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Williams' Basic Nutrition & Diet Therapy Chapter 22 Surgery and Nutrition Support Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights.

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Presentation on theme: "Williams' Basic Nutrition & Diet Therapy Chapter 22 Surgery and Nutrition Support Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights."— Presentation transcript:

1 Williams' Basic Nutrition & Diet Therapy Chapter 22 Surgery and Nutrition Support Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved th Edition

2 Lesson 22.1: Nutrition Support and Methods of Feeding Surgical treatment requires added nutrition support for tissue healing and rapid recovery. To ensure optimal nutrition for surgery patients, diet management may involve enteral and/or parenteral nutrition support. 2 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

3 Introduction (p. 447) Clinical signs of malnutrition in: 38.7% of hospitalized elderly patients 50.5% of elderly patients in rehabilitation facilities Effective nutrition should: Reverse malnutrition Improve prognosis Speed recovery 3 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

4 Nutrition Needs of General Surgery Patients (p. 447) Nutrition needs are greatly increased in patients undergoing surgery Deficiencies easily develop Pay careful attention to: Nutritional status before surgery Individual nutrition needs after surgery 4 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

5 Poor Nutritional Status (p. 447) Has been associated with: Impaired wound healing Increased risk of postoperative infection Reduced quality of life, increased mortality rate Impaired function of gastrointestinal tract, cardiovascular system, respiratory system Increased hospital stay, cost 5 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

6 Preoperative Nutrition Care: Nutrient Reserves (p. 448) Nutrient reserves can be built up before elective surgery to fortify a patient Protein deficiencies are common Sufficient kilocalories are required Extra carbohydrates maintain glycogen stores Vitamin and mineral deficiencies should be corrected Water balance should be assessed 6 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

7 Immediate Preoperative Period (p. 449) Patients are typically directed not to take anything orally for at least 8 hours before surgery Before gastrointestinal surgery, a nonresidue diet may be prescribed Nonresidue elemental formulas provide complete diet in liquid form 7 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

8 Emergency Surgery (p. 449) No time for building up ideal nutrient reserves Reason for maintaining good nutrition status at all times 8 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

9 Postoperative Nutrition Care: Nutrient Needs for Healing (p. 449) Postoperative nutrient losses are great but food intake is diminished Protein losses occur during surgery from tissue breakdown and blood loss Catabolism usually occurs after surgery (tissue breakdown and loss exceed tissue buildup) 9 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

10 Need for Increased Protein (p. 450) Building tissue for wound healing Controlling edema Controlling shock by maintaining blood volume Healing bone: protein is essential Resisting infection: protein tissues are major components of immune system Transporting lipids: fat is important component of tissue structure 10 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

11 Water (p. 451) To prevent dehydration Elderly require special attention Large water losses possible from various routes IV fluids Oral fluids as soon as possible 11 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

12 Energy (p. 451) Provide sufficient nonprotein kilocalories for energy to spare protein for tissue building Mifflin–St. Jeor equations: Male: BMR = (10 × Weight in kg) + (6.25 × Height in cm) – (5 × Age in yr) + 5 Female: BMR = (10 × Weight in kg) + (6.25 × Height in cm) – (5 × Age in yr) – 161 Energy needs increased for extensive surgery or burn patients 12 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

13 Vitamins (p. 451) Vitamin C to build connective tissue B vitamins to metabolize protein and energy B-complex vitamins to build hemoglobin Vitamin K to promote blood clotting 13 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

14 Minerals (p. 451) Potassium Phosphorus Sodium, chloride Iron Zinc 14 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

15 General Dietary Management (p. 452) Routine IV fluids supply hydration and electrolytes, but not energy and nutrients Methods of feeding Oral Enteral: Nourishment through regular gastrointestinal route, either by regular oral feedings or by tube feedings Parenteral: Nourishment through small peripheral veins or large central vein 15 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

16 Methods of Feeding: Oral (p. 452) Allows more needed nutrients to be added Stimulates normal action of the gastrointestinal tract Early feedings associated with reduced complications Progresses from clear to full liquids, then to a soft or regular diet Routine house diet Assisted oral feeding: try to avoid making patient feel inadequate 16 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

