chapter 21 - surgery/ special cases Flashcards
hypermetaboic stress after physical stress
increased energy outpit
catabolksm occurs, causing rapi breakfdown of energy reserves to provide glucsoe and other substances neecessaryt for anoblic phase of wound healing and tissue maintenance
proteins, fat, and mienrals are lost n catablic phase just when tehre is an icnreased need for htem to rebuild tissue
condition includes hemorrahge and vomiting
sufficient nurients, fluids, and cal are required asap to repalce losses, build and repair tissue, and return the body to homesostasis
protein-energy malnutrition
problem among hospitalized clients esp eldery
delays wound healing, contributes to eanemia, depresses immune system, increases susceptibility oto ifnection
sypmtosm includew t loss and dry, pale skin
if malnutrition occurs as a result of hsotialization, iatrogenic malnutrtion
extra protein needed for what after sugery
wound healing
tissue building
blood regeratione
extra carb needed for what after sugery
convereted to gycogen and stored to help provide energy after surgery when clients amy be unable to eat normally
B vitamins needed for what after sugery
increased metabolism
vitmina A and C and zinc needed for what after sugery
wound healing
vitmain D needed for what after sugery
absorption of calcium
vitamin K needed for what after sugery
proper clotting of blood
iron needed for what after sugery
blood building
calcium phoosphorous needed for what after sugery
for bones
other minerals needed for what after sugery
acid-base, electroyte, and fluid balance
why NPO before sirgery
ensures stomach contain no food which could be regurigiated and the naspiratired into lungs
if GI, low-residue for a ew days before surgery
what is postsurgical diet
24 hours immediatley after - IV solutions (water, 5-10% dextroe, elecytoytes, vitamins, and medication, max cal is 400-500 cal)
- estimated requirement is 35-45 cal per kg
- protein requirement range from 1.5-2 g/kg body weight
- ice chips when peristalsis returns then clear-liquid diet
avg client can take food within one to four days after surgery
dumping syndrome
after gastric surgery
1503- min after eating
characterized by dizziness, weakness, cramps, vomiting, and diarrhea
food moving too quickly from stomach into small intestine
how to prevent dumping syndrome
smaller more frequent meals sould be eaten and sugary drinks, sweets, and dried fruits should be avoided
fluids should be limited to 4 oz at meals or restricted completely s has not to fill up stomach w fluids instead of nutrients
fluids can taken 30 min after meals
some clinets dont tolerate milk well after gastric surgery
eneteral nutrtion
forms of feeding that brings nutrition directly into digestive tract
eetarla feedings prefered over parenteral nutrition bc there ar many physiolgic benefits of keeping gut functioning such as improved immune status
tube feedings may be necessary bc unconsciousness, surgery, stroke, severe malnutrition, or extensive burns
usually not onger than 6 weeks - NG tube
longer than 4-6 weeks then esophostomy, gastrostomy, or jejunostomy
percutanesu endoscopic gaststomy tube (PEG)
placed at somtach if patient is not at risk for aspiration
esophagostomy tube might be placed at side of neck at level of cervical spine after head and neck surgery
percutaneosu endoscopic jejunostomy (JPEG)
wegithed feeding tube (from PEG insertion) passed into duodenum
indicated for pt who cant tolerate gastric feedings due to a history of reflux or aspiration or those who may gastric obstruction or function problems of stomach
sometimes there is direct tube placement at the jejunum
polymeric formulas
clients who are able to digest and absorb nutrients
(1-2 cal/ mL)
contains intact proteins, carbs, and fats
elemental or hydrolyzed formulas (1 cal/mL)
limited ability to digest or absorb nutrients
contains products of digestion of protein, carb, and fats, and lactose free
modular formulas
3.8-4 cal/mL
supplements to other formulas or for developing customized formulas for certian clients (such as those w extensive wound-healing needs)
use of modular ofrmuals have been decreasing due to development of high-rpteoin formulas
disease-specific formuals have been developed to be used in cute setting and for a short period (for renal failure, respiratory, fair, or liver failure)
methods for administering tube feedings
continuos
intermittent 0 administer tube feeding at night w solid foods eaten during day (if food-drug interaction such as w phenytoin (Dilantin), TF should be stopepd 1 hour beofre and restarted 1 hour after adm of med via tube)
bolus - daily cal divided to 6 servings per day (400cc at time), 15 min span and folllowed by 25-60 mL of water, usually w PEG tube but could be done w NG tube
how are feedigns adminstered
continuous during a 16-to-24 hour period
start slowly such as 20-25 mL per hour
may be increased by 10-25 mL every 4 hours until toerlance
signs of interolance w feeding
abdominal distetntion, or if client is verbal, verbalization of issues w cramping or nausea, diarrhea, delayed GI motility
tube fedings dont ned to be held until residuals reach 500 mL then gradual return to roal feedings
osmolality of liquid
number of particles per kg of solution
higher osmolality = more pressure and attract water from fluids w lower osmolality
osmolality and food
when formula w high osmolaity reaches intestines body may draw fluid from blood to dilute th formula whic hcan cause weakness and diaarrhea
liquid med containing sorbitol or C. diff. can cause diarrhea
aspiration w enteral nutritio n
formula eneters lung = pneumonia
tube becomes clugged or client may pull out tube
admiinstier flush solution and raise head of bed before begining tube foding
parenteral nutritio n
provision of nutrients IV
used if GI tact isnt functional or if normal feeding isnt adequate
used alone or part of dietary plan that includes oral or tube feeding
used to provide nutrition w/o GI tract = total parenteral nutrition (TPN) or hyperalimentation - combo of dextroe, amino acids, and lipids, electroyltes, and trace elements
