Nutrition & Foodservice Edge Magazine - September/October 2021 - 14

Continued from page 13
* Protein recommendation is 1.25 to 1.5 g/kg of body weight
per day for adults with a PI who are malnourished or at risk
for malnutrition. Protein is vital for growth and maintenance
of cells, fluid balance, and blood clotting.
* Adequate energy and protein intake should be optimized for
the individual based on their overall nutritional status. Note:
Carbohydrates also are important as they are the body's main
fuel source. If energy from carbohydrates and fat fails to
meet the individual's needs, the liver and kidneys synthesize
glucose from noncarbohydrate sources, such as protein.
* Fluid/water serves as the major transport medium for moving
nutrients to the cells and removing waste products. The
recommendation is to encourage fluid intake and cannot
be more specific as there is not research that supports the
optimal formula for calculating fluid requirements for
individuals with PIs. Commonly used is 1 mLfluid/kcal and
additional fluids need to be considered for individuals having
draining wounds, emesis, diarrhea, elevated temperature, or
increased perspiration.
* Micronutrients (vitamins and minerals) play a role in the PI
healing process and are key components of a healthy diet. The
2019 Guidelines Committee did not review micronutrients
because of a lack of evidence-based research on the validity of
their use. While inadequate intake puts a patient at risk for
deficiencies in micronutrients, research is varied on the benefit
of specific micronutrient supplementation above the RDA to
promote wound healing.
* Oral intake should be considered with a focus on improved
intake prior to use or in addition to use of nutrition
supplements. Some comprehensive approaches for improving
oral intake include:
> Nutrition counseling
> Modifying food, such as with fortified foods
> Revising/modifying or liberalizing diet restrictions that
result in decreased intake
> Offering assistance with eating
> Honoring cultural/religious food preferences
> Providing a pleasant eating environment
* Nutrition supplements: When a positive energy and protein
balance cannot be met through oral intake alone, and when
oral feeding is safe, the use of oral nutritional supplements
(ONSs) can be an effective strategy to help meet protein and
calorie requirements.
THE INTERPROFESSIONAL
TEAM should collaborate
with the resident to develop
an individualized care plan. It
should reflect the resident's
choices and offer a variety of
specific interventions to meet
the stated care plan goal.
> It is advised to review nutritional labeling on ONSs
to determine appropriate usage based on their
macronutrients and micronutrients as a part of the
individual's nutrition treatment plan, up to complete
healing. Studies have supported the importance of extra
energy and protein, but also the positive effect of adding
arginine and micronutrients (zinc and antioxidants).
> The use of ONSs duration of intervention should be at
least four weeks and reasonably up to healing.
* Nutrition support for PI intervention and treatments through
use of artificial nutrition and hydration has limited evidence
for support; however, the interprofessional team should
discuss the risks and benefits of enteral (EN, tube feeding)
or parenteral nutrition (PN, feeding through a vein) with
individuals who cannot meet their nutrition requirements
through oral intake despite previous intervention. Individual
patient-centered goals take precedence over nutrition goals.
* Palliative care and hospice patients should be involved
in discussions about the benefits and harms of enteral or
parenteral nutrition. The guiding principles of palliative
care for PI management focus on relieving pain and
providing comfort for the patient. Treatment goals should be
individualized, respecting each person's unique values and
personal decisions.
CARE PLANNING/MONITORING AND
EVALUATION
The interprofessional team including the certified dietary
manager, certified food protection professional (CDM, CFPP),
14 NUTRITION & FOODSERVICE EDGE | September-October 2021
Nutrition & Foodservice Edge Magazine - September/October 2021

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