17 Methods of Feeding: Enteral (p. 454) Used when oral feeding cannot be tolerated Nasogastric tube is most common route Nasoduodenal or nasojejunal tube more appropriate for patients at risk for aspiration, reflux, or continuous vomiting 17 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

18 Methods of Feeding (p. 456) 18 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

19 Alternative Routes (p. 455) Esophagostomy Percutaneous endoscopic gastrostomy Percutaneous endoscopic jejunostomy 19 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

20 Alternative Route Formulas (p. 456) Generally prescribed by the physician Important to regulate amount and rate of administration Wide variety of commercial formulas available Rate: bolus or continuous Monitoring for complications: diarrhea is most common complication 20 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

21 Parenteral Feedings (p. 458) Definition: any method other than the normal GI route Peripheral parenteral nutrition: less than 5 to 7 days Total parenteral nutrition: for large nutrient needs or longer periods Must be discussed with patient and/or family first 21 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

22 Case Study Mrs. White is a 76-year-old female who recently had a stroke. She has a functioning GI tract. The physician has recommended a PEG tube be placed for long-term feeding. Mrs. White will soon be transferred to a long-term care facility. 22 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

23 Case Study (contd) Evaluate appropriateness of recommended feeding route. What evaluation criteria should be considered or what additional questions should be asked? 23 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

24 Case Study (contd) Is parenteral nutrition more appropriate for Mrs. White? Why or why not? 24 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

25 Peripheral Parenteral Feeding (p. 459) 25 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

26 Total Parenteral Nutrition (p. 460) 26 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

27 Total Parenteral Nutrition (contd) (p. 460) 27 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

28 Total Parenteral Nutrition (contd) (p. 460) 28 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

29 Lesson 22.2: Nutrition Support Related to GI Surgery Nutrition problems related to GI surgery require diet modifications because of the surgerys effect on normal food passage. 29 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

30 Special Nutrition Needs after Gastrointestinal Surgery (p. 460) Gastrointestinal surgery requires special nutrition attention Nutrition therapy varies depending on the surgery site 30 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

31 Mouth, Throat, and Neck Surgery (p. 462) Requires modification in the mode of eating Patients cannot chew or swallow normally Oral liquid feedings ensure adequate nutrition Mechanical soft diet may be optimal Enteral feedings required for radical neck or facial surgery 31 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

32 Gastric Surgery (p. 462) Because the stomach is the first major food reservoir in the gastrointestinal tract, stomach surgery poses special problems in maintaining adequate nutrition Problems may develop immediately after surgery or after regular diet resumes 32 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

33 Gastrectomy (p. 462) Increased gastric fullness and distention may result if gastric resection involved a vagotomy (cutting of the vagus nerve) Weight loss is common Patient may be fed by jejunostomy Frequent small, simple oral feedings are resumed according to patients tolerance 33 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

34 Dumping Syndrome (p. 462) Common complication of extensive gastric resection in which readily soluble carbohydrates rapidly dump into small intestine Symptoms include: Cramping, full feeling Rapid pulse Wave of weakness, cold sweating, dizziness Nausea, vomiting, diarrhea Occurs 30 to 60 minutes after meal Results in patient eating less food 34 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

35 Case Study Mary Ann has undergone bariatric surgery for extreme obesity. She is 35 years of age. Her surgery went well. 35 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

36 Case Study (contd) Name two factors that can reduce nutrient availability. 36 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

37 Case Study (contd) Outline the progression of Mary Anns nutrition plan postsurgery. 37 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

38 Bariatric Surgery (p. 463) Typical deficiencies in several micronutrients Progress from clear liquid to regular diet over about 6 weeks Thereafter limited to about 1 cup of food Subject to dumping syndrome 38 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

39 Gallbladder Surgery (p. 463) Cholecystectomy is removal of the gallbladder Surgery is minimally invasive Some moderation in dietary fat is usually indicated after surgery Depending on individual tolerance and response, a relatively low-fat diet may be needed over a period of time 39 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

