Vitamins and Water

Water

• Facilitates control of body temperature
• Maintains pH balance
• Regulates fluid and electrolyte balance
• Intracellular and extracellular fluids contains water
• Impacts blood volume
• Elderly may experience impaired sense of thirst

Vitamins

• Categorized as fat-soluble or water-soluble

Fat-Soluble Vitamins

• Stored in the liver and fatty tissue
• Can accumulate in the body

Water-Soluble Vitamins

• Need to be replenished regularly

Vitamin A

• Important for vision
• Important for infection resistance
• Important for skin integrity
• Can be sourced from liver, milk, and dark green leafy vegetables

Vitamin D

• Helps with bone and tissue formation
• Can be sourced from sunshine and dairy products

Vitamin E

• Acts as an antioxidant needed to protect cells
• Can be sourced from nuts, seeds, and vegetable oil

Vitamin K

• Essential for clotting and coagulation
• Can be sourced from dark leafy green vegetables

Vitamin C

• Helps with collagen synthesis
• Helps with wound healing
• Helps with antibodies development
• Can be sourced from fruits and sweet potatoes

Vitamin B Complex (8 Vitamins)

• Supports RBC production
• Supports energy metabolism
• Supports DNA synthesis
• Can beb sourced from whole grains, nuts, legumes, and dark leafy green vegetables

Minerals

• Needed for bone tissue and teeth maintenance
• Needed for nerve conduction
• Needed for muscle and blood vessel contraction
• Sources include dairy, legumes, tomatoes, smoked meat, fruits, fish and dark leafy green vegetables

Carbohydrates

• Main source of energy
• Include sugars, starches and fiber
• When depleted, the body uses protein and stores fat
• Glycogen is necessary for tissue and brain function
• Fiber benefits the cardiovascular system and helps with bowel regularity
• Sources are bread, starchy vegetables, rice, peas and potatoes

Fats

• Provide production energy
• Support and insulate organs and nerves
• Help absorb and transport certain vitamins
• Contribute to cell membrane structure
• Sourced from avocados, fish, and oils

Protein

• Necessary for development
• Necessary for maintenance
• Necessary for repair of body tissues
• Plays a role in the clotting cascade
• Protein is not stored in the body unlike carbs and fats
• If necessary, protein can be used for energy
• Sources are milk, eggs, cheese, poultry, and meat

Lab Values, what they measure, and potential indications

• Glucose normal range is 70-110
• Glucose indicates the primary energy source and brain function
• Hypoglycemia is indicated by low levels of glucose and can cause a medical emergency
• High levels of glucose indicate hyperglycemia and may cause organ dysfunction
• Prealbumin normal range is 19.5-35.8
• Prealbumin indicates a short-term marker for nutrition (protein)
• Low levels of prealbumin indicate low protein levels
• High levels of prealbumin indicate high protein levels - changes faster and fluctuates more
• Albumin normal range is 3.5-5.0
• Albumin indicates a long-term marker for nutrition (protein)
• Low levels of albumin indicate low protein levels
• High levels of albumin indicate high protein levels, does not change as fast
• Transferrin, when low, indicates malnutrition which causes anemia/iron deficiency
• Male Hemoglobin normal range is 14-18
• Female Hemoglobin normal range is 12-16
• Hemoglobin indicates RBC count and how well oxygen is carried
• Not carrying oxygen well or low RBCs, refers to hemoglobin
• High CO2 indicated by hemoglobin determines how well RBCs are carrying oxygen
• Hematocrit normal range is 35 to 45
• Hematocrit indicates % of RBCs in plasma
• Not carrying oxygen well indicates the % of hematocrit
• High CO2 indicates the % of hematocrit
• BUN normal range is 8-23
• BUN indicates metabolic waste products in the blood
• Fluid overload indicates the metabolic waste product in the blood stream
• Dehydration is an indication of BUN
• Creatinine normal range is 0.5-1.2
• Creatinine indicates kidney function
• Increased kidney function indicates creatinine
• Decreased kidney function indicates creatinine determines how well the kidneys are filtering and functioning
• Lipid profile indicates the cholesterol, LDL, and HDL
• HDL-good cholesterol protects arteries
• Heart disease is indicated when there is risk for atherosclerosis due to blood vessels narrowing and hardening

Calcium

• Normal range is 8.2-10.2
• Indicates muscle contraction, nerve conduction and bone health
• Decreased bone density or vitamin D deficiency or brittle bones indicated by calcium levels
• Overactive parathyroid, kidney disease, or excessive vitamin D indicated by calcium levels

Magnesium

• Normal range is 1.3-2.0
• Indicates Muscle contraction and nerve conduction
• Muscle cramps fatigue or irregular heart rate indicates low magnesium levels
• Seizures, Kidney failure, Muscle weakness, and cardiac arrest indicated by magnesium levels

Sodium

• Normal range is 135-145
• Indicates fluid status, muscle contraction and nerve conduction
• Muscle cramps, nausea, vomiting, fatigue indicates sodium
• Dehydration, confusion, or fatigue indicated by sodium levels
• Hyponutremia indicates sodium levels
• Hypernatremia indicated by sodium levels

Potassium

• Normal range is 3.5-5.0
• Indicates Electrolyte balance
• Muscle weakness, irregular heart rate, or respiratory failure indicated by potassium levels
• Kidney disease, Kidney failure, or Seizures are indicated by potassium levels
• Hyperkalemia is indicated potassium level
• Hypokalemia indicated by potassium blood levels

