BSND Nutrition Therapy 1 Past Paper PDF - Surgical Conditions, Trauma & Burns

QUIRINO STATE UNIVERSITY College of Health Sciences Bachelor of Science in Nutrition and Dietetics …fostering wellness Name of Student: Year/Section: Week No....

QUIRINO STATE UNIVERSITY College of Health Sciences Bachelor of Science in Nutrition and Dietetics …fostering wellness Name of Student: Year/Section: Week No. Date: ND 103- NUTRITION THERAPY 1 4 Topic No. and Title Topic No. 4. Nutrition Therapy in Surgical Conditions, Trauma and Burns Intended Learning Outcomes At the end of this module, the learner can: 1. Explain the pathophysiology and effects of the disease on patient’s nutritional status and the required dietary management. a. Apply the principles involve in the dietary management of a patient’s disease through: b. Correlating signs and symptoms of the disease with the dietary modification and the principles of rationale involved; c. Recommendation of evidence-based nutrition therapy for the disease conditions. Identify the energy and nutrient requirements of the individual based on the disease condition; 2. Identify the possible consequences of inappropriate diet. 3. Formulate a nutritional care plan to address the needs of individuals with medical conditions 4. Modify diets and plan meals of patient considering family traditions and individual preferences; 5. Analyze and present case problems and case studies to develop clinical practice skills; 6. Relate diagnostic procedures, medication and other forms of treatment to nutrition care. Keywords 1. Surgery 5. cholecystectomy 2. Burns 6. dumping syndrome 3. Ileostomy 7. NPO 4. Jejunostomy 8. Low fat Suggested/Assigned Reading/s Read Chapter 7, Surgical Conditions, NDAP Medical Nutrition Therapy (2015) pages 81-92 Read Krause Food and Nutrition Care Process (2017), pages 781-789 Contents INFORMATION SHEET NO. 4-1 Nutrition Therapy in Surgical Conditions and Trauma Surgery- is the anatomical alteration of an organ to arrest or alleviate a pathological process. Metabolic Changes 1. Cessation of peristalsis 2. Rapid protein catabolism> loss of nitrogen> weight loss 3. Increased glucose in the blood> “traumatic diabetes” 4. Increased utilization of adipose tissues 5. Sodium retention> result of wasting QUIRINO STATE College of Health BSND Developed by: NUTRITION THERAPY I ARLYN J. YRA, RND, MSPH, PhD UNIVERSITY Sciences 0720.02 Page 1 of 14  QUIRINO STATE UNIVERSITY College of Health Sciences Bachelor of Science in Nutrition and Dietetics …fostering wellness 6. Dehydration due to blood loss, water loss, K loss 7. Calcium loss 8. Increased vitamin C utilization, a response to stress 9. Anorexia 10. Anemia due to iron and B12 deficiency Dietary Management for Surgical Conditions PREOPERATIVE Diet Rationale Emergency NPO, for good nutritional status to prevent vomiting Parenteral administration of to prevent shock Whole blood or plasma for poor nutritional status Elective High Kcal for underweight to build up reverses Low Kcal for obese to facilitate safe and faster recovery Protein, high to build and repair tissues High CHO to spare protein Vit. And minerals for supplementation to replace losses For wound healing For energy metabolism POST-OPERATIVE Diet Rationale NPO may take a longer time for major surgeries, to prevent aspiration Progressive to clear to normal diet to adjust to the ability of the patient to digest food Tube feeding or TPN when necessary to meet energy requirements QUIRINO STATE College of Health BSND Developed by: NUTRITION THERAPY I ARLYN J. YRA, RND, MSPH, PhD UNIVERSITY Sciences 0720.02 Page 2 of 14  QUIRINO STATE UNIVERSITY College of Health Sciences Bachelor of Science in Nutrition and Dietetics …fostering wellness SPECIFIC SURGICAL CONDITIONS a) Colostomy is a surgical procedure that creates an opening from the colon through the abdominal wall to the surface of