Surgery Nutrition

Question 1

Nutritional Challenges with Surgery

Answer 1

Chronically ill
DM
Advanced lung disease
Perioperative
Advanced age

Question 2

How is nutritional status assessed?

Answer 2

H&P

Labs to assess protein status

Question 3

Goals of Nutritional Support

Answer 3

Meet energy requirements for metabolic processes

Tissue repair

Question 4

Malnutrition Consequences of Surgery

Answer 4

Increased susceptibility to infection
Poor wound healing
Increased frequency of decubitus ulcers
Overgrowth of bacteria in GI tract

Question 5

Important Nutritional Aspects of History

Answer 5

Chronic medical illnesses
Recent hospitalizations
Past surgeries
Medications
SES
Use of alcohol, tobacco, other drugs
Supplements
Foods they eat
Weight loss or gain
GI: N/V, diarrhea, constipation

Question 6

Important Physical Exam Items for Assessing Nutrition

Answer 6

Height & weight (BMI)
HEENT: temporal wasting, pallor, xerostosis, bleeding gums, dentition, angular cheilosis, dentition
Neck: thyromegaly
Extremities: edema, muscle wasting
Neuro: peripheral neuropathy
Skin: ecchymosis, petechiae, pressure ulcers, pallor
CV: evidence of HF

Question 7

Lab Evaluation of Malnutrition

Answer 7

Serum albumin: less than 2.2 g/dL = bad
Serum transferrin: reflects iron status
Serum prealbumin (transthyretin)
CBC
CMP
Vitamin levels

Question 8

Pre-op & Mild Malnutrition

Answer 8

High protein, high calorie

Parenteral support: bowel rest

Question 9

Post-op Nutrition

Answer 9

High protein, high calorie diet PO

Parenteral nutrition early if on bowel rest

Question 10

Reasons Why a Patient May not be Eating

Answer 10

Nausea
Ileus
Start of an infection
Depression
Cancer: anorexia

Question 11

Surgery & Severe Malnutrition

Answer 11

May benefit to have surgery delayed depending on the situation

Question 12

Types of Nutritional Intervention

Answer 12

Enteral

Parenteral

Question 13

Define Enteral

Answer 13

Nutrition via the GI tract

Question 14

Define Parenteral

Answer 14

Nutrition per IV solution

Question 15

Reasons the Gut May not be Working

Answer 15

Obstruction
Ileus
GI ischemia
Persistent vomiting

Question 16

Benefits of Enteral Feeding

Answer 16

Rapid advancement of PO feedings
Fewer infections
Lower cost
Shorter hospital stays
More physiologic way to provide nutrition

Question 17

Short Term Enteral Nutrition

Answer 17

NG or nasoenteric tubes

Intermittent feedings or continual infusions

Question 18

NG Tube Feedings

Answer 18

High volume

Rapid rate

Question 19

Nasojejunal (NJ) Tube Feedings

Answer 19

Reduce GERD
For: gastroparesis, increased risk of aspiration
More difficult to place

Question 20

Indications for a Percutaneous Endoscopic Gastrostomy (PEG)

Answer 20

Stroke
Parkinson’s
Esophageal CA

Question 21

Uses for Percutaneous Jejunostomy Tubes

Answer 21

Early postoperative feedings

Patients at risk for reflux

Question 22

Complications of Tube Feedings

Answer 22

Aspiration
Diarrhea: meds, composition of food, infusion rate, physiological disturbances
Metabolic disturbances: fluid/electrolyte imbalance

Question 23

Symptoms of Dumping Syndrome

Answer 23

Faintness
Palpitations
Diaphoresis
Pallor
Tachycardia
Hypoglycemia

Question 24

Treatment of Dumping Syndrome

Answer 24

Slow rate of feeding or change formula to one with more complex carbs

Question 25

Parenteral Nutrition

Answer 25

Hypertonic solutions

Must be in large central vein: SVC, IVC, RA