SURGERY NUTRITION Flashcards
nutritional challenge in surgery
⦁ Chronically ill ⦁ Diabetes ⦁ Advanced lung disease ⦁ Perioperative ⦁ Advanced age
assess nutritional status in patients through
⦁ History
⦁ PE
⦁ Labs to assess protein status (albumin)
fundamental goals of nutritional support
= to meet the energy requirements for metabolic processes (Basal metabolic rate) & tissue repair
energy source required for certain conditions
⦁ physical activity = 10-50% > basal metabolism
⦁ hospitalized patient = 10-20% > basal metabolism
⦁ Trauma = 10-30% > basal metabolism
⦁ Sepsis = 50-80% > basal metabolism
⦁ Burns = 100-200% > basal metabolism
which condition requires highest energy source
BURNS
need 100-200% energy above basal metabolism rate
the stress of surgery creates a _________ state
hyper-metabolic state (catabolic)
malnutrition consequences after surgery
- Malnutrition consequences ⦁ increased susceptibility to infection ⦁ poor wound healing ⦁ increased frequency of decubitus ulcers ⦁ overgrowth of bacteria in GI tract
PATIENT ASSESSMENT: HISTORY/ROS
-HISTORY ⦁ chronic medical illnesses ⦁ recent hospitalizations ⦁ past surgeries ⦁ medications
- SOCIAL HISTORY
⦁ socioeconomic status
⦁ use of alcohol, tobacco, other drugs - DIET HISTORY
⦁ supplements
⦁ what type of food the pt eats, when they eat during the day - ROS
⦁ any weight loss or weight gain
⦁ GI symptoms: N/V, diarrhea, constipation
PATIENT ASSESSMENT: PE
- height / weight / BMI
- HEENT: temporal wasting, pallor, xerostosis, bleeding gums, dentition, angular cheilosis, dentition
- Neck: thyromegaly (sign of iodine deficiency)
- Extremities: edema, muscle wasting
- Neurologic: peripheral neuropathy (associated with B12 deficiency)
- Skin: Ecchymosis, petechiae, pressure ulcers, pallor (wound healing / signs of wound infection)
- CV: evidence of heart failure
angular cheilosis can be associated with which deficiencies
vitamin B
iron
labs to assess protein status
serum albumin
serum transferrin
serum prealbumin (transthyretin)
- protein status assessment
⦁ Serum Albumin = most frequently used (< 2.2 = predictor of poor outcome)
⦁ Serum transferrin- usually used to assess iron status, but can indicate protein status; can be a more immediate indicator of protein status than albumin
- low indicator of protein status if normal serum iron***
⦁ Serum prealbumin (transthyretin)
⦁ Others = CBC, CMP, vitamin levels as indicated
serum transferrin
- usually used to assess iron status, but can indicate protein status; can be a more immediate indicator of protein status than albumin
*low indicator of protein status if normal serum iron
PRE-OP PATIENTS
- Generally healthy, well-nourished patients who are going in for scheduled surgeries do not need any pre-op nutrition
- Patients with preexisting conditions such as cancer, particularly GI tract cancer, may need pre-op enteral nutrition IF they are significantly malnourished
- If a pre-op patient is mildly malnourished, they may need early nutritional support
⦁ If not on bowel rest and can take PO = need high protein, high calorie nutrition
⦁ If on bowel rest because of bowel surgery / unable to eat for certain number of days = parenteral support is indicated (IV) - earlier if significantly malnourished
why a patient may not be eating post-op
⦁ still nauseous from anesthetic and/or pain meds ⦁ ileus ⦁ start of an infection ⦁ depression ⦁ anorexic because of cancer
with severe malnutrition = may benefit to
may benefit to have the surgery delayed in order to get either enteral or parenteral nutrition, depending on the situation
