Table of Contents
Introduction: Your New Lifestyle.............................................................. 1
Aim…………………………………………………………………………………………………….. 1
Goals of Nutritional guideline ………………………………………………………………2
Nutritional requirement for post op patients……………………………………….2
Nutritional requirement after surgery ..................................................... 2
Surgery Center (Stage 1 & 2) .................................................................... 2
Weeks 1 & 2 .................................................................................................. 3
Weeks 3 & 4 .................................................................................................. 5
Week 5 and beyond ................................................................................... 8
Tips ................................................................................................................11
INTRODUCTION
Post-operative nutrition is patient’s health care; it incorporates primarily the
scientific fields of nutrition to the patients undergone with surgery. It aims to
keep healthy energy balance in patients, as well as providing sufficient amount
of other nutrition’s such as protein, vitamins and minerals.
Patients undergoing surgery may face metabolic and physiological changes
challenges that may compromise nutritional status. Post-Operative nausea,
vomiting, pain, and anorexia may tax those undergoing even minor surgeries,
whereas catabolism, Infection and wound healing may be additional hurdles
for patients after major operations
AIM
Aim of this Nutritional guideline is to cover nutritional aspects that is aimed at
most patients undergoing surgery and covers their nutritional needs, hence
this guideline provides nutritional pathway of common surgeries performed at
Aspen Lautoka Hopital
GOALS OF NUTRITIONAL SUPPORT AFTER SURGERY
Main goal of this guideline is to identify those patients at the risk of
malnutrition’s, this can be done those nutritional assessment i.e.ggr3
(History, physical examination, laboratory investigation)
Prevent or reverse the catabolic effect of disease or injury
To meet the energy requirement of metabolic process
To provide substrates for adequate tissue repair
Reduce Malnutrition
NUTRITIONAL REQUIREMENT FOR POST OP PATIENTS
Calories provided
Fat: 9kcals/g
Carbohydrate: 4kcals/g
Protein: 4kcals/g
NORMAL RANGE
TER: MALE: 30kcals-40kcals/day
FEMALE: 20kcals-25kcals/day
PROTEIN REQUIREMENT: 20-25% of TER
CARBOHYDRATE REQUIREMENT: 55-60% of TER
FAT REQUIREMENT: 25-30% of TER
BASAL ENERGY EXPENDITURE (BEE)
FOR MEN: 66.5 + [13.7 x weight (kg)] + [5 x height (cm)]-[6.8 x age (yrs.)]
FOR WEMON: 655 + [9.6 x weight (kg)] + [1.8 x height (cm)] – [4.7 x age (yrs.)]
TOTAL ENERGY EXPENDITURE (TEE)
TEE= BEE X Activity Factor x Stress factor
ACTIVITY FACTOR: Bed rest: 1.2
: Mobile: 1.3
STRESS FACTOR:
Starvation: 0.8
Postoperative: 1-1.5
Cancer: 1.1-1.45
Sepsis: 1.25-1.55
Multiple trauma: 1.25- 1.55
Burns: 1.5-1.7
ELECTROLYTE REQUIREMENT
Na: 50-90mmols/day
K: 50-70mmols/day
Mg: 01mmols/day
Ca: 05mmols/day
PRINCIPLE GUIDING NUTRITION
Use the oral route if the GI is fully functional and there are no other
contraindications to oral feeding
Initiation nutrition via the enteral route if the patient is not expected to be on
a full oral diet within 7 days pots surgery and there are no GI tract
contraindications
If the enteral route is contraindicated or not tolerated, use the parenteral
route within 24-48hrs in patients who are not expected to be able to tolerate
full enteral nutrition (EN) within 7 days
ROUTES AND METHODS OF FEEDING
1. ORAL
Administration of nutrition is the preferred route since it is the most
physiologic and the lest invasive
Stage 1: Surgery Center Stay
At the surgery center and the rest of your surgery day
Drink clear liquids only. For example: diluted 100% juices, low-fat strained
soup, broths, water, plain herbal tea, etc.
