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Malnutrition contributes to wound development and inhibits healing, so the team must address it accordingly. The challenge is that people may mistakenly see malnutrition as a sign of poor care. However, says Nancy Munoz, DCN, MHA, RDN, FAND, a registered dietitian, “it is okay to make a malnutrition diagnosis; it doesn’t mean that we’re not caring for them. Focus on getting to the root cause so you can at least promote well-being for as long as possible.”An unplanned weight loss, no matter how small, should be addressed and reported, she says. “Don’t keep it in the closet, put it center stage.”

While research supports an association between malnutrition and wound development, evidence is weak that any specific nutritional interventions—beyond meeting basic calorie and protein requirements—prevent wound development or healing, says Nancy Overstreet, DNP, GNP-BC, CWOCN, CDP, a geriatric nurse practitioner. She points to AMDA’s pressure ulcer guideline, which says, “Use appropriate protocols tailored to each patient’s need to manage unplanned weight loss and other nutritional risks. Calorie, protein, and vitamin supplementation may be needed in some cases, but over-supplementing patients who do not have protein, vitamin, or mineral deficiencies is not recommended. It is reasonable to tailor supplementation to each patient’s specific needs, medical condition, and prognosis.”

Overall, consuming adequate amounts of protein, carbohydrates, fats, and fluids is essential for wound healing.

Nutrients such as vitamins C and A, B vitamins, iron, and zinc play a major role in increased wound strength, collagen synthesis, and cross linking and help promote a healthy immune system, says Munoz. Individuals who have a vitamin and mineral deficiency should take a multivitamin. l-Arginine, an amino acid supplement, is recommended for individuals with Stage 3 and 4 pressure injuries who cannot meet their needs with food and oral nutrition supplements alone, she says.