Nutrition 411: Nutrition Advice for Patients Living at Home

  Each year, thousands of outpatients are treated at wound clinics and hospitals across the country. Most of these facilities do not have a registered dietitian (RD) on staff so it is up to the nurses and physicians who work in these settings to provide nutrition advice along with wound care treatment. Generalized recommendations such as “Eat a balanced diet” or “Make sure to eat enough protein” and a printed brochure are often all that is offered. This may leave the patient to handle the often daunting task of assimilating that information into the realities of menu planning, food shopping, meal preparation, and clean up — all quite taxing for infirm patients, especially those with foot ulcers who may have trouble walking or standing.

  While much attention is paid to hospitalized or institutionalized persons, the free-living patient needs practical advice that translates the science of nutrition into easy-to-execute meal ideas and food preparation. Ideally, every wound care professional would weave a discussion about food into the clinical visit and offer some real-world tips that address the most commonly encountered problems and nutrition principles for supporting wound healing.

  The common problems and solutions that follow may help fill the nutrition information gap when an RD is not available. For patients who need more extensive and individualized advice, referral to an RD is recommended. Medicare Part B includes a medical nutrition therapy benefit for patients with diabetes or kidney disease. Table 1 outlines the details of this benefit.

Advice on Calories and Protein

  In order to heal a wound, the human body needs the correct daily amount of calories and protein. Think of calories as fuel for your body just like gasoline is fuel for your car. Without enough fuel, your body — and your car — can’t run properly.

  Protein is one of three nutrients (along with carbohydrate and fat) that comprise total daily calories. Protein is found in every cell of the body and a major part of skin, organs, muscles, and glands. In order to heal a wound, the body must have enough protein each day to re-build itself. Most people get enough daily calories and protein by eating three healthy, nutritious meals and snacks but when you are not feeling well, it may be difficult to eat properly. The following are some tips to help patients boost caloric and protein intake:

    • Plan meals. Planning can help you get the most meals out of your time in the kitchen. For instance, cook chicken once a week, but use it in two or three dishes over a few days.
    • Prepare and freeze extra portions when you cook so you always have meals on hand.
    • Eat frequently. If you cannot eat a large meal, make sure to eat smaller meals more often. It is not unreasonable to eat a small amount every 3 hours.
    • Drink your calories. Instead of diet soda, water, coffee, or tea, consume fruit juice, milkshakes, milk, or bottled meal replacement shakes.
    • Don’t eat plain food — add “extras” like salad dressing, mayonnaise, nuts, croutons, and other toppings.
    • Eat dried fruits and nuts. Raisins, apricots, dates, and nuts are all high-calorie and easy to pack so you can always have some with you.
    • Prepare casseroles, mashed potatoes, soups, and hot cereals with non-fat dry milk powder to add extra calories and protein.
    • Use a slow cooker (eg, a Crock-Pot®). You can make stew, a casserole, bread, or fruit cobbler with very little preparation.
    • Keep hard-boiled eggs on hand. Eggs provide high-quality protein and are easy to prepare.
    • Know that on average, 3 oz of meat contains 21 g of protein or more and is the size of a deck of cards.
    • If you have an aversion to meats, buy protein powder and sprinkle it on foods you enjoy or mix it with liquids.
    • While watching television, take a few bites during each commercial break.

Advice on Managing Blood Glucose

  Patients with diabetes should know how important tight blood sugar control is to their heart, eye, and kidney health. But they might not know that blood sugar control also is vitally important to wound healing. High blood glucose levels put patients at greater risk for wound complications and infections. There is less oxygen and blood flow to the wound, which can make it longer to heal. Some tips to help patients manage blood sugar levels while helping get enough calories and protein each day include:

    • Eat at regular times and don’t skip meals.
    • Select cereals, breads, and pastas made from whole grains.
    • Try different types of whole grains for variety, such as barley, kasha, bulgur, quinoa, wild rice, and couscous, and different pastas and rice, such as whole wheat, brown rice, or quinoa pastas.
    • Read package labels and look for foods high in fiber.
    • Liven up high-fiber cereal with fresh fruit, such as bananas or berries, or with dried fruits, such as raisins, cranberries, or apricots.
    • Choose whole (fresh, frozen, or dried) vegetables and fruits over juices, which have most of the fiber removed.
    • Prepare raw vegetables ahead of time so they are ready for a snack.
    • Keep a fruit bowl on the table or cut up in the refrigerator.
    • Include protein such as fish, lean meats, low fat cheeses, and eggs, or vegetarian protein choices like beans and &lentils at every meal.
    • Snack on oat bran pretzels, whole wheat crackers, air-popped popcorn, dry-roasted nuts or seeds, whole grain cereal, fresh or dried fruit, baked tortilla chips dipped in fresh salsa, or raw vegetables dipped in hummus.