the skin for defecation when the feces cannot pass through the rectum and anus. b) Ileostomy – entire colon is bypassed, and opening is created from the ileum which is attached directly to the anus. QUIRINO STATE College of Health BSND Developed by: NUTRITION THERAPY I ARLYN J. YRA, RND, MSPH, PhD UNIVERSITY Sciences 0720.02 Page 3 of 14  QUIRINO STATE UNIVERSITY College of Health Sciences Bachelor of Science in Nutrition and Dietetics …fostering wellness c) Jejunoileostomy – a short segment of the jejunum is joined to the terminal ileum; effectively 90% of the small bowel d) Tonsillectomy – surgical removal of tonsils QUIRINO STATE College of Health BSND Developed by: NUTRITION THERAPY I ARLYN J. YRA, RND, MSPH, PhD UNIVERSITY Sciences 0720.02 Page 4 of 14  QUIRINO STATE UNIVERSITY College of Health Sciences Bachelor of Science in Nutrition and Dietetics …fostering wellness e) Cholecystectomy – surgical removal of the gallbladder f) Hemorrhoidectomy – surgical removal of hemorrhoids QUIRINO STATE College of Health BSND Developed by: NUTRITION THERAPY I ARLYN J. YRA, RND, MSPH, PhD UNIVERSITY Sciences 0720.02 Page 5 of 14  QUIRINO STATE UNIVERSITY College of Health Sciences Bachelor of Science in Nutrition and Dietetics …fostering wellness Dietary Management Diet Rationale Cold liquid for tooth extraction and tonsillectomy to prevent bleeding Gastrostomy for removal of esophagus to rest organ Low fiber, dry meals, CHO restricted to avoid dumping syndrome High Protein, no simple sugars For gastric surgery Dumping syndrome is the decrease in plasma volume because of increased peristaltic movement. The hypertonic, hyperosmotic food in the jejunum causes rapid emptying time resulting to hypoglycemia, diarrhea, dizziness, and pallor. QUIRINO STATE College of Health BSND Developed by: NUTRITION THERAPY I ARLYN J. YRA, RND, MSPH, PhD UNIVERSITY Sciences 0720.02 Page 6 of 14  QUIRINO STATE UNIVERSITY College of Health Sciences Bachelor of Science in Nutrition and Dietetics …fostering wellness Dietary Management for Intestinal Surgeries Diet Rationale Intestinal Surgeries TPN and tube feeding when to avoid motility, supplies electrolytes necessary Gradual progress from NPO to to adjust to the ability of the body to digest and normal diet absorb food Ileostomy Vitamin B 12 supplementation B12 is absorbed in the ileum Low fiber, low residue, clear to prevent irritation gradual introduction of food Low fat If there is fat malabsorption CHO, increased, low fiber to provide energy requirements, avoiding fermentation Colostomy Low fiber, low residue, clear to prevent irritation gradual introduction of food Low fat there is fat malabsorption Jejunoileostomy Low fiber, low residue, clear to prevent irritation gradual introduction of food Low fat If there is fat malabsorption High protein to prevent fatty liver; to allow fat transport Low CHO prevent fermentation Supplement of vitamin and to replenish losses minerals Hemorrhoidectomy Low fiber, low residue, clear to prevent irritation gradual introduction of food Cholecystectomy Low fat then normal to adjust to the ability to emulsify fat Peritonitis and intestinal obstruction NPO, IVF No peristaltic action; effect of anaesthesia Progressive diets to prevent to the ability to digest and absorb food Low residue to prevent irritation Note: There are certain dietary and growth factors, which promote intestinal adaptation like glutamine (for glucose source), short chain fatty acids (for energy), insulin-like growth factors QUIRINO STATE College of Health BSND Developed by: NUTRITION THERAPY I ARLYN J. YRA, RND, MSPH, PhD UNIVERSITY Sciences 0720.02 Page 7 of 14  QUIRINO STATE UNIVERSITY College of Health Sciences Bachelor of Science in Nutrition and Dietetics …fostering wellness and growth hormone (for increased nutrient uptake and utilization). Nutrient Absorption and Consequences of Intestinal