1. Nutritional Support in Surgical Patients Nuha Al Masoud Noura Al-Shatiry Asma Al-Mandeel

2. Definition Nutritional support is a therapy used to support the surgical patients until they are able to sustain themselves with adequate spontaneous nutrition by mouth.

3. The Importance of Nutrition Assessment Approximately one-third of all patients admitted to an acute hospital will have evidence of protein-calorie malnutrition Two-thirds will leave hospital either malnourished or having lost weight.

4. Malnutrition has damaging effects on psychological status, activity levels and appearance. Patients with severe protein deficiency have a significantly greater incidence of postoperative complications, such as pneumonia and wound infection, and a prolonged hospital stay. The Importance of Nutrition Assessment

5. Nutritional disorders in surgical practice have two principal components Firs: Starvation, can be initiated by: The effects of the disease Restriction of oral intake or both Second : The metabolic effects of stress/inflammation Increased catabolism and reduced anabolism.

6. The key elements of nutritional assessment Current food intake Levels of energy and protein reserves The patient's likely clinical course

7. Which patient require Nutritional support Severely malnourished due to disease Insufficient food intake for 5 days or more Patients with symptoms such as anorexia, nausea, vomiting, are at risk of a reduced food intake and hence undernutrition.

8. ASSESSMENT OF NUTRITIONAL STATUS History: A history of weight loss (more than 10–15% in 4-6 months is highly significant)

9. ASSESSMENT OF NUTRITIONAL STATUS Physical Examination: According to their body mass index BMI = weight (kg)/height (m2) The normal BMI is 18.5–24.9 A value less than 18 is suggestive of significant protein-calorie undernutrition.

10. ASSESSMENT OF NUTRITIONAL STATUS Laboratory evaluation (CBC) Lymphocyte count < 1800/cmm Serum albumin < 30G/L

11. ASSESSMENT OF NUTRITIONAL REQUIREMENETS Energy Protein Nitrogen Depending on: - Weight - Body composition - Clinical status - Mobility - And dietary intake

12. Complicated _stressed Uncomplicated 30-3525 Energy 1.3-1.51.0 Protein

13. CAUSES OF INADEQUATE INTAKE 1- Socioeconomic factors 2- Pt being too weak and anorexia 3- Mechanical problem 4- Increase metabolic demand 5- Normal functional gut du to cumulative effects of repeated periods of fasting 6- Intestinal failure

14. METHODS OF PROVIDING NUTRITIONAL SUPPORT

15. Enteral nutrition -Oral route -Methods of administration of enteral feeds: Nasogastric or nasojejunal tubes Gastrostomy and jejunostomy -Complications of enteral nutrition

16. Routes of Enteral nutrition

18. Parenteral nutrition -Intravenous route -Indications -Administration -Composition

20. Complications Of TPN Catheter problems Infection Thrombophlebitis Metabolic complications

22. MONITORING OF NUTRITIONAL SUPPORT Pulse rate, blood pressure and temperature are recorded regularly Accurate fluid balance chart is maintained (including insensible losses) Urine is checked daily for glycosuria Body weight is measured twice weekly Full blood count, liver function tests, and serum albumin, calcium, magnesium and phosphate are monitored once or twice weekly

23. Reference: Principles and Practice of surgery

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