Surgery Nutrition Flashcards
Nutritional Challenges with Surgery
Chronically ill DM Advanced lung disease Perioperative Advanced age
How is nutritional status assessed?
H&P
Labs to assess protein status
Goals of Nutritional Support
Meet energy requirements for metabolic processes
Tissue repair
Malnutrition Consequences of Surgery
Increased susceptibility to infection
Poor wound healing
Increased frequency of decubitus ulcers
Overgrowth of bacteria in GI tract
Important Nutritional Aspects of History
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
Important Physical Exam Items for Assessing Nutrition
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
Lab Evaluation of Malnutrition
Serum albumin: less than 2.2 g/dL = bad Serum transferrin: reflects iron status Serum prealbumin (transthyretin) CBC CMP Vitamin levels
Pre-op & Mild Malnutrition
High protein, high calorie
Parenteral support: bowel rest
Post-op Nutrition
High protein, high calorie diet PO
Parenteral nutrition early if on bowel rest
Reasons Why a Patient May not be Eating
Nausea Ileus Start of an infection Depression Cancer: anorexia
Surgery & Severe Malnutrition
May benefit to have surgery delayed depending on the situation
Types of Nutritional Intervention
Enteral
Parenteral
Define Enteral
Nutrition via the GI tract
Define Parenteral
Nutrition per IV solution
Reasons the Gut May not be Working
Obstruction
Ileus
GI ischemia
Persistent vomiting
Benefits of Enteral Feeding
Rapid advancement of PO feedings Fewer infections Lower cost Shorter hospital stays More physiologic way to provide nutrition
Short Term Enteral Nutrition
NG or nasoenteric tubes
Intermittent feedings or continual infusions
NG Tube Feedings
High volume
Rapid rate
Nasojejunal (NJ) Tube Feedings
Reduce GERD
For: gastroparesis, increased risk of aspiration
More difficult to place
Indications for a Percutaneous Endoscopic Gastrostomy (PEG)
Stroke
Parkinson’s
Esophageal CA
Uses for Percutaneous Jejunostomy Tubes
Early postoperative feedings
Patients at risk for reflux
Complications of Tube Feedings
Aspiration
Diarrhea: meds, composition of food, infusion rate, physiological disturbances
Metabolic disturbances: fluid/electrolyte imbalance
Symptoms of Dumping Syndrome
Faintness Palpitations Diaphoresis Pallor Tachycardia Hypoglycemia
Treatment of Dumping Syndrome
Slow rate of feeding or change formula to one with more complex carbs
Parenteral Nutrition
Hypertonic solutions
Must be in large central vein: SVC, IVC, RA