Iron

• Men: normal range is 70-175
• Female: normal range is 50-170
• Indicates Hemoglobin production
• Anemia or low RBC count with not carrying oxygen indicates low iron
• Iron overload or liver disease indicated by iron levels

Hemoglobin A1c

• Should be below 5.7%
• Indicates a 3-month average of blood glucose levels
• Hypoglycemia is indicated by low hemoglobin A1c levels
• Hyperglycemia indicated by hemoglobin A1c levels

Stages of Wound Healing

• Wound healing occurs in three stages: inflammation, proliferation, and remodeling
• The appearance of the wound will change as the wound heals

Inflammation (2-5 days)

• Neutrophils and monocytes work to remove debris and prevent infection
• An increase in these cells will be observed in lab work
• Signs and symptoms include redness, warmth, pain, and decreased function in the area

Proliferation (5 days-3 weeks)

• The wound is rebuilt with granulation tissue and collagen to repair the wound
• A scar is formed

Remodeling (3 weeks-2 years)

• The wound contracts and the scar shrinks

Factors Affecting Wound Healing

• Oxygenation and tissue perfusion
• Diabetes
• Nutrition
• Age
• Infection

Wound Complications

• Undermining: area of tissue loss present under intact skin usually along the edges of a wound, forming a “lip” around the wound
• Slough: non-viable tissue, composed of dead cells and an extracellular matrix that appears as a moist, yellow, tan, or white layer on a wound surface hindering healing and increasing the risk of infection
• Necrotic Tissue: dead tissue that is no longer viable, often appearing as dry, leathery “eschar” or moist, stringy “slough”
• Dehiscence: the separation or opening of a wound or incision
• Evisceration: the protrusion of internal organs, especially those in the abdominal cavity, through a wound or incision
• Tunneling: a wound that extends deeper into the tissue than its surface, creating a channel or passageway, often referred to as a sinus tract, and can be difficult to heal

Wound Management

• Negative Pressure Wound Therapy (NPWT)/vacuum assisted closure (VAC): uses negative pressure to remove excess wound fluid, stabilize the wound edges, and stimulate granulation tissue
• Hemovac Drain: soft drain attached to a springlike suction device (closed drain system)
• Jackson-Pratt Drain (JP drain): soft drain attached to a bulblike suction device (closed drain system)

Debridement

• May need to occur in wounds that have stalled in healing due to dead tissue

Types of Debridement

• Sharp: using a sharp instrument (scalpel, curette, or scissors) to remove necrotic tissue, fastest way of removing nonviable tissue and is the method of choice if an underlying infection is suspected or if a large amount of necrotic tissue needs to be removed rapidly
• Enzymatic: achieved through the application of topical agents containing enzymes that work by breaking down the fibrin, collagen, or elastin present in devitalized tissue, thus allowing for its removal; slower method of debridement than mechanical or sharp, it is selective for nonviable tissue and is quite effective when used appropriately (EX: Santyl, Panafil, and Accuzyme)
• Autolytic: uses occlusive dressings (such as hydrocolloids and transparent films) as are hydrogels; based on the principle that wounds have an innate ability to clean themselves of debris and necrotic tissue through the action of the body’s own enzymes and phagocytic cells; requires a moist wound environment and the optimization of the other factors important for wound healing in order to be successful; slowest form of debridement and is contraindicated in infected wounds; most comfortable form of debridement for the patient

Wound Assessment

• -Measurement: Wound measurement provides baseline information while continuous measurement helps to predict healing and aids monitoring of treatment efficacy and evaluation
• Measure the length "head-to-toe" at the longest point (A)
• Measure the width side-to-side at the widest point (B) that is perpendicular to the length, forming a "+"
• Measure the depth (C) at the deepest point of the wound
• All measures should be in centimeters and use a disposable ruler

Wound Bed

• Epithelial: Appears pink or pearly white and wrinkles when touched and occurs in the final stage of healing when the wound is covered by healthy epithelium
• Granulation: Appears red and moist and occurs when healthy tissue is formed in the remodeling phase that is well vascularized and bleeds easily
• Slough: Appears yellow, brown or grey; slough is devitalized tissue made of dead cells or debris
• Necrotic: Appears hard, dry, and black; necrotic tissue is dead tissue that prevents wound healing
• Hyper-granulation: Appears red, uneven, or granular. Occurs in the proliferative phase when tissue is overgrown

Moisture/Exudate

• Essential part of the healing process
• Produced by all wounds to maintain a moist environment, cleanse the wound, provide nutrients and white blood cells, as well as promote epithelialization
• The overall goal of exudate is to effectively donate moisture and contain it within the wound bed
• Excess exudate in the wound bed leads to maceration and degradation of skin, while too little moisture can result in the wound bed drying out
• The type of dressing may change multiple times throughout the healing process to maintain an ideal healing environment

Wound Edges

• The edges of the wound should be showing signs of healing, even if it’s only 1 cm at a time
• Wound edges that are raised, red, or rolled are not conducive to healing and may need to be debrided

Edges

• Wound edges are described by their color and if they are raised or rolled for documentation purposes

Odor

• Wounds should not have a foul odor to them, a foul odor signifies infection
• An odiferous wound may have associated purulent drainage, but not all the time
• Odor is assessed after the wound is cleansed
• Document a 'foul odor' or 'no odor' for documentation purposes

Periwound

• The outer 1 inch of skin surrounding the wound
• The peri wound should be pink or appropriate to the ethnicity of the client
• Document if any edema, redness, or maceration is assessed

Pain

• Assess pain before, during, and after the dressing change
• Pre-medicate for long or complex dressing changes
• Use the numeric scale, Faces scale, or FLACC scale as appropriate