Surgery Nutrition Flashcards
1
Q
What are nutritional challenges in surgery?
A
- chronically ill
- diabetes
- advanced lung disease
- perioperative
- advanced age
2
Q
How is nutritional status assessed b/f surgery?
A
- hx
- physical
- labs to assess protein status
3
Q
What are the fundamental goals of nutritional support?
A
- meet energy requirements for metabolic processes: basic metabolic rate
- tissue repair
4
Q
Amt of energy needed during diff circumstances?
A
- during physical activity: 10-50% above basal metabolism
- hosp pt: 10-20% above
- trauma: 10-30% above
- sepsis: 50-80% above
- burns: 100-200% above
- stress of surgery creates hypermetabolic (catabolic state)
5
Q
Malnutrition consequences?
A
- increased susceptibility to infection
- poor wound healing
- increased frequency of decubitus ulcers
- overgrowth of bacteria in GI tract
6
Q
Nutritional assessment components?
A
- Hx: chronic medial illnesses recent hosp. past surgeries meds - Social hx: socioeconomic status use of alcohol, tobacco, other drugs - diet hx: supplements square meals - ROS: wt loss or gain GI sx: N/V, diarrhea, constipation - Physical exam: ht and wt: 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 (wound healing/signs of wound infection) CV: evidence of heart failure
7
Q
Lab eval b/f surgery if concerned about nutritional status?
A
protein status assessment:
- serum albumin (most frequently used) - less than 2.2g/dL predictor of poor outcome
- serum transferrin (over past 2-4 wks) - also reflects iron status, low indicator of protein status if normal serum iron
- serum prealbumin (transthyretin)
- others: CBC, CMP, vitamin levels as indicated (B12)
8
Q
What pts need preop nutrition?
A
- generally healthy, well nourished pts who are going in for scheduled surgeries don’t need any preop nutrition
- those w/ preexisting conditions such as cancer, particularly GI tract cancer may need preop enteral nutrition IF they are significantly malnourished
- if a pre-op pt is mildly malnourished he/she may need early nutritional support:
if not on bowel rest and can take PO diet: make sure high protein, high calorie
if on bowel rest b/c of bowel surgery/unable to eat for so many days then parenteral support is indicated - earlier if significantly malnourished
9
Q
Postop nutrition for pt?
A
- if able to use gut by day 2-3 again high protein, high calorie diet orally if malnourished
- if unable to use gut b/c of bowel surgery need parenteral nutrition early if still not going to be eating for prolonged period
10
Q
Why may a pt not be eating postop?
A
- still nauseated from the anesthetic and/or pain meds
- ileus
- start of an infection
- depression
- anorexic b/c of cancer
- Nutrition consult
11
Q
if a pt has severe malnutrition should the surgery go on?
A
- it depends on the situation, may benefit to have surgery delayed to get either enteral or parenteral nutrition depending on situation
12
Q
Mortality rate and low albumin correlation?
A
- study done of 2006 hosp veterans found a linear correlation b/t plasma albumin concentration and short term mortality
- 30 day mortality rate of 62% was seen among pts whose plasma albumin fell below 2.0 g/dL
- at BMI below 15th percentile on admission was assoc w/ 23% increase in 6 month mortality
13
Q
When is enteral feeding CI?
A
- when the gut isn't working: obstruction ileus GI ischemia bilious or persistent vomiting - need to intervene via parenteral (IV)
14
Q
What is enteral intervention? Diff types?
A
nutrition via intestinal route orally or via feeding tube
- calories, protein, lytes, vitamins, minerals and fluids either orall or via a feeding tube
- wide variety of supplements
- NG tubes - MC, high feeding rates, simple to insert, short term usually
- NJ tubes - short term, reduce GERD, impaired stomach motility, increased risk of aspiration: frequent in post op, more difficult than NG
- PEG tubes (percutaneous endoscopic gastrostomy): extended period of time, indications: parkinsons, esophageal cancer, inserted through stomach wall endoscopically or surgically
- percutaneous jejunostomy tubes: early postop feedings, useful in pts at risk for reflux, difficult and more complications
15
Q
Benefits of enteral feedings compared to parenteral?
A
- lead to more rapid advancement of PO feedings
- fewer infections
- lower costs
- shorter hosp stays
- more physiologic way to provide nutrition
