292萬芳醫院營養室.pptVIP

Nutritional Care for Diabetes with Pressure Sore patient 萬芳醫院營養室 江詩雯 Pressure sore pressure ulcer, decubitus ulcers, bed sores Stage I: non-blanchable erythema of intact skin, the heralding of skin ulceration Stage II: partial thickness skin loss involving epidermis, dermis or both Stage III: full thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to, but not through Stage IV: full thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures pressure relief care of the sore good nutrition High protein intake (24%~25% of energy) v.s. lower protein intake (14%~16% of energy) Uncontrolled blood glucose impairs blood flow through the critical small vessels at the wound surface by impeding red blood cell permeability. The increased glucose makes the cell wall rigid, thereby impeding flow. In addition, the hemoglobin release of oxygen is impaired, resulting in an oxygen and nutrient deficit in the healing wound. Diabetic infection take longer to heal because of delayed macrophage introduction and diminished leukocyte migration, which causes a prolonged inflammatory in wound healing. Gender: female Age: 81 y/o Admission date: 2005 May 16 Meta C/o: fever on and off for 3 days Past disease history: DM, CAD, HCVD, Dementia, Parkinsonism Dx: 1. fever, cause ? Suspect wound infection of the pressure sore 2. UTI 3. Hyperglycemia 4. pressure sore Admission records 1999 Oct. 6: Parkinsonism disease, DM, HTN 10+ yr 1999 Oct. 29: dehydration, UTI, Parkinsonism, CAD, HTN, DM 2001 May. 19: sepsis r/o bed sore (III) related, parkinsonism, old CVA, DM, HCVD, dementia 2005 Apr. 11: UTI, electrolyte imbalance, HTN, DM, old CVA, pressure sore Ht: 155 cm Admission BW: 43.8 kg UBW: 40 kg (2001 yr) IBW: 53 ± 5.3 kg BMI: 18.23 (underweight) BEE: 974 Cal/d TER: 1286~140