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Flashcards in Surgery Nutrition Deck (25)
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1
Q

Nutritional Challenges with Surgery

A
Chronically ill
DM
Advanced lung disease
Perioperative
Advanced age
2
Q

How is nutritional status assessed?

A

H&P

Labs to assess protein status

3
Q

Goals of Nutritional Support

A

Meet energy requirements for metabolic processes

Tissue repair

4
Q

Malnutrition Consequences of Surgery

A

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

5
Q

Important Nutritional Aspects of History

A
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
Q

Important Physical Exam Items for Assessing Nutrition

A

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
Q

Lab Evaluation of Malnutrition

A
Serum albumin: less than 2.2 g/dL = bad
Serum transferrin: reflects iron status
Serum prealbumin (transthyretin)
CBC
CMP
Vitamin levels
8
Q

Pre-op & Mild Malnutrition

A

High protein, high calorie

Parenteral support: bowel rest

9
Q

Post-op Nutrition

A

High protein, high calorie diet PO

Parenteral nutrition early if on bowel rest

10
Q

Reasons Why a Patient May not be Eating

A
Nausea
Ileus
Start of an infection
Depression
Cancer: anorexia
11
Q

Surgery & Severe Malnutrition

A

May benefit to have surgery delayed depending on the situation

12
Q

Types of Nutritional Intervention

A

Enteral

Parenteral

13
Q

Define Enteral

A

Nutrition via the GI tract

14
Q

Define Parenteral

A

Nutrition per IV solution

15
Q

Reasons the Gut May not be Working

A

Obstruction
Ileus
GI ischemia
Persistent vomiting

16
Q

Benefits of Enteral Feeding

A
Rapid advancement of PO feedings
Fewer infections
Lower cost
Shorter hospital stays
More physiologic way to provide nutrition
17
Q

Short Term Enteral Nutrition

A

NG or nasoenteric tubes

Intermittent feedings or continual infusions

18
Q

NG Tube Feedings

A

High volume

Rapid rate

19
Q

Nasojejunal (NJ) Tube Feedings

A

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

20
Q

Indications for a Percutaneous Endoscopic Gastrostomy (PEG)

A

Stroke
Parkinson’s
Esophageal CA

21
Q

Uses for Percutaneous Jejunostomy Tubes

A

Early postoperative feedings

Patients at risk for reflux

22
Q

Complications of Tube Feedings

A

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

23
Q

Symptoms of Dumping Syndrome

A
Faintness
Palpitations
Diaphoresis
Pallor
Tachycardia
Hypoglycemia
24
Q

Treatment of Dumping Syndrome

A

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

25
Q

Parenteral Nutrition

A

Hypertonic solutions

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