressure ulcer after a major surgery, designated as a type of "never event" by CMS. What is a "never event?" A) an event that has never happened before B) an event that causes immediate jeopardy to the life of the patient C) an event that can be cause to deny payment for costs associated with a preventable complication. D) an event that should never happen, is inexcusable, and can be penalized with fines.
C. an event that can be cause to deny payment for costs associated with a preventable complication A "never event" is a CMS term used to deny payment for costs associated with select complications of patient care that could be prevented. Pressure injuries/ulcers reportedly are the second most common adverse event in medical facilities. Starting in 2008, CMS stopped reimbursing inpatient medical facilities for care for stage 3 and stage 4 pressure injuries/ulcers that develop during the inpatient stay.
What are the 3 phases of wound healing? A) Injury, Inflammation, Healing B) Inflammation, Response, and Maturation C) Inflammation/hemostasis, Proliferative, and Maturation D) Acute Response, Rebuilding, and Maturation
C: Inflammation/hemostasis, Proliferative phase, and Maturation Phase 1. Hemostasis/inflammation - occurs immediately after injury 2. Proliferative phase - "constructive phase" occurs around day 4 to day 14 3. Maturation phase - "remodeling phase" occurs from day 8 until 12 months
What is the recommended calorie intake for adults with or at risk for a pressure ulcer? A) Mifflin St Jeor RMR with Injury factor 1.5 B) Penn State equation REE plus 20% C) 22-25 kcal/kg of ideal body weight D) 30-35 kcal/kg body weight
D) 30-35 kcal/kg body weight Provide 30-35 kcal/kg body weight for those at risk for a pressure ulcer or have a pressure ulcer who are assessed as being at risk for malnutrition. Adjust energy intake based on weight change or level of obesity. Adults who are underweight, or who have had significant unintended weight loss, may need additional energy intake. Strategies to achieve energy goals: -Revise and modify/liberalize dietary restrictions when limitations result in decreased food and fluid intake. -Offer fortified foods and/or high calorie, high protein ONS between meals if nutritional requirements cannot be achieved by dietary intake. -Consider enteral or parenteral nutrition support when oral intake is inadequate.
How does a wound VAC provide a benefit in healing? A) assists with removal of inflammatory substrates, interstitial fluid, and edema B) promotes tissue oxygenation and wound granulation C) Reduces infection D) All of the above.
D) All of the above. A wound VAC helps support healing by assisting with the removal of inflammatory substrates, excess interstitial fluid, and edema. This promotes improvements in tissue oxygenation. It is also associated with reduced infection, and promotes of wound granulation.
According to the SCCM/ASPEN guidelines, when in critical illness should supplemental PN be started? A) when the patient is unable to achieve 60% of their energy and protein requirements with EN alone after 7-10 days B) when the patient is at high nutrition risk or already malnourished, nutrition support is indicated, but EN is not feasible C) never, supplemental PN increases risk of infection in critical illness D) Both A and B
D) Both A and B. SCCM/ASPEN guidelines recommend supplemental parenteral nutrition if the patient is unable to achieve 60% of their energy and protein requirements with EN alone after 7 - 10 days. PN should also be considered when patients who are at high nutrition risk or malnourished and nutrition support is indicated but EN is not feasible
What is the consequence of vitamin K deficiency in wound healing? A) excessive clotting which impairs nutrient delivery B) excessive bleeding C) higher risk of wound infection D) Both B and C
D) Both B and C. Vitamin K deficiency in wound healing can result in excessive bleeding in wounds, and predispose patients to wound infections.
What is the NPIAP definition of a stage IV pressure injury? A) Intact, non-blanchable redness B) Intact-serum filled blister, or loss of top layer of skin with a pink or red, moist, viable wound bed showing skin tissue only C) Open wound with full thickness skin loss , in which adipose is visible in the ulcer and granulation tissue and epibole (rolled wound edges) are often present. D) Full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle tendon, ligament, cartilage or bone in the ulcer.
D) Full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle tendon, ligament, cartilage or bone in the ulcer. Slough and/or eschar may be visible. Epibole (rolled edges), undermining, and/or tunneling often occur. Depth varies by anatomical location. If slough or eschar obscures the extent of tissue loss, this is an unstageable pressure injury.
