preop nutrition

Question 1

when should you refer to pre-op nutrition clinic? (4)

Answer 1

1. BMI under 18.5 (or 20 if over 65)
2. unplanned wt loss over 10% in past 6 mo
3. eating under 50% of normal diet in preceding week
4. +/- albumin under 3.o

this is PONS Score

Question 2

benefits of immunonutrition (1)

Answer 2

• reduces LOS, infection and abx use

Question 3

who gets immunonutrition?

Answer 3

all getting major elective surgery regardless of nutrition status

Question 4

what can you recommend for pts w severe malnutrition?

Answer 4

ESPEN/ASPEN- delay of surger for preop nutrition 1-2wks

Question 5

Indications: functioning GI, mechanical ventilation, can’t eat/maintain wt
C/I: ileus, major GI bleed, hemodynamically unstable, high pressor needs

Answer 5

enteral feeding/tube feeding

Question 6

long term vs short term tubes: placed surgically, endoscopic, fluoroscopi and radiologic; C/I: ascites, peritonitis

Answer 6

• LONG TERM- enterostomy

Question 7

Post pyloric placement vs gastric: less aspiration, continuous/cycle feeds

Answer 7

post pyloric

Question 8

Post pyloric placement vs gastric: bolus feeds, intermittent-gravity feeds

Answer 8

gastric

Question 9

What is this? how is it treated? (3)

• metabolic alterations that happen in nutrition repletion of malnourished
• low Mg, K, Phosphate, thamin
• sodium retention/fluid overload

Answer 9

refeeding syndrome
- correct electrolytes before starting feeds
- go slow and monitor lags
- thiamine 100mg x 5-7 days IV/PO

Question 10

• surgery that removes bad part of esophagus & stomach is attached to rest
• get J tube at surgery; leak study
• HOB over 30 all times, small aound of liquids with meals

Answer 10

esophagectomy

Question 11

• removes pancreas head, duodenum, gallbladder and the bile duct
• can cause delayed gastric emptying, diarrhea, fat malabsorption

Answer 11

whipple/pancreaticoduodenectomy

Question 12

deficiencies of what 4 nutrients are seen with gastric bypass?

Answer 12

iron
B12
calcium
Vit D

Question 13

2 ways to manage chyle leaks

Answer 13

• restrict enteral fat intake– slows leak
• adequate protein to account for loss

Question 14

how is essential fatty acid deficiency diagnosed? how is it treated?

Answer 14

triene to tetraene ratio of over 0.4 &/or physical signs
IV fat may be required, does not increase output

Question 15

why do a low fiber diet afer ostomy surgery?

Answer 15

gas from it can be mistaken for surgical pain

Question 16

what defines high ileostomy output? this is a sign of what?

Answer 16

over 1.2L output daily
sign of dehydration

Question 17

3 signs of dehydration

Answer 17

over 1.2L ostomy output
under 700ml urine output
weight loss over 2.2 in one week

Question 18

medication to minimize gastric secretion

Answer 18

Protonix BID (prantoprazole– a PPI)

Question 19

why do we typically start with Imodium for non-cdiff diarrhea

Answer 19

its OTC and does not have atropine