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Flashcards in Surgery Nutrition Deck (25):
1

Nutritional Challenges with Surgery

Chronically ill
DM
Advanced lung disease
Perioperative
Advanced age

2

How is nutritional status assessed?

H&P
Labs to assess protein status

3

Goals of Nutritional Support

Meet energy requirements for metabolic processes
Tissue repair

4

Malnutrition Consequences of Surgery

Increased susceptibility to infection
Poor wound healing
Increased frequency of decubitus ulcers
Overgrowth of bacteria in GI tract

5

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

6

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

7

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

8

Pre-op & Mild Malnutrition

High protein, high calorie
Parenteral support: bowel rest

9

Post-op Nutrition

High protein, high calorie diet PO
Parenteral nutrition early if on bowel rest

10

Reasons Why a Patient May not be Eating

Nausea
Ileus
Start of an infection
Depression
Cancer: anorexia

11

Surgery & Severe Malnutrition

May benefit to have surgery delayed depending on the situation

12

Types of Nutritional Intervention

Enteral
Parenteral

13

Define Enteral

Nutrition via the GI tract

14

Define Parenteral

Nutrition per IV solution

15

Reasons the Gut May not be Working

Obstruction
Ileus
GI ischemia
Persistent vomiting

16

Benefits of Enteral Feeding

Rapid advancement of PO feedings
Fewer infections
Lower cost
Shorter hospital stays
More physiologic way to provide nutrition

17

Short Term Enteral Nutrition

NG or nasoenteric tubes
Intermittent feedings or continual infusions

18

NG Tube Feedings

High volume
Rapid rate

19

Nasojejunal (NJ) Tube Feedings

Reduce GERD
For: gastroparesis, increased risk of aspiration
More difficult to place

20

Indications for a Percutaneous Endoscopic Gastrostomy (PEG)

Stroke
Parkinson's
Esophageal CA

21

Uses for Percutaneous Jejunostomy Tubes

Early postoperative feedings
Patients at risk for reflux

22

Complications of Tube Feedings

Aspiration
Diarrhea: meds, composition of food, infusion rate, physiological disturbances
Metabolic disturbances: fluid/electrolyte imbalance

23

Symptoms of Dumping Syndrome

Faintness
Palpitations
Diaphoresis
Pallor
Tachycardia
Hypoglycemia

24

Treatment of Dumping Syndrome

Slow rate of feeding or change formula to one with more complex carbs

25

Parenteral Nutrition

Hypertonic solutions
Must be in large central vein: SVC, IVC, RA