Pressure Injury Case Study

Review the webinar Nutrition and Pressure Injuries: Putting the New Guidelines into Practice. Review the
Braden Scale for Predicting Pressure Sore Risk

Note: if you plan to hand write your answers, you may want to made the size of some of the boxes larger. This
handout is formatted as a table in which you can type.

Date of admission 1/16/16 Age on admission 85 Male/Female

Ht. on admission 58 Wt. on admission 113# Current wt. 86# (39 kg.) IBW r/t Left AKA=80#

Diet on admission Mechanically soft, NAS Current diet order Regular NAS

Dx on admission: Pressure ulcer to coccyx stage 4/unstageable, recent Left AKA (11/16), history of PVD, HTN

Describe number and stage of pressure injuries and subsequent changes (improving or worsening)

Arrived s/p Left AKA with unstageable pressure ulcer to coccyx, remained unstageable until approximately 1 month ago, now
stage 4. Also had a stage 1 ulcer on lower back, which was resolved approximately 1 month ago. Slight improvement to coccyx
pressure ulcer but still having difficulty due to poor p/o intake and poor mobility r/t amputation. Receiving calcium arginate on
wound with collagen wound dressing. She is being monitored closely by the wound care nurse and is a subject of coordination of
care with dietitian and nursing staff to improve her status.

Based on the Braden Scale what risk factors are present that made the client at risk for developing a pressure injury or will
interfere with health.

As of 12/9/16 Braden results were as followed: 3,3,2,2,1,1. Totaling to 12. This is classified as high risk for pressure ulcer
development. Her risk factors for developing a pressure ulcer include limited mobility from Left AKA, inadequate p/o intake,
and requires a lot of assistance for movement.

Describe any diagnoses that complicate treatment.

Currently experiencing diarrhea, so she is scared to eat, compromising the healing process. Also complicating treatment is her
amputation, which severely limits her mobility. Her previous diagnoses of HTN and thymus disease can also compromise
dietary habits and nutritional status.

Estimated caloric needs: (using her actual weight)

MSJ: (10x39 kg.)+ (6.25x127.6 cm)-(5x85)-161=602 kcal BEE x 1.3 AF x 1.5 IF = 1175 kcal/d. Patient still receives
approximately 2000 kcal/d as part of regular diet order, but may not be consuming all of it.

Based on pt intake, are caloric needs being met? Show your estimation

Currently eating approximately 25% of meals. A regular diet in the facility provides 2335 kcal/d, with 25% of this being 585
kcal/d. Her needs are not being met through meals with this p/o intake, but is tolerating Magic Cups BID, which provide an
additional 560 kcal/d. With 25% from meals and 2 Magic Cups, she is consuming approximately 1145 kcal/d, which is very
close to meeting her needs. She would benefit from Prostat to promote wound healing, but does not tolerate.

Estimate protein needs and indicate whose guidelines you are using:

Based on 1-1.2g/kg to promote healing, her daily needs are 39-47 g/d.
Based on pt intake, are protein needs being met? Show your estimation
Standard facility meals provide 101 g protein, with 25% p/o intake estimated. 25% of 101g protein is 25g protein consumed
from meals per day. With the 2 Magic Cups, she is getting an additional 20g protein, totaling approximately 45g protein
consumed per day. This is meeting her needs.
Estimate fluid needs:

Based on 30cc/kg, she will need approximately 1100 mL per day.

Compare recorded input and output to estimated fluid needs. Are fluid needs being met?

Fluid intake is good, with at least 240 mL being offered at every meal or 3x per day. This would provide 720 mL from drinking
water, with the additional 380 mL needed provided from foods and Magic Cups.

Briefly, discuss the role of micronutrient supplementation in wound healing. Does this facility use supplementation as part of
their protocol?

Micronutrient supplementation for wound healing is provided through Prostat AWC products, which provides vitamin C, zinc,
sodium, magnesium, and potassium. This is used as part of the wound healing protocol, however, it appears many patients reject
it because of the flavor or texture. Vitamin C supplementation with wounds can be useful for healing due to its collagen
synthesis.

Briefly, discuss the role of arginine and glutamine supplementation in wound healing. Does this facility use supplementation as
part of their protocol?

Prostat AWC is also used for supplementation of arginine and glutamine in wound healing patients. Prostat AWC provides
9g/100g pro of arginine and 7g/100g pro of glutamic acid. Arginine and glutamine are necessary for cell proliferation and repair,
which is required for wound healing.

Case Study Part II.

Choose a second patient that has been recently admitted to facility without pressure sores upon admission. Assess the patients
potential for developing a pressure injury based on the Braden Scale.

88 YOWM with CHF, SOB, HTN, Ischemic heart disease

score comments
3 Patient is alert, oriented, and independent
Sensory perception

4 Patient appears to have dry skin

Moisture

3 Able to move, can walk independently

Activity

3 Able to reposition himself

Mobility

4 Great p/o intake, close to 100% at meals

Nutrition

2 Problem may occur upon repositioning

Friction and shear

19 Classified as low to no immediate risk

Total score