Wound Care Plan Example: All Dietitians Need to Know

Building a wound care plan is key for Dietitians to help plan how they will promote wound healing in their patients.  This can help to plan nutrition interventions as well as a follow up plan to continually evaluate how the healing is progressing.

While each patient will need an individualised care plan, this wound care plan example will give you the guidelines to help you build it.

woman looking curiously on a pink and blue background with the words, what do I need to include in my wound care plan written.

What are Wounds?

A wound occurs when there is damage to the skin integrity leaving what we now call a pressure injury (PI).  Pressure injuries were previously called wounds or pressure wounds, but the National Pressure Injury Association Panel (NPIAP) agreed on the terminology change.

I tend to use them interchangeably, and you will likely still hear them called wounds in healthcare facilities.  

Wounds are essentially a break in the skin integrity that leaves it exposed to varying degrees.  They can be caused by a variety of issues, but most are due to a physical pressure that shears the skin.

I have noted more often than not, you get this from the name, that PIs happen when a person has constant pressure on an area of the skin.

This is why we tend to see PIs in areas of high pressure such as coccyx, buttocks, tailbone, elbows, and other boney areas of the body.

Stages of Wounds

Wounds vary in severity from stage 1 to stage 4.  Stage 1 is the least deep wound, whereas stage 4 is very severe, deep, and can be difficult to heal even with the best care plan in the world.

Any stage of wound is of course a serious health issue and the goal always needs to be to heal it as fast as possible.  Having any damaged skin integrity leaves the skin exposed 

Purpose of a Wound Care Plan

The purpose of a wound care plan is to have an exact framework for how the healthcare team is trying to promote wound healing.  Nursing will likely have many aspects of a wound healing care plan such as:

  • Positioning
  • Time out of bed
  • Time out of a wheelchair
  • Dressing
  • Timing of dressing change
  • Consults for further evaluation

For a Dietitian their wound care plan will detail exactly the nutrition care plan that will promote wound healing.  This may include:

  • Protein supplementation
  • High calorie high protein drinks
  • Oral nutritional supplements
  • Vitamin/Mineral supplementation
  • Fortified foods
  • Increased meals
  • Snacks
  • Increased fluids
  • Meal time assistance
  • Meal time monitoring and calorie count audits

The nutrition interventions will vary based on the nutrition assessment on how to best provide nutrition for wound healing.

So how does a Dietitian build a wound care plan?  As someone who has built countless ones over a decade, it’s really not complicated.  Here’s my easy recommendations, let’s start with nutrition goals.

The Nutrition Care Plan

All nutrition care plans follow the exact same format.  I’ve gone into this before, you can find building a basic nutrition care plan here, but you need to individualise them.  

This means that you need to do a full nutrition assessment from A to Z, and detail what will work for that particular individual.  

You need to sit down with the resident and/or their power of attorney, to find out what their nutrition goals are (wound healing I hope!).  Build it WITH them.

Nutrition Diagnosis

Use the standardised nutrition diagnostic terminology, you can find a free copy of it by clicking here.

If you want a full breakdown on how to find the right nutrition diagnosis, I gave a full masterclass article here!

My top nutrition diagnosis for wounds are:

  1. Increased nutrient needs (See a full PES statement article on this nutrition diagnosis here!)
  2. Hypermetabolism (Similar to increased nutrient needs)

These are the two that I currently recommend using.  You can specify that the increased nutrient needs are protein and calories as well.

Nutrition Goals

Make sure that you have a meeting with the patient and their loved ones so they help you SET the nutrition goals.  It may seem obvious that wound healing is the goal, but they still get a say in it or at the very least, be made aware of it.

Some nutrition goals that I would set for wound healing would be:

  1. Mrs Smith’s protein, energy, and fluids will be adequate to meet her nutrient needs and requirements to promote stage 4 wound healing.
  2. Mrs Smith will consume oral nutrition supplement 60 mL, TID, as provided by nursing during Medpass to aid in stage 4 wound healing.
  3. Mrs Smith will have adequate protein, calories, and fluids provided to her to aid in stage 3 wound healing.  

You don’t need to use all of these, but in some variations it’s a good idea.  I recommend having a few nutrition goals where needed.  Make sure they are specific to the:

  1. Wound type
  2. Name of resident
  3. Recommended nutrients

Nutrition Interventions

There are MANY different nutrition interventions that go into promoting wound healing. If a wound is stage 3 or 4 it will require more protein, energy and fluids, a stage 1 may require no big interventions at all.

If you want a full webinar on how much exactly is needed for wound healing, find my live webinar here!

This is why it’s so important to assess each person with a full nutrition assessment.

Some nutrition interventions that I recommend are:

  1. High protein, high calorie nutrition supplement TID at 90 mL.
  2. 2000 mL fluids daily.
  3. 1.0-1.5 grams of protein per day per kilogram body weight daily.
  4. 30-40 calories per kilogram of body weight daily.
  5. Fortified oatmeal at breakfast with 1 scoop of protein powder blended.
  6. Fortified potatoes at lunch and supper with 1 scoop of protein powder.
  7. Wound healing supplement TID between meals.
  8. Extra protein sources at all meals.
  9. Double portion of protein at lunch and dinner
  10. In-house high protein smoothie recipe with breakfast.

Again, when you recommend these in your care plan make sure they are individualised and specific to the patient.

For example:

  1.  Mrs Smith will be given 60 mL TID of the in-house high protein oral nutritional supplement.
  2. Mrs Smith will be provided with fortified potatoes at dinner daily.
  3. Mrs Smith will be provided with a double portion of protein at lunch and supper.
  4. Mrs Smith will be provided with 1.5 grams per kilogram of her body weight of protein daily.

Nutrition Monitoring & Evaluation Plan

I always recommend that any person with a wound should be followed up with at minimum once per week.  They should also be placed on a Dietitian’s high risk tracking spreadsheet, or however they track high risk patients.

It doesn’t matter if it is stage 1 or stage 4, they need to be followed closely.  A stage 1 PI can easily and very rapidly transition to a stage 4 PI before you know it.  Sometimes there is much more beneath the surface of a wound that we don’t see.

For a stage 4 wound I obviously recommend following up, at the very least reviewing the charting on the person every shift.

A nutrition and monitoring evaluation plan can be as follows:

  1. Will follow up with Mrs Smith’s wound care 3 times per week.  
  2. Will join with staff to evaluate Mrs Smith’s wound at dressing change 2 times per week. 
  3. Will reassess Mrs Smith’s acceptance of protein supplement within 7 days of trial.
  4. Will meet with Mrs Smith in 7 days to reevaluate nutrition interventions and update as requested.

If you want want more great, FREE care plans, be sure to sign up for our e-mail subscriber list!  If there’s a particular nutrition care plan example that you want to see, e-mail me at info@longtermcarerd.com and I’ll work on it!

Drop your questions in the comments.

Michelle saari dietitian
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Michelle Saari is a Registered Dietitian based in Canada. She has a Master's Degree in Human Nutritional Sciences and is a passionate advocate for spreading easy to understand, reliable, and trustworthy nutrition information. She is currently a full time online entrepreneur with two nutrition focused websites.

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