3+SURGERY.pdf

13/09/2024...

13/09/2024 1 NUTRITION THERAPY 1 Document History (ND 7318) Developed by: UNIT 3 ASST. PROF. DIANE MENDOZA-SARMIENTO, RND, MSc. AY 2020-2021 Updated by: MS. JOANNA L. LUSTERIO, RND, MSc. AY 2023-2024 SURGERY AND TRAUMA AY 2024-2025 University of Santo Tomas| 1st Sem AY 2024 -2025 University of Santo Tomas | 2024 2 3 OBJECTIVES KEY CONCEPTS: ADEQUATE NUTRITIONAL SUPPORT IS AN 1 University of Santo Tomas | 2024 Discuss common surgical procedures ESSENTIAL REQUIREMENT IN WOUND HEALING. 2 Discuss the metabolic changes that occurs THE ABILITY OF THE PATIENT TO HEAL/RECOVER IS 3 Discuss the nutritional requirements DEPENDENT ON HIS/HER NUTRITIONAL STATUS. Image from google University of Santo Tomas | 2024 SOURCE/S: 2007 ASPEN CORE CURRICULUM S.R. SHERMAN.NUTRITION AND WOUND HEALING,. JOURNAL OF WOUND CARE VOL.20,NO.8, AUGUST 2011. Ng MFY. Cachexia – an intrinsic factor in wound healing.Int Wound J 2010; 7:107–113 1  13/09/2024 4 5 METABOLIC CHANGES: SURGERY/TRAUMA METABOLIC CHANGES: SURGERY/TRAUMA ▪ METABOLIC STRESS ▪ Changes in adaptive mechanisms Normal Starvation: Metabolic Stress: -decreased energy needs - increased needs - Lipolysis; preservation of - Lean body mass is used of lean body mass for energy - minimal catabolism - increase CHON loss - depletion of glutamine, Antioxidants, micronutrients - Catabolic University of Santo Tomas | 2024 University of Santo Tomas | 2024 What is happening? 6 SURGERY 7 An operative procedure used to diagnose, repair or treat an organ or tissue. Can be classified into: Major or minor Elective or emergency Diagnostic, excision, palliative, reconstructive or transplant University of Santo Tomas | 2024 University of Santo Tomas | 2024 2  13/09/2024 Principles in Surgical Nutrition 8 Clinical Manifestations 9 ▪Surgery causes cellular damage and metabolic responses that increase energy and nutrient needs - Pre operative- fasting 12 hours ▪Immunosuppression increases susceptibility to bacterial and other infectious agent intrusion with their corresponding side - Post operative- nasogastric tube (to remove gastric secretions) effects ▪Wound healing requires increased energy and nutrient needs - General anesthesia- post-op ileus (lack of motility) ▪Malnutrition affects surgical outcome(s) ▪Optimum outcome is dependent on preparation, operative - Resolution of ileus generally occurs 24-48 hours method, and adequate support University of Santo Tomas | 2024 University of Santo Tomas | 2024 10 SPECIFIC SURGICAL CONDITIONS 11 PREOPERATIVE Dietary Management Diet Rationale EMERGENCY Jejunoileostomy ▪ NPO, for good nutritional status To prevent vomiting ▪ ▪ A short segment of the jejunum is ▪ Parenteral administration of whole blood plasma, ▪ To prevent shock joined to the terminal ileum; for poor nut’l status effectively 90% of the small bowel Tonsilectomy ELECTIVE ▪ to build up reserves ▪ Surgical removal of tonsils ▪ High Kcal for underweight ▪ to facilitate fast/safe recovery ▪ Low Kcal for obese ▪ To build repair tissues Hemmorrhoidectomy ▪ Protein, high ▪ To spare protein ▪ Surgical removal of hemmorrhoids ▪ High CHO ▪ To replace losses ▪ Vit. & Minerals for supplementation ▪ For wound healing ▪ for energy metabolism University of Santo Tomas | 2024 University of Santo Tomas | 2024 3  13/09/2024 12 13 POSTOPERATIVE Goals POSTOPERATIVE Dietary Management Diet Rationale ▪ Specific goals are dependent on the type of surgery ▪ NPO ⮚may take longer time for surgeries, to prevent aspiration ▪ Maintenance of fluid and electrolyte balance ▪ Progress from clear to normal diet ⮚Toadjust the ability of the patient to digest food ▪ Adequate total nutrient intake for resumption of normal bodily activities ▪ Tube feeding or TPN when necessary ⮚To meet energy requirement University of Santo Tomas | 2024 University of Santo Tomas | 2024 14 15 POSTOPERATIVE Dietary Management POSTOPERATIVE Dietary Management Diet Rationale Diet Rationale INTESTINAL SURGERIES ▪ Cold liquid for tooth extraction & tonsillectomy ⮚to prevent bleeding ▪ TPN, tubefeeding when necessary ⮚To avoid motility, supplies electrolytes ▪ Gastrostomy for removal of esophagus ⮚To rest the organ ▪ Gradual progress from NPO to normal diet ⮚Toadjust to the ability of the body to digest Low fiber, dry meals, CHO restricted and absorb food ILEOSTOMY ▪ High protein, no simple sugars ⮚To avoid dumping syndrome ▪ Vit. B12 supplementation ⮚B12 is absorbed in the ileum *for gastric surgery * Dumping syndrome is the decrease in ▪ Low fiber, low residue, clear ⮚ to prevent irritation, gradual introduction of plasma volume because of increased food peristaltic movement. Hypertonic food in ▪ Low fat ⮚There is fat malabsorption the jejunum causes rapid emptying time ▪ CHO increased low fiber ⮚ to provide energy reqts. Avoiding fermentation resulting to hypoglycemia, diarrhea, dizziness and pallor University of Santo Tomas | 2024 University of Santo Tomas | 2024 4  13/09/2024 16 17 POSTOPERATIVE Dietary Management POSTOPERATIVE Dietary Management Diet Rationale COLOSTOMY ▪ Low fiber, low residue, clear ⮚to prevent irritation gradual introduction of food Diet Rationale ▪ Low fat ⮚There is fat malabsorption HEMMORHOIDECTOMY ▪ Low fiber, low residue, clear ⮚to prevent irritation gradual introduction of food JEJUNOILEOSTOMY ▪ Low fiber, low residue, clear ⮚to prevent irritation gradual introduction of food CHOLECYSTECTOMY ▪ Low fat ⮚There is fat malabsorption ▪ Low fat ⮚ to adjust to the ability to emulsify fat ⮚To prevent fatty liver, to allow fat transport ▪ High Protein ⮚Wound healing ▪ Low CHO ⮚Prevent fermentation ▪ Supplement vitamins minerals ⮚ to replenish losses University of Santo Tomas | 2024 University of Santo Tomas | 2024 18 ANTHROPOMETRIC ASSESSMENT 19 LOSS OF LEAN LOSS OF LEAN BODY MASS BODY MASS = = MORTALITY MORTALITY University of Santo Tomas | 2024 University of Santo Tomas | 2024 5  13/09/2024 ANTHROPOMETRICASSESSMENT 20 21 EFFECT OF MALNUTRITION ▪ WOUND HEALING IS DELAYED (STARVATION-BEFORE) ▪ DELAYED NEOVASCULARIZATION AND DECREASED COLLAGEN SYNTHESIS ▪ PROLONGED PHASE INFLAMMATION ▪ DECREASED PHAGOCYTOSIS ▪ DYSFUNCTION OF B AND T CELLS ▪ DECREASED MECHANICAL STRENGTH Weight loss is associated with SURGICAL COMPLICATIONS, LOS. OF THE SKIN University of Santo Tomas | 2024 University of Santo Tomas | 2024 22 23 RISK OF MALNUTRITION INCREASED METABOLIC RATE EARLY IDENTIFICATION OF LOSS OF BODY WATER INCREASED CATHECHOLAMINE LEVELS CELLULAR PROTEIN TURNOVER MALNUTRITION CATABOLIC STATE IS CRITICAL!!! University of Santo Tomas | 2024 University of Santo Tomas | 2024 6  13/09/2024 24 25 Anthropometric Assessment Biochemical Assessment ▪ % Weight loss Albumin (correlate with Pre-albumin (correlate with Transferrin (more sensitive degree of malnutrition and degree of malnutrition and than albumin; 8-10 days half ▪ 5% in 1 month; 7.5% in 3 months; 10% in 6 months inc. risk for morbidity and inc. risk for morbidity and life) mortality, reflects chronic mortality, reflects chronic 150-200 mg/dL: mild protein depletion): protein depletion) ▪ % Usual wt, depletion ▪ 3.0-3.4g/dL: mild 10-15 mg/dL: mild ▪ 100-149 mg/dL: depletion depletion moderate ▪