Activity 2-unit 2-update 2024. English translation
surgical_nutrition_.pptx
1.
2. Nutrix – to nurse
Nutrire – to suckle
(breast milk – best food for children up to 2
years old)
Nourish – to provide with substances necessary
to sustain life and promote growth of living
organisms
Process by which living organism assimilates
food and using it for growth and replacement
of tissues
FOOD
3. To meet increased energy requirements for
◦ Basal metabolic processes
◦ Maintenance of core temperature
◦ Tissue repair
To provide adequate substrates for protein
synthesis in order to minimize protein
breakdown
To reduce mortality and morbidity following
surgical stress and trauma
4. (need of patient to sustain nutrition)
Amount of heat necessary to raise
temperature of 1000g (approx 1 L) of water
by 1°C
WEIGHT (clinical manifestation)
5. Basal metabolism
Physical activity
Specific dynamic action (thermic effect) of
food (how food is broken down)
6. Basal metabolism
Physical activity (decreased)
Specific dynamic action (thermic effect) of
food
Stress of injury and surgery (↑↑↑)
8. Most important source of energy
Filipino diet: 60% total caloric allowance
Should not be less than 100g/day for
efficient oxidation of fats
◦ 1 cup of white rice = 200 kCal
◦ 200 kCal ÷ 4 kCal/g = 50g
9. Functions
◦ Immediate needs for energy
Excess glycogen – liver, muscle, adipose tissue
◦ Spares protein
◦ For normal oxidation of fat
Prevents production and accumulation of ketones
◦ Synthesis of B-complex vitamins
◦ Provide chemical substances that serve as starting
point for synthesis of non essential amino acids
◦ Stimulate peristalsis, absorb, and hold water
◦ Synthesis of nerve and cartilage
10. Mainly for synthesis and repair of body structures if
sufficient calories are available
Filipino diet: 20% total caloric allowance
Recommended intake: 1.12g/kbw/day
6.25g CHON = 1 g dietary nitrogen
Essential and non essential amino acids
Functions:
◦ Enzymes
◦ Antibodies
◦ Blood proteins
Osmotic pressure regulation
Water and acid/base balance
Excess amino acid is de-aminized in the liver and
nitrogen is secreted in urine as urea and the rest is
oxidized in energy or stored as adipose tissue
11. Stored as adipose tissue in unlimited amount
Recommended for Filipinos = 20-25% of total
caloric allowance
Functions
◦ Spares protein as energy source
◦ Maintain constant body temperature by providing
effective insulation
◦ Facilitate absorption of fat-soluble vitamins (ADEK)
◦ …essential and non essential fatty acids…
◦ …phospholipids…
12. Energy
Carbon dioxide
Water
Ketones from fat
Ammonia and nitrogen from protein
Lactic acid (during anaerobic metabolism)
from carbohydrates
13. Vitamins
13 essential (fat & water-soluble)
Minerals
Maintain acid/base balance
Catalyze metabolic reactions
Transmit nerve impulses
Regulate contractility of muscles
For bone & Tooth formation
Provide components for essential body
compounds
14. Pseudovitamins
◦ Choline
◦ Inositol
Water
◦ 60% total body water in adults
◦ Recommended intake: 1 cc/kCal
◦ Consumed = 2-2.5L or 8-10 glasses/day
◦ Function:
Universal solvent
Chemical reactant
Takes up heat
Structural component of cells
15. Dietary management
How much food should be given?
What kind of food should be given?
How will this food be given?
How much food should be given?
Determine:
Energy requirements per day
◦ Basal energy expenditure (BEE)
◦ Estimated energy expenditure (EEE)
How much CHO, CHON, CHOH?
16. Energy needs/day
For resting, nonstressed adults
◦ BEE (in kCal/day)
◦ Harris-Benedict equation
◦ (men) = 66 + 13.8(w) + 5.0(h) – 6.8(a)
◦ (women) = 655 + 9.6(w) + 1.8(h) – 4.7(a)
For stressed adults
◦ EEE
◦ Non ventilated = 629 – 11(a) + 25(w) – 609(o)
◦ Ventilated = 1925 – 10(a) + 292(t) + 5(w) + 281(s) +
851(b)
◦ a = age in yrs
◦ w = weight in kg
◦ h = height in cm
◦ O = obesity
◦ T = trauma
◦ B = burns (1=present; 0=absent)
◦ S = sex (1=male; 0=female)
17.
18. Energy needs/day
Example: 70 kg / male / 40 yo / 173cm
◦ BEE = 66 + 13.8(70)+5(173) – 6.8(40)
◦ BEE = 1,625 kCal/day
Blunt chest trauma, on ventilatory support
◦ EEE = 1,925 – 10(40) + 292 + 5(70) + 281
◦ EEE = 2,448 kCal/day
Percentage C, P, F
◦ Carbohydrates = 60%
◦ Proteins = 20%
◦ Fats = 20%
19. Example: 70 kg / male / 40 yo / 173cm
◦ BEE = 66 + 13.8(70)+5(173) – 6.8(40)
◦ BEE = 1,625 kCal/day
◦ C = 60% =975 kcal/day
◦ P =20% = 325 kcal/day
◦ F =20% = 325 kcal/day
◦ C= 975 kCal/4 kCal/g = 243.75 g = 244 g
◦ P= 325 kCal/4 kCal/g = 81.25 g = 62 g
◦ F = 325 kCal/9 kCal/g = 36.11 g = 36 g
20. What kind of food shall be given?
How will this food be given?