40 Gallbladder Surgery (contd) (p. 465) 40 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

41 Intestinal Surgery (p. 464) Intestinal resections are required in cases involving tumors, lesions, or obstructions When most of the small intestine is removed, total parenteral nutrition is used with small allowance of oral feeding Stoma may be created for elimination of fecal waste (ileostomy, colostomy) 41 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

42 Intestinal Surgery (contd) (p. 466) 42 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

43 Intestinal Surgery (contd) (p. 466) 43 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

44 Rectal Surgery (p. 466) Clear fluid or nonresidue diet may be indicated after surgery to reduce painful elimination and allow healing. Return to a regular diet is usually rapid. 44 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

45 Special Nutrition Needs for Patients with Burns (p. 466) Tremendous nutritional challenge Plan of care influenced by: Age Health condition Burn severity Plan constantly adjusted Critical attention paid to amino acid needs 45 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

46 Special Nutrition Needs for Patients with Burns (contd) (p. 466) 46 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

47 Stages of Nutrition Care of Burn Patients (p. 466) Burn shock or ebb phase Massive edema at burn site Loss of heat, water, electrolytes, protein Immediate IV fluid therapy with salt solution or lactated Ringers solution After 12 hours, albumin solutions or plasma MNT not a priority at this time 47 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

48 Stages of Nutrition Care of Burn Patients (p. 467) Acute or flow phase Sudden diuresis indicates initial therapy success Constant attention to fluid intake and output Around the end of first week, bowel function returns and rigorous MNT begins 48 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

49 Medical Nutrition Therapy (p. 467) High protein intake High energy intake Caloric needs based on total BSA burned Liberal portion of kilocalories from carbohydrates Avoid overfeeding High vitamin and mineral intake 49 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

50 Stages of Nutrition Care of Burn Patients (p. 468) Dietary management Careful intake record Oral feedings preferred Enteral or parenteral route may be used if oral intake deficient Follow-up reconstruction Nutrition support for skin grafting, reconstructive surgery Personal support to rebuild will and spirit 50 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

51 Williams' Basic Nutrition & Diet Therapy Chapter 14 Food Habits and Cultural Patterns Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved th Edition

52 Lesson 14.1: Social, Cultural, and Economic Patterns and Food Habits Personal food habits develop as part of a persons social and cultural heritage as well as individual lifestyle and environment. Social and economic change often results in alterations in food patterns. American eating patterns are influenced by many different cultures. 52 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

53 Social, Psychological, and Economic Influences on Food Habits (p. 264) Social structure Groups may be formed by economic status, education, residence, occupation, family Group affiliation influences food attitudes and choices Food and social factors Food symbolizes acceptance and warmth in social relationships Certain foods trigger childhood memories 53 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

54 Psychologic Influences (p. 265) Diet patterns Food has many personal meanings Many psychologic factors rooted in childhood Food and psychosocial development Food relates closely to psychosocial development Toddlers may become picky eaters to control parents Food neophobia (fear of unfamiliar foods) is normal developmental factor 54 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

55 Marketing and Environmental Influences (p. 265) Media Peers Convenience items Grocery stores Cartoon characters 55 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

56 Family Income (p. 265) Low-income families suffer extreme need Illness, hunger, and malnutrition are more common in this group About 14.3% of Americans live below poverty level 56 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

57 Cultural Development of Food Habits (p. 265) Food habits grow from many influences Personal Cultural Social Economic Psychological 57 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

58 Cultural Development of Food Habits (contd) (p. 266) Food habits are learned through everyday living and family relationships Food habits are primarily based on food availability, economics, personal food beliefs Cultural background and customs largely determine what is eaten Foods may take on symbolic meaning 58 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

59 Case Study List three ways your own culture has helped share your personal food experiences. Share with the group if desired. 59 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

60 Traditional Cultural Food Patterns (p. 266) Shift in focus from melting pot to diversity American cities retain pockets of ethnic groups Cultural food habits are retained 60 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

61 Religious Dietary Laws (p. 266) Religious dietary laws Christianity Catholic Protestant Eastern Orthodox Judaism Hinduism Buddhism Islam 61 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

