This document discusses the role of nutrition in wound healing. It outlines the four phases of wound healing and key nutrients involved in each phase such as vitamins C, A, and K, protein, zinc, and arginine. Poor nutrition status can compromise wound healing by limiting the nutrients available. The document recommends assessing patients' nutrition risk, referring to a dietitian, optimizing protein and calories through oral supplements if needed, and considering arginine or zinc supplementation depending on serum levels. Nursing staff are responsible for nutrition screening, communication, and ensuring dietary recommendations are followed to support wound healing.

1. NUTRITION: SETTING
THE LIMITS FOR WOUND
HEALING
ELIMINATING THE WEAKEST LINK
Laura King APD, AEP

2. Agenda and Objectives
 Increase awareness of the ability of
compromised nutrition status to compromise
wound healing
 Increase knowledge of broad range of
nutrients that can play a nutritional role in
wound healing physiology
 Increase knowledge of active ways that you
can positively influence the wound care
outcomes for your residents

3. Wound Severity
 Stage 1
 Stage 11
 Stage 111
 Stage 1V
Increasing
severity

4. Phases of Wound Healing- 4 R’s
 Regeneration - Inflammatory phase
 Repair- Proliferative phase
 Revascularisation- Proliferative phase
 Re-epithilialisation- Remodelling or maturation
phase

5. Regeneration- Inflammatory phase
 Day 1-6
 Key nutrient involvement
 Vitamin K and Calcium contribute to blood clotting
 Arginine and Vitamin C regulates nitric oxide
 Glutamine and carbohydrates are utilised with
increased energy requirements
 Glutamine is utilised as a DNA/ RNA precursor
 Vitamin A stimulates immune response

6. Repair-Proliferative phase
 Day 3 to Week 3
 Key nutrient involvement
 Arginine regulates fibroblast and macrophage
contributions to the repair phase
 Zinc, Vitamin A, Vitamin C and Iron stabilise, or
contribute to the development of, collagen
structure

7. Revascularisation-Proliferative phase
 Day 3 to Week 3
 Key nutrient involvement
 Vitamin C contributes to capillary formation
 Protein (amino acids) provides the building blocks
for collagen synthesis
 Protein (amino acids) are involve in making
enzymes required for vascularisation
 Inadequate protein and fatty acids lead to
processes that interfere revascularisation

8. Re-epithilialisation-
Remodelling or maturation phase
 2 weeks to 2 years
 Key nutrient involvement
 Zinc is used for dozens of enzymes that
contribute to epithelialisation
 Vitamin C, Magnesium and Zinc contribute to
ongoing stability of late stage wound

9. Nutrients involved in Wound Healing
Carbohydrate
Fat
Protein
Zinc
Vitamin C
Vitamin A
Copper
Arginine
Glutamine
Selenium
This broad
range of
nutrients
implicates
any resident
with low
nutrition
status

10. Good nutrition is a must!
 The broad range of nutrients required means that
residents who are:
At risk of poor nutrition
+
Have a wound
=
Recipe for poor healing

11. Nutrition Intervention
So... What can be done?

12. 1. Adequate protein and energy
Well how do we measure this?
 Unintended weight loss (>10% loss in 1-3/12)
 Not receiving oral supplementation
 Poor MMT score
Nutrition screening, using a validated tool for the appropriate
clinical setting, should be undertaken on all adults with pressure
injuries to identify those at risk of poor healing due to nutritional
problems.
NHMRC Grade of recommendation: B
Onward referral to Dietitian as indicated

13. 2. Nutrient Supplementation
 Zinc
 Vitamin C
 Vitamin A
 Copper
*Supplementation is valuable ONLY when serum
levels are low*
NOTE: Supplementation of zinc or copper in normal
serum is detrimental- it impacts on zinc/copper and
iron metabolism- a delicate balance

14. 3. Arginine supplementation
 A conditionally essential amino acid
 If deficient, may be the weakest link to
effective wound healing
 In chronic wounds > stage 2; the benefit from
arginine supplementation will be seen in 2-3
weeks if going to be effective

15. Okay, so can be done?
 Assess risk in regards to nutrient
intake- identify weight change, loss
of appetite and refer as necessary
 Dietitian assessment and request of personalised
measures to optimise oral protein and energy
intake
 Dietitian assessment may indicate opportunity to
optimise serum levels- LMO request for serum
 Replacement of inadequate nutrients as indicated
by serum results
 Dietitian may consider Arginine supplementation
in specific cases

16. Okay, so can be done?
 Assess risk in regards to nutrient intake- identify
weight change, loss of appetite and refer as
necessary
 Dietitian assessment and request of
personalised measures to optimise
oral protein and energy intake
 Dietitian assessment may indicate opportunity to
optimise serum levels- LMO request for serum
 Replacement of inadequate nutrients as indicated
by serum results
 Dietitian may consider Arginine supplementation
in specific cases

17. Okay, so can be done?
 Assess risk in regards to nutrient intake- identify
weight change, loss of appetite and refer as
necessary
 Dietitian assessment and request of personalised
measures to optimise oral protein and energy
intake
 Dietitian assessment may indicate
opportunity to optimise serum levels-
LMO request for serum
 Replacement of inadequate nutrients as indicated
by serum results
 Dietitian may consider Arginine supplementation
in specific cases

18. Okay, so can be done?
 Assess risk in regards to nutrient intake- identify
weight change, loss of appetite and refer as
necessary
 Dietitian assessment and request of personalised
measures to optimise oral protein and energy
intake
 Dietitian assessment may indicate opportunity to
optimise serum levels- LMO request for serum
 Replacement of inadequate nutrients
as indicated by serum results
 Dietitian may consider Arginine supplementation
in specific cases

19. Okay, so can be done?
 Assess risk in regards to nutrient intake- identify
weight change, loss of appetite and refer as
necessary
 Dietitian assessment and request of personalised
measures to optimise oral protein and energy
intake
 Dietitian assessment may indicate opportunity to
optimise serum levels- LMO request for serum
 Replacement of inadequate nutrients as indicated
by serum results
 Dietitian may consider Arginine
supplementation in specific cases

20. Assessable component
 Okay! So now that you have learnt about how
nutrition can optimise wound healing- put
yourself to the test...

21. Assessable component
1. With regards to nutritional wound care
management, nursing staff in residential aged
care are responsible for:
a. Commencing oral supplementation and referral to
Dietitian as indicated
b. Ordering blood tests and prescribing nutrient
supplementation
c. Nutrition screening, communication and
documentation, actioning referrals, ensuring
compliance with supplementation
d. All of the above
e. A and C

22. Assessable component
2. In your own words describe why poor nutrition
can be considered the weakest link in
effective wound healing.

23. Assessable component
3. True or false:
Poor nutrition is always the cause of poor
wound healing.
(If false, provide brief list of other factors that
may need consideration)

24. Assessable component
Email your answers, along with any additional
queries or questions, to:
laura.hosking@greatideas.net.au
I look forward to providing you with feedback,
and further information as needed.
Thank you for completing this CPD activity!

25. NUTRITION: SETTING
THE LIMITS FOR WOUND
HEALING
ELIMINATING THE WEAKEST LINK
Laura King APD, AEP