Nutrition of the Medical Surgical Patient Todays Content

Nutrition of the Medical. Surgical Patient

Today’s Content • Nutrition Therapy in the acute health-care setting – For medical patients – For surgical patients

MEDICAL NUTRITION THERAPY IN A HEALTH CARE SETTING • Provided to: – Aid in recovery – To stabilize the health condition – ↑ nutritional status – Prepare for surgery • ↓ surgical risk • Help with healing

Involves: • Physical assessment • Nutritional assessment – Usually done 24 -72 hours after admission • Labs – Albumin – Na, K – Ca – Hbg, Hct

Special Diets • • For patients with certain diseases To prepare for special test For surgery To increase or decrease weight

Diets are modified: • • • Texture Calories Specific nutrients Seasonings Consistency

Common diets seen in acute care setting: • • NPO (nothing by mouth) Clear liquid Full liquid Soft Diet as tolerated Regular diet Other diets

NPO • Nothing by mouth – Before anethesia or after surgery until bowel sounds return • Most patients ok with NPO for several days • Some patients may require nutrition and fluids per IV

Clear Liquid • Next step after NPO • How do we know when a patient is ready for this next step? – – Bowel sounds Passing flatus

Clear Liquid • Supplies patient with: – Fluid – CHO (as sugar) – 600 kcal/day • Short term; about 24 -36 hours

Clear Liquid • Major goals of this diet: – relieve thirst – prevent dehydration – minimize stimulation of GI tract

Clear Liquid • Includes: – Water – Tea – Coffee – Clear broths – Carbonated beverages – Strained and clear juices – Plain gelatin

Full liquid diet • Next step after clear liquids • Liquids or foods that turn to liquid at body temperatur • For patients with: – GI problems – Unable to tolerate solid or semisolid foods – Post-surgery

Full liquid diet • Low in: – Iron – Protein – Calories • High in – Cholesterol

Full liquid diet includes: • Clear liquids plus: – Milk and milk drinks – Puddings, custards – Ice cream, sherbet, yogurt – Vegetable juices – Strained cereals – Cream, butter, margarine

Soft diet (soft mechanical diet) • Easily chewed and digested • For patients who have difficulty chewing and swallowing (ex: _______) • Also for some patients after surgery – from clear to full liquid to soft diet • Low-residue (fiber) diet containing very few uncooked foods • Can be modified Pureed diet

Diet as Tolerated •

Regular • • For patients with no special needs A balanced diet about 2000 kcals “light” diet – for postoperative patients not quite ready for regular diet

Diets Modified for Disease • Diabetes (ADA) • Heart disease (prudent diet, low sodium) • GI alterations (bland diets)

Prudent diet (low cholesterol and sodium) • To lower the LDL cholesterol levels and sodium intake • For heart disease, atherosclerosis, hyperlipidemia

Which is prudent?

Sodium-restricted diet • No added salt – 4 -5 grams per day allowed • Mild sodium restriction – 2 -3 gms/day • Moderate sodium restriction – 1 gm/day • Severe sodium restriction – 500 mg/day

• High sodium foods include: – pickles, olives – salted nuts – soy sauce – hot dogs, bacon, sausage – processed cheese

– canned soups – potato chips – canned fish and meats – luncheon meats, ham – mustard and ketchup

Low sodium foods

High Fiber diet • Includes: – whole-wheat breads and cereals – Bran – Oatmeal – fresh fruits and vegetables with skins – and more!

NUTRITIONAL NEEDS OF SURGICAL PATIENT • Needs vary based on: – Patient’s disease process – Other chronic illnesses – Baseline nutritional status

Immediate Preoperative Period • NPO 8 – 12 hours before surgery – Ensures empty stomach to prevent: • Vomiting • Aspiration – Can impair patient’s ability to respond to metabolic stress of surgery

Postoperative Nutrition • Goal: – Maintain current lean body mass • Several factors to consider: – Surgical procedure – Expected time to resume oral intake – Complications of surgery – Preop nutritional status

Energy & Protein Requirements • Most common nutritional deficiency after surgery is protein

Energy & Protein Requirements • Protein: – Required to build new and maintain existing body tissue – Wound healing – Control edema – Bone healing – Resistance to infection

Water • Another essential nutrient after surgery • Daily water requirements for surgical patients: – Uncomplicated = 2000 -3000 cc/24 hours – Complicated = 3000 -4000 cc/24 hours – Seriously ill with drainage = up to 7000 or more cc/24 hours

Energy Needs • 2800 kcals/day needed before protein can be used in the body to repair tissue

Vitamins • Vitamin C • B- vitamins – Provide coenzyme function • Vitamin K

Minerals • Potassium lost with tissue breakdown • Other electrolyte losses – Na and Cl • Blood loss iron loss – H/H

How does a surgical patient have nutritional needs met? • • IV infusing? Eats as soon as possible? Is this enough? What if a patient has an NG tube for 3 -5 days? How will that person’s nutritional needs be met?

What do IV fluids provide? • Simple IV fluids used routinely after surgery: – Provide: water, dextrose, electrolytes – Do not provide many calories or fat – Do not provide protein

If NPO for 5 days or more …. • TPN (Total Parenteral Nutrition) is usually started – Higher amount of dextrose – Amino acids – Vitamins, minerals – Lipids (fat emulsions) can be infused with TPN

Routine Postoperative Diets • Begun after adequate bowel function returns: – Flatus – Bowel sounds present • Begins with clear liquids • Advanced to full liquids • Soft/regular

Specialized Nutrition Support • Used if oral diet is not tolerated • Includes: – Tube feeding (enteral) – Parenteral nutrition • • Bowel obstructions Unable to tolerate tube feedings Ileus Major upper GI bleed

Institutional Meal Concerns & Considerations • Mealtime is often major event of the day. – Make food attractive – Have patient brush teeth or rinse out mouth – Comfortable room temperature – Comfortable lighting – Get rid of odors