Surgeries About 90 to 95 percent of nutrient absorption takes place in the half of the small intestine. After resection, nutrient absorption may be reduced. Intestinal Part Nutrient Absorbed Possible Consequences of Resection Duodenum/jejunum Simple carbohydrates Minimal consequences if the remains Fats intact Amino acids Calcium and iron malabsorption if Vitamins duodenum Minerals resected Water Ileum Bile salts Fat malabsorption; Protein Vitamin B12 malabsorption Water Carbohydrates malabsorption (assumes absorptive Calcium, magnesium, and phosporus function of duodenum and losses jejunum wit adaptation Fluid and electrolyte losses Diarrhea/steatorrhea Colon Water Fluid and electrolytes losses Electrolytes Diarrhea Short-chain fatty acids (losses are compounded if ileum is also resected) * The absorption of vitamins and minerals begins in the duodenum and continuous throughout the length of the small intestine. INFORMATION SHEET NO. 4-2 Nutrition Therapy in Burns BURNS Burns are injured tissue caused by heat, flame, chemicals, electricity or radiation characterized by decrease of blood volume, plasma loss, edema, damage vessel walls, increased metabolic rate, weight losses, nitrogen and nutrient losses, hyperglycemia. Metabolic Changes 1. Loss of tissue from the burn itself> exposure and loss of extracellular fluids> loss of intracellular fluid> dehydration 2. Losses of protein, salt and fluid take place when large areas of the body have been burned, resulting in electrolyte and fluid imbalances> decreased vascular volume and pressure> QUIRINO STATE College of Health BSND Developed by: NUTRITION THERAPY I ARLYN J. YRA, RND, MSPH, PhD UNIVERSITY Sciences 0720.02 Page 8 of 14  QUIRINO STATE UNIVERSITY College of Health Sciences Bachelor of Science in Nutrition and Dietetics …fostering wellness decreased urinary output 3. Energy expenditure following major burns is increased 50-100% above basal needs 4. Edema at the site of injury during first hours to 2nd day is noticed. 5. Gastric atony 6. Weight loss 7. Increased withdrawal of cell potassium> increased serum K levels Classification 1) First degree – affects epidermis, increased warmth, tenderness and pain 2) Second degree – affects epidermis and muscles 3) Third degree – affects epidermis, muscles and fats Management Medical – pain relievers, anti-infective drugs, for epithelial regeneration Dietary Management Diet Rationale IVF to replace fluid losses Tube feeding when necessary to meet energy requirements when oral intake is impossible Fluid and Na controlled to control water retention Increased fluid and electrolytes To replace losses and to prevent the development of shock High calorie to provide energy reserves High CHO To spare proteins and meet energy needs High Protein to regenerate tissues, building tissues and to replace large losses High vitamins (Vitamin C and B complex)and for energy metabolism, wound healing, tissue minerals regeneration and to supply oxidative enzymes systems to metabolize extra CHO and PRO Iron supplement To correct/prevent anemia QUIRINO STATE College of Health BSND Developed by: NUTRITION THERAPY I ARLYN J. YRA, RND, MSPH, PhD UNIVERSITY Sciences 0720.02 Page 9 of 14  QUIRINO STATE UNIVERSITY College of Health Sciences Bachelor of Science in Nutrition and Dietetics …fostering wellness Dietary Calculation TER for Burn Patients Adults: [25 kcal x Preburn Body Weight (kg)]+ 40 kcal x percent BSA burned] Children: [30 kcal to 100 kcal (RDA for Age) x Preburm Body weight) (kg)+ [40 kcal x percent BSA burned] Computation of Protein Requirements Adults: [lg protein x Preburn body weight (kg)]+ [3g protein x percent BSA burned] Children: [3g protein x Preburn body weight (kg)+ [lg protein x percent BSA burned] For burn wound >10% total body surface area (TBSA), allow 20% TER for protein (non-protein kcal:. nitrogen ratio of 100:1) For burn wound