Surgery Nutrition

Question 1

Malnutrition Consequences

What on physical exam may suggest malnutrition?

Answer 1

Consequences:

• increased susceptibility to infection
• poor wound healing
• increased frequency of decubitis ulcers
• overgrowth of bacteria in GI

Malnutrition PE:

• BMI
• temporal wasting
• pallor
• xerostosis
• bleeding gums
• dentition
• angular cheilosis (dry cracked lips)
• dentition
• thyromegaly
• extremities: edema, muscle wastin g
• neuro: peripheral neuropathy
• ecchymosis, petechiae, pressure ulcers
• evidence of heart failure.

Question 2

Lab evaluation of Nutrition

Answer 2

Labs:

• protein assessment:
• -serum albumin (less than 2.2g/dL = poor outcomes)
• -serum transferrin (reflects Fe status)
• -serum prealbumin
• CBC
• CMP
• Vitamin levels

Question 3

T/F pts undergoing surgery have better outcomes if they are healthy, eat high protein and caloric diets.

Answer 3

True. if they are not and require surgery then they need parenteral nutrition. may benefit to have delayed surgery to get nutrition if severe malnutrition.

Question 4

What is the difference between enteral and parenteral feedings?

Answer 4

Enteral = nutrition via intestinal route

Parenteral = nurtrition per IV solution

Question 5

Benefits of enteral feeding?

Answer 5

Lead to more rapid of PO feedings

Fewer infections

lower cost

shorter hospital stays

Question 6

Enteral nutrition consists of what?

How is enteral nutrition administered?

Answer 6

Calories, protein, electrolytes, vitamins, minerals, & fluid.

AdministratioN:

• NG or nasoenteric tube (less than 30d)
• nasojejunal tubes (used for those with impaired stomach motility, increased risk of aspiration) (also short term)
• PEG (used for extended period of time)
• percutaneous jejunostomy tubes

Question 7

Complications of Tube feedings

Answer 7

Aspiration

Diarrhea (from meds, composition of feeding, infusion rate)

Metabolic disturbances

Question 8

Dumping Syndrome:

• what is this?
• sx
• tx

Answer 8

What: can follow rapid infusion of feeds via jejunal tubes or rapid gastric bolus feeds.

Sx: faintness, palpitations, diaphoresis, pallor, tachycardia, and hypoglycemia

Tx: slow rate of feeding or change formula to one with more complex carbs

Question 9

Parenteral nutrition:

• infuse through which type of line?
• what type of solution is used?

Answer 9

Infused through a large central vein such as SVC, RA, IVC

Solution: hypertonic