Lecture 3 - Part 2 Flashcards
(48 cards)
What is ERAS?
Enhanced Recovery After Surgery
Multimodal, multidisciplinary approach
Care protocol based on evidence
What are the changes to the ERAS?
◦ Overnight fasting→Solids 6 hrs prior, CHO drinks 2 hrs before surgery
◦ Large incisions→minimally invasive approaches
◦ Large volumes IV fluids→management of fluids to seek balance ◦ Avoidance or early removal tubes/ drains
◦ Early mobilization
◦ Serve food/drink day of surgery
Why did they start questioning ERAS?
Fasting isnt based on science, feeding upuntil surgery is good for their recovery and can shorten length of hospital stay
What does ERAS include?
◦ Pre-operative Nutrition Screening
◦ Antibiotic prophylaxis
◦ Gum chewing to stimulate bowel post surgery
◦ Early feeding & oral supplements 200ml 2-3x/day until normal intake
◦ Continued Nutrition support for pts malnourished at baseline
◦ Opioid sparing
What are the outcomes of ERAS?
- reduced preoperative hunger, thirst, and anxiety
- improved postoperative insulin sensitivity
- shorter LOS
- faster recovery
- earlier return GI function
What are things that enhance surgery?
- People heal faster if they have an optimal nutrition status
- Start people pre surgery for antibiotics
- Chewing gum stimulates to regian function
- Avoid opiods and use othres if possible
What is Enteral Nutrition?
Delivery of nutrients to the GI tract
◦Via tube, catheter, or stoma
◦Also called tube feeding or enteral feeding
If the gut works use it!!!
What is a catheter?
• Catherter tube directly to stomach
What is a stoma?
• Stoma surgical into the intestines
What is GI access?
The type of feeding access is described according to where the tube enters the body and where the tip is located
What are the different kinds of GI access?
◦ Nasogastric
◦ Orogastric
◦ Nasointestinal
What is a gastrostomy?
A tube delivering feedings to the stomach
What is a jejunostomy?
A tube delivering feedings through the abdominal wall to the jejunum
What is a surgical gastrostomy?
When a surgeon performs the procedure
What is PEG?
Percutaneous endoscopic gastrostomy (PEG)
Feeding tubes placed through the skin without a surgical incision with the use of an endoscope
Where shouldn’t you insure a tube into?
Don’t feed past the jejeunum for a tube
What are the feeding delivery methods?
Bolus feedings
Intermittent feedings Continuous feedings Nocturnal feedings
What is a bolus feeding?
• Replicates what we do as normal humans, like regular meals in the day. For people on long term feeds. Feed over a shorter period of time.
What is intermittent feeding?
• Less time between intervals, feeding stopped for a few hours to have a break or get uo and walk around. Inbetween continuous and bolous
What is continuous feeding?
• 24hr feeding and constantly attached to tube
What is nocturnal feeding?
• Fed over night because thye may not be meeeting their needs during the day
What are the enteral nutrition complications?
Tube-related complications (pulls it out)
GI complications (not tolerating rate of feed)
Aspiration
Dehydration
Electrolyte imbalances Overfeeding or underfeeding Hyperglycemia
Refeeding syndrome
What is aspiration?
when fluid is drawn into the lungs. If you have a problem with reflux it can get inhaled into your lungs
What is refeeding syndrome?
When starting nutrution support you want to see if the person is at risk for refeedinig syndrome. See if they havent eaten a lot in a while. Start them small and move up
When start tor efeed, it starts the insulin secretion and causes the body to increase protein and lgycogen synthesis. Increase uptake of K MG and PO4
Body is trying to maintain homeostasis, and when we start to refeed it draws nutrients from the blood into the cells and results in refeeding syndrome
