Chapter 24: MNT in Surgical Conditions and Burns Flashcards
is the anatomic alteration of the human organism that is designed to arrest or alleviate a pathologic process
surgery
characteristics of this conditions
-insulin resistance
-hormonal changes
-peristalsis is inhibited
-electrolyte losses
-increased utilization of nutrients
surgery
hormonal changes during surgery
increased secretion of _____ (3)
Antidiuretic hormone (adh/vasopressin), catecholamines, adlosterone
surgery - dietary mgmt (pre-op)
case: elective surgery
diet: ?
rationale: to prevent vomitus aspiration
npo at least 6 hrs before surgery
surgery - dietary mgmt (pre-op)
case: elective surgery
diet: ?
rationale: promote glycogen storage and facilitate safe and faster recovery
high calorie
surgery - dietary mgmt (pre-op)
case: elective surgery
diet: ?
rationale: if obese, to facilitate safe and faster recovery
low calori
surgery - dietary mgmt (pre-op)
case: elective surgery
diet: ?
rationale: build-up nitrogen reserves, increase resistance to infection, wound healing, regeneration of hemoglobin
high protein
surgery - dietary mgmt (pre-op)
case: elective surgery
diet: ?
rationale: regulates fluid and electrolyte balance, promoted blood building and clotting
vitamin and mineral supplementation
surgery - dietary mgmt (pre-op)
case: emergency surgery
diet: ?
rationale: fastest method of nourishing patient prior to operation; to prevent shock
parenteral feeding
surgery - dietary mgmt (post-op)
case: -
diet: ?
rationale: to prevent aspiration
NPO
surgery - dietary mgmt (post-op)
case: -
diet: ?
rationale: to adjust to the ability of the patient to digest food
progress to clear liquid to regular diet
surgery - dietary mgmt (post-op)
case: -
diet: ?
rationale: to prevent ketosis; for increased metabolism; to spare protein
high calorie
surgery - dietary mgmt (post-op)
case: -
diet: ?
rationale: replace protein losses; promotes wound healing; helps prevent infection; promoted blood building
high protein
surgery - dietary mgmt (post-op)
case: -
diet: ?
rationale: promotes wound healing; replace losses; prevents dehydration and shock; promotes blood building and clotting
vitamin and mineral supplementation
surgery - dietary mgmt (post-op)
case: -
diet: ?
rationale: to meet nutrient requirements
tube feeding or TPN when necessary
specific surgical conditions
a surgical procedure that creates an opening from the colon through the abdominal wall to the surface of the skin for defecation when the feces cannot pass through the rectum and anus
colostomy
specific surgical conditions
refers to a surgical procedure that creates an opening from the ileum to the surface of the abdominal wall to permit drainage of the contents of the small intestine
ileostomy
specific surgical conditions
short segment of the jejunum is joined to the terminal ileum; effectively 90% of the small bowel
jejunoileostomy
specific surgical conditions
refers to the surgical removal of the gallbladder
cholecystectomy
specific surgical conditions
refers to the surgical removal of tonsilitis
tonsilectomy
specific surgical conditions
surgical removal of hemorrhoids
hemmorhoidectomy
specific surgical conditions
procedure when the entire colon is bypassed, and opening ic created from the oleum that is attached directly to the anus
ileorectal anastomosis
the decrease in plasma volume because of increased peristaltic movement
hypertonic, hyperosmotic food in the jejunum causes rapid emptying time resulting to hypoglycemia, diarrhea, dizziness, and pallor
dumping syndrome
nut. absorption and consequences of intestinal surgeries
a. 90-95% of nutrient absorption takes place in the first half of the _____
after a resection, nutrient absorption may be reduced
small intestine
Surgery to remove tissue or part or all of an organ
resection
nut. absorption and consequences of intestinal surgeries
b. there are certain dietary and growth factors that promote intestinal adaptation, like _____ (for glucose source)
glutamine
nut. absorption and consequences of intestinal surgeries
b. there are certain dietary and growth factors that promote intestinal adaptation, like _____ (for energy)
short-chain fatty acids
nut. absorption and consequences of intestinal surgeries
b. there are certain dietary and growth factors that promote intestinal adaptation, like _____ (for increased nutrient uptake and utilization)
insulin-like growth factors and growth hormone
surgery - dietary mgmt
case: tooth extraction and tonsilectomy
diet: ?
rationale: to prevent bleeding
cold liquid
surgery - dietary mgmt
case: gastronomy when removal of esophagus is necessary
diet: ?
rationale: to rest the organ
low fiber, dry meals, cho-restricted
surgery - dietary mgmt
case: gastric surgery
diet: ?
rationale: to avoid dumping syndrome
high-chon, no simple sugars
surgery - dietary mgmt
case: intestinal surgeries
diet: ?
