chapter 21 - surgery/ special cases

Question 1

hypermetaboic stress after physical stress

Answer 1

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

Question 2

protein-energy malnutrition

Answer 2

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

Question 3

extra protein needed for what after sugery

Answer 3

wound healing
tissue building
blood regeratione

Question 4

extra carb needed for what after sugery

Answer 4

convereted to gycogen and stored to help provide energy after surgery when clients amy be unable to eat normally

Question 5

B vitamins needed for what after sugery

Answer 5

increased metabolism

Question 6

vitmina A and C and zinc needed for what after sugery

Answer 6

wound healing

Question 7

vitmain D needed for what after sugery

Answer 7

absorption of calcium

Question 8

vitamin K needed for what after sugery

Answer 8

proper clotting of blood

Question 9

iron needed for what after sugery

Answer 9

blood building

Question 10

calcium phoosphorous needed for what after sugery

Answer 10

for bones

Question 11

other minerals needed for what after sugery

Answer 11

acid-base, electroyte, and fluid balance

Question 12

why NPO before sirgery

Answer 12

ensures stomach contain no food which could be regurigiated and the naspiratired into lungs

if GI, low-residue for a ew days before surgery

Question 13

what is postsurgical diet

Answer 13

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

Question 14

dumping syndrome

Answer 14

after gastric surgery
1503- min after eating

characterized by dizziness, weakness, cramps, vomiting, and diarrhea

food moving too quickly from stomach into small intestine

Question 15

how to prevent dumping syndrome

Answer 15

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

Question 16

eneteral nutrtion

Answer 16

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

Question 17

percutanesu endoscopic gaststomy tube (PEG)

Answer 17

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

Question 18

percutaneosu endoscopic jejunostomy (JPEG)

Answer 18

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

Question 19

polymeric formulas

Answer 19

clients who are able to digest and absorb nutrients

(1-2 cal/ mL)

contains intact proteins, carbs, and fats

Question 20

elemental or hydrolyzed formulas (1 cal/mL)

Answer 20

limited ability to digest or absorb nutrients

contains products of digestion of protein, carb, and fats, and lactose free

Question 21

modular formulas

Answer 21

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)

Question 22

methods for administering tube feedings

Answer 22

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

Question 23

how are feedigns adminstered

Answer 23

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

Question 24

signs of interolance w feeding

Answer 24

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

Question 25

osmolality of liquid

Answer 25

number of particles per kg of solution higher osmolality = more pressure and attract water from fluids w lower osmolality

Question 26

osmolality and food

Answer 26

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

Question 27

aspiration w enteral nutritio n

Answer 27

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

Question 28

parenteral nutritio n

Answer 28

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

Question 29

how to administer TPN for extended time

Answer 29

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

Question 30

how to wean off parenteral nurition

Answer 30

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

Question 31

sepsis

Answer 31

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

Question 32

what do serious burns cause loss of

Answer 32

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

Question 33

how to treat after burns

Answer 33

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

Question 34

chldren encessary protein after burn

Answer 34

2.5-3g/ kg

Question 35

provide ___% of nonprotien cal fro fat after burns

Answer 35

12-15

Question 36

extra nutrient after burns

Answer 36

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

Question 37

feeding after burns

Answer 37

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

Question 38

infection and food

Answer 38

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

Question 39

appetiet for clients w fever

Answer 39

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

Question 40

antibiotics during fever

Answer 40

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)

Question 41

HIV

Answer 41

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

Question 42

symptoms as HIV progresses

Answer 42

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

Question 43

HIV wasting syndrome

Answer 43

serious protein -energy malnutrition (PEM) body wasting hypoalbuminemia and wt loss

Question 44

causesof nutrient loss in AIDS clients

Answer 44

anorexia cancer dairrhea increased metablism due to fever certain meds malabsorption caused by cancer or diarrhea protein-energy malnutriotn

Question 45

methods to imrpove appetite of aids client

Answer 45

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

Question 46

what might dietitian do if decrease intake of food

Answer 46

inform client about nutritional needs offer supplement or other foods invite friends and relatives to bring some of favorite foods

Question 47

feeding blind client

Answer 47

appeitizing descirption of meal to create desire to eat help w self feeding by arranging good as if plate were face of clock

Question 48

pressure ulcers

Answer 48

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

Question 49

cause of constipation

Answer 49

inadequate fiber, fluid, or execise mediciation reduced peristalisis former abuse of laxatives

Question 50

caue of diarrhea

Answer 50

digestive disorders meidcation viruses bacteria other sources cause reduced absoroptj of nurtietns and can contribute to dehtdration

Question 51

sense of smell and appatiet

Answer 51

decliens w age

Question 52

reduction sense of taste

Answer 52

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

Question 53

dysphagia

Answer 53

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 `