Advice for Kidney Health

  Patients on dialysis are aware of the need to be extra careful about the types of foods they eat. Hemodialysis, one common type of dialysis, is a lifesaving treatment used when someone has very little or no kidney function. The dialysis process cleans the blood of waste and excess fluids. To make the process easier and help patients feel better between treatments, the physician should prescribe a special hemodialysis diet. To help patients feel their best and help wounds heal as quickly as possible, the following is suggested:

    • Patients need to understand their unique diet restrictions. They are prescribed a special hemodialysis diet that is just right for their medical condition. They should be encouraged to ask questions about healthy foods.
    • Most hemodialysis diets include regular servings of high-quality protein (eg, lean meats, poultry, fish, and egg whites), which helps wound healing as well.
    • Limit foods high in sodium such as Chinese food, hot dogs, ham, pepperoni, potato chips, and soy sauce (see www.rd411.com/renalcenter/article.php?ID=10pat). If canned foods must be used, look for low sodium versions.
    • Limit foods high in potassium such as bananas, lentils, prunes, potatoes, tomatoes, and raisins (see www.rd411.com/renalcenter/article.php?ID=7pat). A dietitian should be consulted for a list of foods high in potassium or visit RD411.com online to print a list.
    • Limit foods high in phosphorus such as cocoa, ice cream, organ meat, bran cereals, and wheat germ (see www.rd411.com/renalcenter/article.php?ID=4pat). The physician also may prescribe a phosphorus binder to help remove the excess phosphorus from the body.
    • Monitor fluid intake. Excessive fluid build-up between dialysis treatments can cause swelling that complicates wound healing.
    • Consider special renal multivitamins. Some vitamin formulations may contain vitamins that should be limited; consult a physician to ask for a renal vitamin.

Advice for Healthy Snacks and Small Meals

  Being overweight can affect health, diabetes management, and wound healing. Patients often find it difficult to completely give up snacks but with proper choices, they can snack healthfully. Some satisfying and healthful snack ideas include:

    • 1 oz cheese and one piece of fruit or fresh vegetables
    • One hard-boiled egg and five whole-grain crackers
    • 1 Tbsp hummus (made with tahini) and one small pita pocket with vegetables
    • One slice of turkey, one slice of cheese, and one slice of bread with one piece fresh fruit
    • ½ cup (C) low-fat cottage cheese, ½ C pineapple, and 1 Tbsp almonds
    • One half of a peanut butter and jelly sandwich and one piece fresh fruit
    • 6 oz Greek-style yogurt with ¼ C granola
    • 2 oz soft pretzel, mustard, and 4 fl oz orange juice
    • 3 C popcorn prepared in 1 Tbsp canola oil, with 1 Tbsp shredded cheese
    • 2 C green salad with ¼ C beans and 1 Tbsp salad dressing
    • Two graham crackers with 1 Tbsp hazelnut spread and one small banana
    • One baked potato or sweet potato, served with 1 teaspoon (tsp) SmartBalance® Buttery Spread and ½ C broccoli
    • ½ C sorbet with 1 C berries
    • ¾ C high-fiber cereal, with 6 fl oz skim milk and berries
    • One fiber bar and one piece of fruit
    • Fruit leather and a 12-oz yogurt smoothie
    • 12 pieces or one roll maki sushi
    • 20 almonds and one piece of fresh fruit
    • One low-fat cookie or three fig bars and one piece of fresh fruit dip
    • One slice whole-grain bread, one slice cheese, tomato, and mustard
    • 1 oz pretzels, chips, or tortillas, salsa, and one fourth of an avocado
    • ½ C dried fruit
    • ½ C pasta with marinara sauce and a 1-oz meatball with vegetables

The Team Approach

  Improving patient outcomes is everyone’s goal. Whether you are a nurse, a physician, or a therapist, time spent talking about food can help. For the patient living at home, some practical advice to turn the science of nutrition into a meal that fuels the wound healing process can be priceless.

Coming Next Month: Physical Assessment of Nutritional Status

Nancy Collins, PhD, RD, LD/N, FAPWCA, is founder and executive director of RD411.com and Wounds411.com. For the past 20 years, she has served as a consultant to healthcare institutions and as a medico-legal expert to law firms involved in healthcare litigation. Correspondence may be sent to Dr. Collins at NCtheRD@aol.com.

This article was not subject to the Ostomy Wound Management peer-review process.