administedred via central vein or peripheral vein (if less than 2 weeks)
solution for TPN combined just before entry to vein
how to administer TPN for extended time
central vein; Cather into subclavian or superior vena cava
vena cava bc high blood flow = quick dilution of highly concentrated TPN which reduced possiblity of phlebitis and thrombosis
how to wean off parenteral nurition
gradual transfer toroal diet
given tube feeding before roal feeding
daily oral fluid and cal goal must be close to being met before weaning
parenteral nutriton infusion volume may be decreased on a daily basis or there may be reduction in number of day of week the nifsuio takes place
assessment is done via oral intake, stool, urine output analysis
sepsis
infection occur at site of catherter and enter bloodstream
infection of the blood
bacterial or fungal infection can develop in solution if its unrefrigerated for over 24 hours
abn elecytrolye levels may develop as can phlebitis or blood clots
what do serious burns cause loss of
enermuous loss of fluids, elecyroyles, and proteins from loss of skin surface
water moves from other tissues to burn site in an efort to compensate for the loss which compoinds issue
- reduce blood volume and thus bp and urine outpit
how to treat after burns
fluids and elecyrolytes are replaced by IV
not glucose included in these fluids for first 2-3 days after burn to avoid hyperglycemia
hypermetabolic state after serious burn contiues until skin is largely healed so enormous increase in energy needed to heal
chldren encessary protein after burn
2.5-3g/ kg
provide ___% of nonprotien cal fro fat after burns
12-15
extra nutrient after burns
high protein
high cal
increaed need for vitamin C, zinc, b, vitamin A
amin acodsi arginine and glutaine (immune functioning and would healing)
arginine - wond healing by aiding in collagen formation and intrenge retention
glutamine - help prevent baceterial infection, improve immune function, and preserve gut integrity
sufficient to help kidneys
feeding after burns
oral feedings if possible
liquid commerical feedings at first
solid foods during second week after burn
tube feedings immediatley if client is unable to eat
parenteral feeding in some cases
infection and food
fever is hypermetablic state in which h eage degree of fever on fahrentheit scale raises BMR by 7%
extra cal are not provided during fever, the body first uses supply of glycogen then its stored fat and the nmuscle tissue
protein intake should be increased bc sepsis and need to replace body tissues and produce antibodies
minerals are needed to help build and repair body tissue and maintain acid-base, elecytoylte and fluid balance
extra cal for icnreased metablic rate and to fight infection causing fever
extra fluid to replace that lost thorugh perspiration, vomiting, or diarrhea which often accompany infection
appetiet for clients w fever
v poor appetites
will often accept ice water, fruit juice, and carbonated beverages
broth, jello, popsicles
progress from liquid to regular diet w freuent, small meals
high in protein, cal and vitamins
antibiotics during fever
high dose of antiiotics can lead to oral thrust
thrush = decreased appetite due to pain on tingue during eating (treatment is not needed,clients can take acidophilus capsules or eat uogourt containing acidophilus to speed recovery)
HIV
invades t cels
t cells cant function normally = body has no resistance to opprtountistic infections (caused by organisms that are rpresent but dont affect ppl w healthy immune systems(
ultimetale leads to AIDS
transmitted via bodily fludis
symptoms as HIV progresses
fatigue
skin rashes
headache
night sweats
diarrhea
wt loss
oral lesions
cough
fevers
increase metabli.c rate and nutrient and calorie needs and decrease appetite and bodysability t oabsorb nutrients
oral infection = change in taste and dysphagia
fever, pain and depression depress appetite
dysphagia and dementia also contribute to anorexia
HIV wasting syndrome
serious protein -energy malnutrition (PEM)
body wasting
hypoalbuminemia and wt loss
causesof nutrient loss in AIDS clients
anorexia
cancer
dairrhea
increased metablism due to fever
certain meds
malabsorption caused by cancer or diarrhea
protein-energy malnutriotn
methods to imrpove appetite of aids client
med after meals
soft foods
avoid spicy, acidic, and extremely hot or cold foods
serve frequent, small meals
add sugar, and flavorings to liquid supplements
take advantage of good days and offer any food client tolerates
talk w client to help ease concerns about fiancnes, family and riends
what might dietitian do if decrease intake of food
inform client about nutritional needs
offer supplement or other foods
invite friends and relatives to bring some of favorite foods
feeding blind client
appeitizing descirption of meal to create desire to eat
help w self feeding by arranging good as if plate were face of clock
pressure ulcers
areas where unreleived pressure on skin prevents blood from brining nutrients and oxyen and removing waste
healing requires treatment of ulcer relief ofpressure, high-cal diet w sufficient protein, and itamin C and zinc
cause of constipation
inadequate fiber, fluid, or execise
mediciation
reduced peristalisis
former abuse of laxatives
caue of diarrhea
digestive disorders
meidcation
viruses
bacteria
other sources
cause reduced absoroptj of nurtietns and can contribute to dehtdration
sense of smell and appatiet
decliens w age
reduction sense of taste
caused by medication
disease
merinal deficiencies
xerostomia (drymouth) - caused by disease or med
addition of spices, herbs, salt, and sugar can help
drinking water, eating requent small meals, sugar-free gum or hard candies
inadequate amt of saliva can cause tooth decay
dysphagia
difficulty in swallowing
caused by stroke, closed head trauma, head or neck cancer, surgery or alzheimers
tgickened liquids
always in upright poition w chin tuckedtoward their chest when eating to prevent aspiration
cut food into small pieces `
