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Nutrition for Nurses

20.2 Nutrition and Chronic Musculoskeletal and Integumentary Illness

Nutrition for Nurses20.2 Nutrition and Chronic Musculoskeletal and Integumentary Illness

Learning Outcomes

By the end of this section, you should be able to:

  • 20.2.1 Discuss the impact of nutrition on musculoskeletal and integumentary illness.

Nutritional Requirements for Optimal Musculoskeletal and Integumentary Health

Diet is an important factor to consider for preserving muscle mass. Protein and amino acids support muscle synthesis and help maintain healthy muscle mass in all individuals. The nurse should teach the client with decreased muscle mass the importance of maintaining adequate protein intake. Additionally, various studies have shown that certain individuals experiencing low muscle mass due to malnutrition can benefit from oral nutritional supplements (Prado et al., 2022). An assessment by a health care provider will allow them to help a client decide which supplements are appropriate for their individualized needs.

One of the most important ways an individual of any age can maintain optimal musculoskeletal and integumentary health is through a healthy diet and exercise and by maintaining a healthy body weight and composition. In addition to monitoring a client’s weight, measuring body mass index (BMI) and waist-hip ratio (WHR) are examples of noninvasive tools used to screen clients for obesity. Not only do underweight and overweight individuals have a greater risk for musculoskeletal problems, but because adipose tissue is part of the integumentary system, weight is intimately tied to this body system.

Nutrition and Skin Integrity

As explained previously, the relationship between pressure injuries (also known as pressure ulcer, pressure injury, decubitus) and the aging process in the older adult is complex. Although aging results in thinner and more fragile skin, other variables can add to an older adult’s increased risk for skin breakdown and wounds. Some older adults live sedentary lifestyles that contribute not only to increased pressure on certain areas of the skin but also to deconditioning of the muscles. Older adults may have unintended weight loss. In addition, older adults can experience malnutrition for many reasons, leading to insufficient intake of macronutrients and micronutrients. Because nutrition and adequate hydration are essential for wound healing, malnutrition can in turn increase the risk for developing wounds and pressure injuries and may interfere with wound healing (Munoz, 2019).

Even small periods of malnutrition can cause delayed wound healing. Therefore, in addition to a healthy, balanced diet, health care providers usually recommend oral nutritional supplements with added protein and amino acids for clients with delayed wound healing due to malnutrition (Manley & Mitchell, 2022).

Nurses should encourage the use of a standardized nutritional risk assessment tool for older adults with wounds in their care practice setting. These tools, such as the Mini Nutritional Assessment (MNA), can help the nurse identify clients at risk for delayed wound healing and can help identify targeted areas of nutrition education for older adults with delayed wound healing (Fulton et al., 2016).

The MNA has been validated and is highly sensitive; it has demonstrated good reliability and accuracy in identifying older adults who are malnourished or at risk for malnutrition. It is typically administered by health care professionals, and it can be used in various health care settings, including hospitals, nursing homes, and community care settings. The assessment considers various factors that influence nutritional status, including dietary intake, mobility, weight loss, and psychological factors. The MNA questionnaire portion consists of questions that cover a range of topics, such as appetite, weight loss, mobility, and chronic diseases. The questions aim to gather information about the individual’s dietary habits, recent weight changes, and ability to perform daily activities. Additionally, the MNA includes anthropometric measurements such as BMI, calf circumference, and mid-arm circumference, which provide objective data on muscle and fat stores.

Based on the responses to the MNA questionnaire and the measurements taken, individuals are categorized into one of three groups:

  • Well-nourished: Individuals who have good nutritional status and no apparent risk for malnutrition
  • At risk for malnutrition: Individuals who show signs of poor nutritional status or have certain risk factors for malnutrition
  • Malnourished: Individuals who are already malnourished or have severe nutritional deficiencies

The MNA can help health care professionals make informed decisions regarding nutritional interventions for clients, such as the need for dietary modifications, oral nutritional supplements, or referral to a dietitian for further assessment and management.

Mini Nutritional Assessment

The MNA was developed more than two decades ago by the Nestlé Nutrition Institute. Nurses can use this tool in a variety of settings to identify clients at risk for malnutrition or delayed wound healing and to implement appropriate interventions. The short version of the assessment is available at this site, which includes a video on its use.

Unfolding Case Study

Part D

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up from Case Study Parts A, B, and C.

Time flies! Jose is now 74 years old and has a pressure injury. Read through the following summary of Jose’s visit to the wound clinic.

Vital Signs Nurse’s Note
Temperature: 98.6° F
  • 74-year-old presents for initial visit and evaluation of stage 2 pressure ulcer on right hip. Reports that wound has been present for 4 months, that it causes severe pain, and that it started when bedbound due to a right knee replacement in December. Over the past 4 months, reports occasional sadness due to loss of mobility. Is able to transfer from bed to chair but cannot leave the house like they used to. Experiencing a decrease in appetite recently because they can no longer cook for themselves and don’t like the frozen meals their daughter buys. Estimates they have lost approximately 10 pounds in the last 4 months.
Blood pressure: 122/68 mm Hg
Heart rate: 80 beats/min
Respiratory rate: 14 breaths/min
Pain: 6/10 in right hip decubitus
BMI: 18.5
Calf circumference: 29 cm
Table 20.8
Which of the following interventions would promote a healthy integumentary system and better wound-healing outcomes?
  1. Taking prescribed oral nutritional supplements
  2. Repeating the MNA screening at regular intervals
  3. Switching from skim milk to 2% milk
  4. Eating less red meat
The nurse is preparing to complete the Mini Nutrition Assessment (MNA) for the client. Which of the following is a potential classification based on the results?
  1. Obese
  2. Underweight
  3. Overweight
  4. Malnourished

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