Nutrition of the Medical- Surgical Patient

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

M EDICAL N UTRITION T HERAPY 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 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 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!

N UTRITIONAL NEEDS OF S URGICAL P ATIENT 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 = cc/24 hours –Complicated = 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