Perioperative nutrition Flashcards
Why is it important to assess for evidence of malnutrition in any patient undergoing elective or semi-elective surgery?
- Malnourished patients make poor surgical candidates
- Surgery induces a hyper-metabolic state and catabolic response
- Some surgical patients will have malnutrition due to their underlying disease process
- Malnourished patients at greater risk of post-op complications:
- Reduced wound healing
- Increased infection rates
- Skin breakdown
How can patients be screened for malnutrition?
- Malnutrition Universal Screening Tool (MUST)
- Obvious bedside observation
- Input from a dietician
What signs from the bedside may indicate malnutrition?
- Muscle wasting
- Loose skin
- Patient’s clothes no longer fitting
- Aphthous ulcers, angular cheilitis, pressure sores
What tools can dieticians use to assess a nutritional state
- Weight
- BMI
- Grip stregnth
- Triceps skin fold thickness
How can BMI be calculated?
- Weight (kg) / height(m)2
- Normal = 18.5 - 24.9
What is the preferred option of devliery of pre or post-op nutritional support?
Oral route
Describe the hierarchy of feeding?
How should nutrition be delivered if a patient is unable to eat sufficient calories?
Oral nutritional supplements (ONS)
How should nutrition be delivered if a patient is unable to take sufficient calories orally or dysfunctional swallow?
NG tube feeding
How should nutrition be delivered if stomach inaccessible or outflow obstruction?
Jejunal feeding (jejunostomy)
How should nutrition be delivered if a patient is oesophagus is blocked/dysfunctional?
Gastrostomy feeding (PEG/RIG)
How should nutrition be delivered if jejunum is inaccessible or intestinal failure (IF)?
Parenteral nutrition
Describe the nutritional considerations in intestinal failure?
- Intestinal failure patients often need parenteral nutrition
- SNAP:
- Sepsis: infection must be corrected otherwise feeding will be useless
- Nutrition: once infection corrected, nutrition should be provided
- Anatomy: define anatomy of GIT so surgery can be planned
- Procedure: defnitive surgery once any infection is eradicated
Describe the albumin myth?
- Low albumin is associated with poor surgery outcomes
- However, it does not reflex nutritional state
- Low albumin reflects chronic inflammation, protein loss or hepatic dysfunction
- Should not attempt to correct albumin prior to surgery
Describe intra-operative nutrition?
- Enhanced Recovery After Surgery (ERAS):
- Reduction in nil by mouth times
- Pre-operative carbohydrate loading
- Minimise use of drains and NG tubes
- Rapid reintroduction of feeding post-op
- Early mobilisation