Determine:
Can the gut be used safely?
◦ Yes?
NPO?
Oral feeding?
Enteral feeding?
◦ No?
NPO?
Parenteral nutrition?
21. Oral feeding? Yes.
Consistency modification
◦ Solid
◦ Soft
◦ Liquid – clear or full
Composition modifications
◦ Regular
◦ Low residue
◦ Bland
22. Oral feeding – liquid diet
Clear
◦ Supply fluids with no residue
◦ Intends to allay thirst, replace water loss and start
oral nourishment
◦ No nutritional essentials
◦ Sugar dissolved in clear liquid
◦ Water
◦ Tea/coffee (should not exceed 2 cups in 24 hours)
◦ Intended for 1-2 days only
*just to jump start oral nutrition
23. Full
◦ Satisfy normal calorie requirement of energy
◦ Requiring little effort in digestion and absorption
◦ Liquid, strained semi-liquid food, food that liquefy
at body temperature
◦ Can be used for prolonged periods
◦ Free from cellulose, spices, and condiments
◦ Calorie content can be increased (by adding sugar
or baker’s yeast)
◦ *ileus – patient might vomit
Cold liquid
◦ Ice cream
◦ To minimize oozing and prevent bleeding after
tonsillectomy
24. Oral feeding – soft diet
Provides adequate nutrition
Simple, easily digested, mildly flavored food
Low in fiber, free from tough connective
tissue
A transition from full liquid to regular diet
May be prolonged if unable to chew
Oral feeding – soft diet
Residue diet
To produce bowel movement
Inadequate in vitamins and minerals (because
the purpose is to make the patient defecate)
25. Oral feeding – soft diet
Bland diet
Nutritionally adequate
To avoid stimulation of a diseased gut (gastric
ulcers, colitis, recent UGIB from esophageal
varices, etc.)
Oral feeding? No; gut intact
Enteral feeding
◦ Nasogastric
white:6, black:8, blue:10, green:14, orange:16, red:18
adult patients – between level 2 and 3
signs that the tube is inside: reflux of gastric juice, gurgling
sound onset
26. ◦ Stomal
Pharyngostomy
Esophagostomy
Gastrostomy (surgery or PEG – percutaneous
endoscopic gastrostomy)
Jejunostomy (20-30 cm after ligament of Treitz)
*duodenostomy – not done d/t duodenum’s
retroperitoneal position and immobility
*ileostomy – not done d/t less absorption of food in
the ileum
27.
28. Nasogastric/nasoenteral feeding
Easiest to perform
Uncomfortable, cause nasal irritation and
chronic sinusitis
Osteorized/blenderized
◦ For patients that cannot tolerate feeding by
mouth(comatose, severe burns, paralysis of
swallowing mm)
◦ Fed thru a polyvinyl nasogastric tube (NGT)
◦ Consists of natural food with egg and milk as base
◦ 1 cc of liquid/calorie of formula
◦ Highly fibrous, spicy, strongly flavored food are
avoided
29.
30.
31. Stromal Feeding
Osteorized/blenderized
◦ For pharyngostomy, esophagostomy, gastrostomy
Elemental diet
◦ For jejunostomy
◦ Synthetically formulated
◦ Readily and completely absorbed from upper GIT
◦ Low residue, bulk-free
◦ *predigested
25-50 cc/hr/day as tolerated
Begun at ½ strength with increasing
concentration
32. Gut cannot be used safely
Total Parenteral Nutrition (TPN)
◦ Provide necessary nutritional elements directly into
the blood
◦ Must be given by intravenous (IV) infusion into a
central vein
◦ TPN Indications
33. 4 categories of problems for TPN use
Pre-operative preparation of
malnourished patients
Post-operative surgical complications
Inflammatory bowel disease requiring
prolonged bowel rest
Insufficient oral intake but with marked
increase metabolic requirements
34. Newborn with GI malformation
Short bowel syndrome
GI fistulas
Inflammatory bowel disease
Moderate to severe pancreatitis
Prolonged ileus (sepsis)
Severe ARF
Patients with decubitus ulcers in which fecal
contamination is a problem
Patients who aspirate enteral feedings
Patients with cancer in which malnutrition might
interfere with therapy
35. ◦ Central venous access
Subclavian vein – most common
Jugular vein
Femoral vein – less common
Monitor catheter position by CXR or plain abdominal
film = *always mandatory
*CXR – to determine presence of pneumothorax or
obstructive shock
*plain abdo film – expect to find catheter in common iliac
vein
36. ◦ Components
Energy
Calories come from carbohydrates ± fat
Glucose (10-35% dextrose)
Lipid emulsions have linoleic acid (5-20%)
Standard TPN solutions provide 1.4 kCal/mL
37. Protein
Provided as amino acids as 5% mixture
Vitamins
Minerals
Electrolytes
Na
P
Mg
K
Ca
Measurements done at least OD for 1 wk until levels have
stabilized