1. Surgery, Burns and Pruritis

2. Surgery -patient should be well nourished prior to surgery-this gives better recovery -however, surgical patients are often malnourished due to anorexia, nausea, vomiting, burns, fever, malabsorption, and blood loss -surgical prep- range of actions include: -high calorie protein diet -enteral feeding -parenteral feeding

3. Surgery -nothing by mouth (NPO) for a least 8 hours prior to general anesthesia due to risk of aspiration -oral intake is resumed after bowel sounds return- usually 24-48 hours after surgery -start with clear liquids to full liquids to soft or regular diet as tolerated post-op -usually a high protein high calorie diet is appropriate-this helps with healing

4. Burns Extensive burns are the most severe form of metabolic stress. Fluid and electrolyte replacement to maintain adequate blood volume and blood pressure are the priorities of the initial postburn period. Degree of hypermetabolism and hypercatabolism in the metabolic response phase correlates to the extent of burn.

5. Burns—(cont.) Nutrition therapy – Priority is to meet calorie (for energy to repair) and protein needs (protein is critical for tissue repair). oProtein needs are typically 2.0 to 2.5 g/kg.  Especially if burns cover more than 10% of total body surface area oCalorie and protein needs increase if complications develop. oVitamin C, vitamin A, and zinc plus a multivitamin are recommended (required for tissue repair and maintenance of the repaired tissue).

6. Burns—(cont.) Nutrition therapy—(cont.) – When oral intake is less than 75% of estimated need for more than 3 days, EN should be used for total or supplemental nutrition. – Total parenteral nutrition is used with extreme caution due to risk of infection and sepsis but may be necessary if nutrition needs are extremely high and cannot be met by EN (multiple surgeries, ileus, or organ failure). Nutrition needs can seldom be met by PPN. – Sepsis occurs when chemicals released into the bloodstream to fight the infection trigger inflammatory responses throughout the body. This inflammation can trigger a cascade of changes that can damage multiple organ systems, causing them to fail.

7. Pruritis -this is itch -can result from liver and kidney disease, cancers, parasites, aging and dry skin, and contact dermatitis

8. Pruritis and Nutrition - nutritionally address each of diseases generating the pruritis, address life cycle issues (aging and dry skin frequently go together) or address aging or dry skin separately as appropriate -contact dermatitis can be dealt with as per earlier mention of dermatitis -Evening primrose oil has had controversial success in this regard (i.e. pruritis)