Nutrition, Pain Management, and Patient/Caregiver Education
Nutrition
Healing demands energy, protein, and micronutrients. Screen with a validated tool (MUST, MNA) on admission and with change; unintentional loss of more than 5% in 30 days or 10% in 180 days is significant. Stage 3-4 pressure injuries and major wounds often need roughly 30-35 kcal/kg/day and 1.25-1.5 g/kg/day protein, with adequate fluid. Vitamin C, zinc, and vitamin A matter when there is deficiency, but megadosing zinc impairs healing and copper status. Albumin and prealbumin fall with inflammation, so read them as context, not as the sole nutrition marker.
Pain
Identify the source: background wound pain, periwound pain, procedural pain, or pain from the cause (ischemia, infection). Use a validated scale appropriate to the patient (0-10 numeric, Wong-Baker FACES, PAINAD for advanced dementia). Premedicate 30-60 minutes before debridement, use nonadherent silicone dressings, minimize changes, and consider topical anesthetics for sharp debridement. Treat ischemia and infection, which are themselves pain generators.
Education
Teach in plain language and confirm with teach-back. Cover pressure redistribution and repositioning, inspection routines, footwear, nutrition and hydration, dressing schedules, signs of infection, and when to call. Include caregivers, respect health literacy and culture, and document what was taught and what the patient or caregiver repeated back.
Traps
- Using albumin as the primary nutrition screen.
- Withholding analgesia because "debridement is quick."
- Supplementing zinc without documented deficiency.
- Documenting education without confirming comprehension.
Rule of thumb
Premedicate 30 to 60 minutes out; teach back to be sure. Before sharp debridement, give the prescribed short-acting analgesic, then verify the patient can restate the warning signs of infection before discharge.