What are the most common type of chronic wounds that develop in the lower extremities? A) Diabetic toe wounds B) Surgical wounds C) Friction points and blisters D) Venous leg ulcers
D) Venous leg ulcers Patients at risk for venous ulcers are older adults with a history of DVT and previous surgery for varicose veins. Note that these wounds are nutritionally demanding as the ulcerations often drain moderate amounts of protein-rich exudate, and are painful and debilitating
What are 3 consequences of vitamin A deficiency with wound healing? A) halts collagen production; impaired lung function; increased cell permeability B) reduced wound tensile strength; bleeding; and tissue fragility/breakdown C) excessive antioxidant activity; anemia; rapid development of night blindness D) altered immune function; increased risk of infection; impaired collagen synthesis if high dose glucocorticoids are also used
D) altered immune function; increased risk of infection; impaired collagen synthesis if high dose glucocorticoids are also used. 1. widespread alterations in immune function (altered epithelial and mucosal surfaces, T and B cell function and antibody response) 2. increases risk of infection (diarrheal and respiratory) 3. impaired collagen synthesis with delayed wound healing may occur with high doses of glucocorticoids
What is the role of vitamin K in wound healing? A) antioxidant B) necessary for enzyme production C) respiratory system support D) cofactor in prothrombin and clotting factors
D) cofactor for synthesis of prothrombin and clotting factors VII, IX and X
What is the role of copper in wound healing? A) co-factor in protein synthesis B) improves oxygen delivery to the wound bed C) modulates inflammatory response D) essential for collagen cross-linking
D) copper is essential for collagen cross-linking
What is the recommend nutrition support for the open abdomen? A) initiate PN support within 24 hours if ICU admission, and trial EN within the first 7 days B) full PN support until fascial closure, to reduce GI stimulation C) introduce trophic EN within the first 5 days of ICU admission, and advance to goal within 10 days if secretions remain below 2L/day D) enteral nutrition support started within 24-48 hours of ICU admission
D) enteral nutrition support started within 24-48 hours of ICU admission. EN reduces the time to abdominal fascial closure, reduces fistula formation and decreases intra-abdominal complications and mortality compared with standard therapy, particularly when patients are fed within 24-48 hours following admission to the ICU.
All wounds begin as acute wounds. Which of the following distinguishes an acute wound from a chronic wound? A. An acute wound will generally heal within 2 to 3 days, whereas a chronic wound will likely take 7 to 10 days to heal B. Acute wounds are related to an initial injury, whereas chronic wounds develop due to an underlying pathological process C. The microenvironments of the 2 types of wounds are different with acute wounds having fewer inflammatory mediators present D. Both B and C
D. Both B and C When disruptions in the healing process occur, they lead to poor wound healing and the presence of a chronic wound. An acute wound tends to heal within 4 weeks, though there is no strict timetable for when a wound will heal. Acute wounds occur due to an initial insult but can become chronic, typically because of abnormalities in underlying pathophysiology. The microenvironment is very different between acute and chronic wounds. Chronic wounds are characterized by a disruption in the sequence of expected healing events or prolonged inflammatory metabolism. There are distinct differences at the molecular level of chronic wounds. For example, there are increased levels of inflammatory cytokines (TNF, ILE-1, ILE-6), and proteases (matrix metalloproteinases) are evident in chronic wound fluid. This results in an inhibition of fibroblast and endothelial cell proliferation and function, and decreased levels of tissue inhibitors of metalloproteinases. Increased bacterial burden (tissue bacterial levels exceed 100,000 CFU per gram of tissue) and altered keratinocyte function as well as extracellular matrix degradation have also been implicated in chronic wounds.
What is the ideal wound dressing? What kind of conditions would it facilitate? A) one that replicates the conditions that would be provided by skin grafting. B) provides additional nutrients needed in healing, while reducing risk of infection. C) an air-tight environment to keep in beneficial wound secretions and proteins, while protecting it from microorganism contamination D) one that provides moisture management (promotes a moist environment, AND absorbs excess exudate), is breathable, and provides protection from microorganism contamination.
D. One that provides moisture management (promotes a moist environment, AND absorbs excess exudate), is breathable, and provides protection from microorganism contamination. Ideal wound dressing characteristics: -moisture management: promotes a moist wound environment, AND absorbs any excess exudate -breathable: allows gaseous exchange -protection: protects the wound site from microorganism contamination
Which of the following are micronutrients of concern with wound healing? A) Vitamin A B) Vitamin C C) Iron D) Zinc E) all of the above F) A and B
E) All of the above Micronutrients of concern with wound healing include: 1. Vitamin A 2. Vitamin C 3. Vitamin E 4. Vitamin K 5. Iron 6. Zinc 7. Copper
What is the NPIAP definition of pressure injury?
Pressure Injury: Localized damage to the skin and underlying soft tissue, usually over a bony prominence or related to a medical or other device. Can present as intact skin or an open ulcer, may be painful. Injury occurs as a result of intense or prolonged pressure or pressure in combination with sheer. Tolerance of soft tissue for pressure and shear may also be affected by microclimate, nutrition, perfusion, comorbidities and condition of the soft tissue.
True or False: The Braden Scale is a validated tool that includes a nutrition screen commonly used to assess risk for pressure injury development.
True The Braden pressure injury risk assessment scale is widely used to screen for pressure injury risk in adults in all settings and includes a subscale for nutrition risk that has been validated.