Factors associated with the development of pressure ulcers: the impact of nutrition
Keywords:
Nutritional status, Hospitalization, Pressure ulcerAbstract
Objective
This prospective study aimed to determine the incidence of pressure ulcers in a university hospital and investigate the nutritional factors involved in their development.
Methods
The clinical, sociodemographic, anthropometric and dietary data of 50 patients were collected and analyzed by the software Epi Info 3.2.
Results
Females aged M=66.6, SD=18.0 years prevailed. The incidence of pressure ulcers was 28.0%, resulting in roughly 1.7 pressure ulcers per patient. The most common sites were the sacral region (57.1%) and heels (35.7%). Statistical significance (p<0.05) was found for the following variables: changing position in bed, activity level, use of diaper, mental or neurological illness, anemia and use of antibiotics, anti-inflammatories and immunosuppressants. With respect to nutritional factors, positive associations were found between patients with ulcers and low arm muscle area, low calf circumference, low triceps and subscapular skinfold thicknesses,
low hemoglobin level, low hematocrit, and high white blood cell count. The wounds also were associated with higher mortality rates and longer hospital stays.
Conclusion
There is a close association between poor nutritional status and the development of pressure ulcers. This study identified some nutritional parameters related to this event which may become important tools for the identification and treatment of patients at risk.
References
Meijers JMM, Schols JMG, Jakson PA, Langer G, Clark M, Halfens RJG. Differences in nutritional care in pressure ulcer patients whether or not using nutritional guidelines. Nutrition. 2008; 24(2):127-32
Costa IG. Incidência de úlcera de pressão e fatores de risco relacionados em pacientes de um Centro de Terapia Intensiva [dissertação]. São Paulo: Universidade de São Paulo; 2003.
Desneves Kj, Todorovic BE, Cassar A, Crowe TC. Treatment with supplementary arginine, vitamin C and zinc in patients with pressure ulcer: a randomized controlled trial. Clin Nutr. 2005; 24(6): 979-87.
Lewis M, Pearson A, Ward C. Pressure ulcer prevention and treatment: transforming research findings into consensus based clinical guidelines. J Nurs Pract. 2003; 9(2):92-102.
Uzun Ö, Tan M. A Prospective, descriptive pressure ulcer risk factor and prevalence study at a university hospital in Turkey. Ostomy Wound Manage. 2007; 53(2):44-56.
Theilla M, Singer P, Cohen J, Dekeyser F. A diet enriched in eicosapentanoic acid, gamma-linolenic acid and antioxidants in the prevention of new pressure ulcer formation in critically ill patients with acute lung injury: a randomized, prospective, controlled study. Clin Nutr. 2007; 26(6):752-7.
de Luis D, Aller R. Systematic review of nutritional support in pressure ulcer. An Med Interna. 2007; 24(7):342-5.
Souza DMST, Santos VLCG. Risk factors for pressure ulcer development in institutionalized elderly. Rev Lat-Am Enfermagem. 2007; 15(5):958-64.
National Pressure Ulcer Advisory Panel. Pressure ulcer prevalence, cost and risk assessment: consensus development conference statement. Decubitus. 1989; 2(2):24-8.
European Pressure Ulcer Advisory Panel. Pressure Ulcer Treatment Guidelines. Oxford: advisory panel. [cited 2008 Jul 2]. Available from: <http://www.epuap.org/gltreatment.html>.
Gomes FSL, Magalhães MBB. Úlcera por pressão. In: Borges EL, Saar SRC, Lima VLAN, Gomes FSL, Magalhães MBB. Feridas: como tratar. 2ª ed. Belo Horizonte: Coopmed; 2007. p.189-223
Cunha DF, Frota RB, Arruda MS, Cunha da SFC, Teixeira VPA. Pressure sores among malnourished necropsied adults: preliminary data. Rev Hosp Clin Fac Med São Paulo. 2000; 55(3):79-82.
Blanes L, Duarte IS, Calil JA, Ferreira LM. Avaliação clínica e epidemiológica das úlceras por pressão em pacientes internados no Hospital São Paulo. Rev Assoc Med Bras. 2004; 50(2):182-7.