rationale: to avoid motility and supply electrolytes
TPN and tube feeding when necessary
surgery - dietary mgmt
case: intestinal surgeries
diet: ?
rationale: to adjust to the ability of the body to digest and absorb food
gradual progress from npo to normal diet
surgery - dietary mgmt
case: ileostomy
diet: ?
rationale: b12 is absorbed in the ileum
vitamin b12 supplementation
surgery - dietary mgmt
case: ileostomy
diet: ?
rationale: to prevent irritation, gradual introduction of food
low fiber, low residue, clear
surgery - dietary mgmt
case: ileostomy
diet: ?
rationale: there is fat absorption
low fat
surgery - dietary mgmt
case: colostomy
diet: ?
rationale: to prevent irritation; gradual introduction of food
low fiber, low residue, clear
surgery - dietary mgmt
case: colostomy
diet: ?
rationale: there is fat malabsorption
low fat
surgery - dietary mgmt
case: jejunoileostomy
diet: ?
rationale: to prevent irritation; gradual introduction of food
low fiber, low residue, clear
surgery - dietary mgmt
case: jejunoileostomy
diet: ?
rationale: there is fat malabsorption
low fat
surgery - dietary mgmt
case: jejunoileostomy
diet: ?
rationale: to prevent fatty liver; to allow fat transport
high chon
surgery - dietary mgmt
case: jejunoileostomy
diet: ?
rationale: to prevent fermentation
low cho
surgery - dietary mgmt
case: hemorrhoidectomy
diet: ?
rationale: to prevent irritation; gradual introduction of food
low fiber, low residue, clear
surgery - dietary mgmt
case: jejunoileostomy
diet: ?
rationale: to replenish losses
supplement of vitamins and minerals
surgery - dietary mgmt
case: cholecystectomy
diet: ?
rationale: to adjust to the ability to emulsify fat
low fat then normal
surgery - dietary mgmt
case: peritonitis and intestinal obstruction
diet: ?
rationale: no peristaltic action
NPO, IVF
surgery - dietary mgmt
case: peritonitis and intestinal obstruction
diet: ?
rationale: to adjust to the ability to digest and absorb food
progressive diets
surgery - dietary mgmt
case: peritonitis and intestinal obstruction
diet: ?
rationale: to prevent irritation
low residue
absorption of vitamins and minerals begins in the _____ and continues throughout the length of the small intestine
duodenum
possible consequences of resection on nutrient absorption
nutrient absorbed:
-simple cho
-fats
-amino acids
-vitamins
-minerals
-water
duodenum/jejunum
possible consequences of resection on nutrient absorption
nutrient absorbed:
-bile salts
-vitamin b12
-water
ileum
possible consequences of resection on nutrient absorption
nutrient absorbed:
-water
-electrolytes
-short-chain fatty acids
colon
possible consequences of resection on what intestinal part
-minimal consequences if the ileum remains intact
-calcium and iron malabsorption if duodenum resected
duodenum/jejunum
possible consequences of resection on what intestinal part
-fat malabsorption; protein malabsorption
-cho malabsorption
-calcium, magnesium, and phosphorous malabsorption
-fluid and electrolyte losses
-diarrhea/steatorrhea
ileum
possible consequences of resection on what intestinal part
-fluid and electrolytes losses
-diarrhea (losses are compounded if ileum is also resected)
colon
are the injured tissue caused by heat, flame, chemicals, electricity, or radiation characterized by decrease of blood volume, plasma loss, edema, damage to blood vessel walls, increased metabolic rate, weight losses, nitrogen and nutrient losses, and hyperglycemia
burns
burns - medical mgmt
fluid and electrolyte replacement timeframe
in the first 24 to 48 hrs treatment
burns - medical mgmt
mgmt: ?
rationale: for epithelial regeneration
pain relievers, anti-infective drugs
dietary mgmt
case: burns
diet: ?
rationale: to replace fluid losses
IVF
dietary mgmt
case: burns
diet: ?
rationale: to meet energy requirements when oral intake is impossible
tube feeding when necessary
dietary mgmt
case: burns
diet: ?
rationale: to control water retention
fluid and na controlled
dietary mgmt
case: burns
diet: ?
rationale: to provide energy reserves
high kcal
dietary mgmt
case: burns
diet: ?
rationale: replace losses, increase in gluconeogenesis, wound healing
high chon, 20-25% TER, HBV
dietary mgmt
case: burns
diet: ?
rationale: for energy metabolism, wound healing
vitamins and minerals
dietary mgmt
case: burns
diet: ?
rationale: for immune system and epithelia tissue
vitamin a
dietary mgmt
case: burns
diet: ?
rationale: for tissue regeneration
vitamin c
dietary mgmt
case: burns
diet: ?
rationale: to supply oxidative enzymes for cho and chon metabolism
thiamin, riboflavin, and niacin
dietary mgmt
case: burns
diet: ?
rationale: for wound healing
zinc