62 Jewish (p. 266) Different dietary laws depending on orthodox, conservative, or reform beliefs Dietary laws are called Rules of Kashruth; foods prepared according to these laws are kosher Meat should come only from animals that chew their cud and have cloven hooves; no pork or birds of prey Meat and milk products are not mixed Shellfish and crustaceans are avoided No eggs with blood spots are eaten 62 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

63 Influence of Festivals (Jewish) (p. 266) Many traditional Jewish foods relate to festivals of the Jewish calendar Examples: bagels, blintzes, borscht, challah, gefilte fish, kasha, knishes, lox, matzo, strudel 63 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

64 Muslim (p. 267) Dietary laws depend on restriction or prohibition of some foods, promotion of other foods Milk products: permitted at all times Fruits and vegetables: permitted unless fermented Breads and cereals: permitted unless contaminated Seafood and land animals: permitted Pork and alcohol: prohibited 64 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

65 Representative Foods (Muslim) (p. 267) Bulgur Falafel Fatayeh Kibbeh Pilaf Pita Tabouli 65 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

66 Influence of Festivals (Muslim) (p. 268) Ramadan 30-day period of daylight fasting Nights often spent in special feasts All Muslims, regardless of condition, observe this fasting Some patients (e.g., pregnant or breast-feeding) may have complications 66 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

67 Case Study Mr. H practices Muslim dietary laws. Discuss these laws in regard to a meal consisting of pork medallions, milk, fresh salad with lettuce and tomato and cucumber, steamed carrots and pilaf. 67 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

68 Spanish Influences (p. 268) Mexican Basic foods are dried beans, chili peppers, corn Small amounts of meat and eggs are used Fruit consumption depends on availability and price Puerto Rican Food pattern is similar to Mexican Tropical fruits and vegetables are added Basic foods include viandas (starchy vegetables and fruits), rice, beans 68 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

69 National Food Guides for Mexico and Puerto Rico (p. 269) 69 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

70 Native American (p. 268) Indian and Alaska Natives Many diverse groups All have a spiritual devotion to the land Food has great religious and social significance Food differs according to what can be grown locally, harvested or hunted on the land, or fished from local waters 70 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

71 Native American (contd) (p. 270) Native American: Southern Arizona American Indian Food Guide: Choices for a Healthy Life 71 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

72 Influences of Southern United States (p. 270) African Americans Food patterns developed through creative ability to turn basic staples into memorable food Traditional breads include hot breads (biscuits, spoonbread, cornbread) Wide variety of vegetables and leafy greens (turnip, collard, mustard) are used Pork is a common meat 72 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

73 French Americans (p. 272) Cajuns in southern Louisiana are descendants of the French colonists of Arcadia (now Nova Scotia) French culinary background blended with Creole cooking around New Orleans Foods are strongly flavored, spicy Seafood is abundant 73 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

74 Asian Food Patterns (p. 273) Chinese Use a wok for quick stir-frying with little fat Vegetables and rice are staples Meat, eggs, and tofu are sources of protein Japanese Rice is basic grain Many varieties of fish and shellfish used Vegetables usually steamed Diet is high in sodium, low in milk 74 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

75 Southeast Asian (p. 273) Southeast Asian: Vietnamese, Indonesian, Cambodian, Laotian Rice is a staple Soups are common Fish, shellfish, pork, chicken, and duck are common Red meat eaten only once or twice a month 75 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

76 National Food Guides for China, Japan, and Korea (p. 274) 76 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

77 Mediterranean Influences (p. 274) Italian Bread and pasta are basic ingredients Cheese, meats, poultry, fish, sausages, cold cuts, and vegetables commonly used Olive oil, garlic, herbs, and wine used in cooking Greek Bread is the center of every meal Cheese, yogurt, vegetables, rice, lamb, and fish commonly used 77 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

78 Mediterranean Influences (contd) (p. 275) 78 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

79 Changes in American Food Habits (p. 275) Basic determinants Physical Social Psychological Factors influencing change Income Technology Environment Access to food Vision 79 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

80 Changes in American Food Habits (contd) (p. 276) Changing American food patterns Household dynamics Family meals Pattern of grazing, growing portion sizes Fast foods Health and fitness Economical buying 80 Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.


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