Rogenski NMB, Santos VLCG. Estudo sobre a incidência de úlceras por pressão em um hospital universitário. Rev Lat-Am Enfermagem. 2005; 13(4): 474-80.
Pedro-Hidalgo PL, Garcia-Fernando FP, López-Medina IM, López-Ortega J. Pressure ulcer care in Spain: nurses’ knowledge and clinical practice. J Adv Nurs. 2007; 58(4):327-38.
Hengstermann S, Fischer A, Steinhagen-Thiessen E, Schulz R. Nutrition status and pressure ulcer: what we need for nutrition screening. J Parenter Enteral Nutr. 2007; 31(4):288-94.
Reddy M, Gill SS, Rochon PA. Preventing pressure ulcers: a systematic review. J Am Med Assoc. 2006; 296(8):974-84.
Harris CL, Fraser C. Malnutrition in the institutionalized elderly: the effects on wound healing. Ostomy Wound Manage. 2004; 50(10):54-63.
Cuddigan J, Berlowitz DR, Ayello EA. Pressure ulcers in America: prevalence, incidence, and implications for the future. Adv Skin Wound Care. 2001; 14(4): 208-15.
Rocha JA, Miranda MJ, Andrade MJ. Abordagem terapêutica das úlceras de pressão - intervenções baseadas em evidências. Acta Med Port. 2006; 19:29-38.
Schols JMGA, Ende MAJ. Nutritional intervention in pressure ulcer guidelines: an inventory. Nutrition. 2004; 20(6):548-53,
Nogueira PC, Caliri MHL, Santos CB. Fatores de risco e medidas preventivas para úlcera de pressão no lesado medular. Experiência da equipe de enfermagem do HCFMRP-USP. Medicina (Ribeirão Preto). 2002; 35(1):14-23.
Ayello EA, Braden B. How and why to do pressure ulcer risk assessment. Adv Skin Wound Care. 2002; 15(3):125-33.
World Health Organization. Physical status: the use and interpretation of anthropometry. Geneva: WHO; 1995. Technical Report, Series 854.
Menezes TN, Marucci MFN. Perfil dos indicadores de gordura e massa muscular corporal dos idosos de Fortaleza, Ceará, Brasil. Cad Saúde Pública. 2007; 23(12):2887-95.
Organização Mundial da Saúde. Manual da classificação estatística internacional de doenças, lesões e causas de óbito. São Paulo: USP; 1985.
Brasil.Portaria nº 1.587. Agência Nacional de Vigilância Sanitária. 2002.
Martins C, Moreira SM, Pierosan SR. Interação droga nutriente. 2ª ed. Curitiba: Nutroclínica; 2003.
Núcleo de Estudos e Pesquisas em Alimentação. Tabela brasileira de composição dos alimentos. 2ª versão. Campinas: Unicamp; 2006.
Rocha ABL, Barros SMO. Avaliação de risco de úlcera por pressão: propriedades de medida da versão em português da escala Waterlow. Acta Paul Enferm. 2007; 20(2):143-50.
Costa MP, Sturtz G, Costa FPP, Ferreira MC, Filho TEPB. Epidemiologia e tratamento das úlceras de pressão: experiência de 77 casos. Acta Ortop Bras 2005; 13(3):124-33.
Stratton RJ, Ek AC, Engfer M, Moore Z, Rigby P, Wolfe R, et al. Enteral nutritional support in prevention and treatment of pressure ulcers: A systematic review and meta-analysis. Ageing Res Rev. 2005; 4(3):422-50.
Langkamp-Henken B, Hudgens J, Stechmiller JK, Herrlinger-Garcia KA. Mini nutritional assessment and screening scores are associated with nutritional indicators in elderly people with pressure ulcers. J Am Diet Assoc. 2005; 105(10):1590-96.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Suellen Fabiane CAMPOS, Ângela Conceição Pereira CHAGAS, Aline Bárbara Pereira COSTA, Rosilene Estevão de Melo FRANÇA, Ann Kristine JANSEN
This work is licensed under a Creative Commons Attribution 4.0 International License.