Drink in small sips and limit intake to only 2 to 3 ounces per hour.
Only liquids should be consumed for 2 weeks post-surgery
AVOID: straws, carbonated beverages
Stage 2: Weeks 1 & 2
Starting the day after surgery for two weeks.
Starting the day after your surgery you can start drinking protein shakes and
other calorie-free, non-carbonated beverages such as water, Crystal Light
Other “liquid food” can be included such as low-fat, strained soups, nondairy
milks, or skim milk.
Remember that protein is necessary for proper healing and allows for weight
loss while maintaining lean body mass.
Liquids to Introduce: Water, Protein shakes (Complan), Skim milk , Non-dairy
milks
Freshly prepared vegetable and fruit drinks
Diluted 100% juice, vegetable, or chicken broth, LowCalorie-free beverages (i.e., Crystal Light)
TIPS: Remember to sip your liquids slowly. No straws, if patient is well
hydrated urine will be clear.
What NOT to Eat: Any solid food, carbonated beverages, Gum, Cream Soups
Stage 3: Weeks 3 & 4
You will be introducing foods that are soft and moist, which means foods that
can be mashed, pureed, or chewed easily to a puree
Start replacing your protein shakes, one meal at a time, with pureed/semisolid
foods.
At week 3, continue to get 25-30 grams of protein from shakes. At week 4,
discontinue shakes if soft foods are tolerated.
Consume 5 to 6 small meals daily until you can tolerate ½ cup of food at one
time – then eat 3 small meals and 1 snack.
Avoid drinking liquids 30 minutes before a meal and 1 hour after a meal.
Foods need to be eaten and swallowing in a slow motion. Food needs to
thoroughly chew.
New Foods to Introduce:
PROTEIN: Choose meats that are grilled, baked, broiled, or poached – NOT
, tuna, trout, halibut, salmon, Lean ground turkey or beef
Skinless, white meat chicken or turkey
MEATLESS OPTIONS: Egg whites, Eggbeaters, beans, fat-free cottage cheese,
and fat-free yogurt.
VEGETABLES: Enjoy vegetables steamed, grilled, baked, or boiled – NOT FRIED!
Carrots Collards Cucumber (peeled)
Eggplant Edamame Kale Squash Broccoli Peas Bell peppers
FRUITS:
Avocado Soft bananas Peeled apples and oranges Mango Plums
Pineapple, Pears ,Peaches Watermelon
Week 5 and Beyond
Low fat, protein rich regular diet: now it is time to start introducing regular
food as part of a lifestyle of healthy, portion-controlled eating. Remember to
be careful with what and how much you eat because your pouch can become
weakened or over-distended.
Introduce new foods one at a time to identify problem foods.
Continue to consume 60-80 grams of protein per day.
Include at least 5 servings of fruits and vegetables.
Avoid liquids 30 minutes before meals and 1 hour afterwards.
Take at least 20-30 minutes to eat each meal.
2. ENTERAL NUTRITION (EN)
Process of delivery of nutrition into healthy and functioning GI Tract.
Most preferred when oral route is contraindicated
Advantages of enteral feeding are
Maintain gut mucosal integrity
Maintain normal gut flora and pH
Less Complication
Cheaper than parenteral feeding
Indications of EN
Oral intake < 50% of required in the previous 710 days
Dysphagia or chewing problem due to strokes, brain tumor, head injuries
Major Burns
3. PARENTERAL NUTRITION
Process of delivery of all nutritional requirements by IV route without the
use of GI. This method uses sterile liquid chemical formula which may be
delivered via centeral line or peripheral line.
INDICATIONS OF TPN
GI malfunction
OBSTRUCTED: Carcinoma oesophagus/stomach, stricture
FISTULATED: Post Op entero-cutaneous fistula
INFLAMMED: Crohn’s disease, acute severe pancreatitis
Failure of enteral feeding to meet calorie requirement
Patients with postoperative complications with impairing
gastrointestinal function, i.e. unable to receive and absorb adequate
amount of oral/enteral feeding for at least 7 days
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