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Maximize Nutrition and Hydration

In-depth Nutritional Assessment

The following all influence a person’s ability to prevent and heal a wound, and are recommended as investigations1. Patients who are suspected of being undernourished should be referred to a registered dietician (RD) for assessment without delay.

In addition to inquiring about recent weight loss, signs of dehydration, and assessing the Braden Scale Nutritional sub-scale, which helps to capture protein intake, there are several signs of micronutritient deficiencies that are easy to detect when you know what to look for:

  • Reddish coloured tongue with a smooth surface (Vitamin B deficiency)
  • Magenta coloured flank-steak appearing tongue with cracks at corners of the mouth (called angular stomatitis) (Vitamin B2 deficiency)
  • Dementia, diarrhea, dermatitis (pellagra)—crepe paper skin with wrinkles in the skin and flat surfaces between the wrinkles –also associated with bullous pemphigoid and gramuloma annulare (Vitamin B3 deficiency)
  • Prominent “snowflake” exfoliation of the epidermis of the lower legs (Essential Fatty Acid deficiency)
  • Skin and capillary fragility with purpura, skin tears, increase risk of pressure ulcers, severe collagen deficiency so that the skin is like plastic wrap, and extensor tendons and venous plexus is easily seen through the transparent epidermis (Chronic Scurvy/Vitamin C deficiency)
  • Reddish, scaly, itchy skin lesions (Vitamin A, E, and K deficiency)
  • Seborrheic-like rash that is red, flaky seen along the lateral eyebrows, nasal labial folds and chin (Zinc deficiency)
  • Prolonged tenting of the skin in the presence of adequate fluid intake (believed to be a Glucosamine/Chondroitin deficiency)

The Nestle MNA (Mini Nutritional Assessment) is a screening and assessment tool that identifies individuals age 65 and above who are malnourished or at risk of malnutrition, allowing for earlier intervention to provide adequate nutritional support. It has not been validated for use with younger individuals. The screening tool consists of 6 questions.

  • Complete the screen by filling in the boxes with the appropriate numbers.
  • Total the numbers for the screening score.
  • The screening score (max 14 points):
    • A score of 12- 14 points = normal nutritional status
    • 8-11 points = at risk of malnutrition
    • 0 -7 points = malnourished

Individual permission will need to be obtained by each organization wishing to use the MNA.

Control Moisture and Incontinence
  1. Fraser, C. (2010) The Identification of Barriers to Pressure Ulcer Healing: Using Nutrition/Hydration-related Blood Work. Wound Care Canada 6(2): 20-25

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