Graduating with a nursing degree in hand, I was ready to bring my new knowledge and skills to the bedside. Thirty years later, I am amazed at how much I still have to learn and apply to my practice.
Lately, I have been researching and exploring the relationship of malnutrition and dehydration to skin breakdown. In recently released guidelines by the National Pressure Ulcer Advisory Panel, it illustrated further the causative relationship between those two factors. In fact, researchers in a U.S. study demonstrated that in hospitalized patients over the age of 65 years old at risk for pressure ulcers, 76% of study participants were malnourished.
In caring for this population, we have missed an important tool for helping the skin be stronger and more resilient. Simply stated, it is protein. Protein is essential for healing and preventing pressure ulcers. One study showed that oral nutritional supplements with high level of protein and calories were associated with a significant reduction in pressure ulcer development compared to routine intake. Experts also say renal function must be taken into consideration before utilizing a high-protein diet.
We know that keeping the skin moisturized on the outside is a vital preventative step. How often do we think about hydration working from the inside out? Having many loved ones who are aging in my life, I have found myself asking them about their hydration habits. One of them has congestive heart failure, the other kidney disease; the one who can drink freely is too busy to remember and actually has the more issues with dehydration.
So what can be done to keep skin moist from the inside out?
• Set up hydration stations with residents and measure the amounts they can drink in the day. I have found that those who are on limited intake actually drink less due to fear of consequences related to having too many fluids.
• Look at what kinds of fluids are being taken in. Do they dehydrate or hydrate? Teas, coffees and other type of drinks can have a diuretic effect and take fluids out of the body.
• Remember protein is a critical building block for healthy skin. Help those you care for to understand why protein is so important for them to assure that they take in on a daily basis. In addition, look at supplements to assure that adequate protein intake is occurring. Less is more so try to find ones that are easy to swallow and only take a few swallows. Always consider renal status with protein supplements.
What is fun about these new studies is that eating and drinking really can save your skin. It just has to be the right types of eating and drinking.
Martie Moore is chief nursing officer at Medline Industries and a member of NPUAP’s Corporate Advisory Council.