Perioperative Nutrition Flashcards
Why is nutrition important in surgery?
Malnourished patients make poor surgical candidates
Why do malnourished patients make poor surgical candidates?
Because surgery causes physiological stress with resultant hyper-metabolic state and catabolic response, which is not favoured in the malnourished patient
Why will a proportion of surgical patients have a degree of malnutrition?
Because their underlying disease process reduces their nutritional reserves in the post-operative period
What is the problem with malnourished patients post-operatively?
They are at increased risk of post-operative complications such as reduced wound healing, infection, and skin breakdown
What should be done regarding nutrition in surgery?
Any patient undergoing elective or semi-elective surgery should be assessed for evidence of malnutrition, and where possible this should be corrected, or nutrition supported both pre and post operatively
What should happen to all patients admitted to hospital, regarding nutrition?
They should be screened for malnutrition, and have their nutritional state assessed
How can screening for malnutrition be achieved?
Using the Malnutrition Universal Screening Tool (MUST)
When might MUST score calculation be unnecessary?
In disease-related cachexia
Why might MUST score be unnecessary in disease-related cachexia?
It is usually obvious with bedside observation
What features of disease-related cachexia may be obvious on bedside examination?
- Muscle wasting
- Loose skin
- Patient’s usual clothes no longer fitting
What may following screening for malnutrition?
Nutritional assessment
What does a nutritional assessment require?
Expert input from a Registered Dietitian
What tools are used to assess nutritional state?
- Weight
- BMI
- Grip strength
- Triceps Skin Fold thickness
- Mid Arm circumference
How is BMI calculated?
Weight (kg) / (height (m)2)
What is the normal range for BMI?
18.5-24.9 kg/m2
What features may be found on examination that suggest disease related cachexia?
- Apthous ulcers
- Angular chelitis
- Pressure sores
What might be appropriate if malnutrition is identified?
Nutritional support
Why is nutritional support important in malnourished surgical patients?
It improves surgical outcomes
What decisions need to be made on a case-by-case basis regarding nutritional support?
- When and how to deliver nutritional support
- The timing of subsequent surgery
Who is involved in the development of an appropriate schedule for nutritional support?
It should be done with the assistance and under the direction of a registered dietician
What does the type of nutritional support that can be offered depend on?
Largely on the pathology present
As a general principle, what is the best way to administered nutrional support?
Best to give enteral nutrition via the oral route wherever possible (this applies to pre- and post-operative nutrition