Note
Lecture 10c
18 March 2013
Surgery and Burns
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
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
Burns
-hypermetabolism involved- why?
-solution to hypermetabolism?
-large quantities of nutrients leech through
burn area
-therefore fluid and electrolyte imbalances are
a problem
Burns
-result in anorexia, pain, emotional trauma,
weight loss and immune incompetence,
malnutrition
-nutritionally how are these overcome?
Burns
-after fluid and electrolytes are addressed and by
hour 72 (if bowel sounds)- oral intake begins
-if no bowel sounds by hour 96 then PPN or TPN
Burns
- regardless of routes of administration
-Protein 1.5-3.0 g /kg body weight/day
20-25 % protein, 50 % carbohydrate, 25 %
fat
-Kcal- additional 40-60 kcal/kg body
weight/day
-high fluid intake –including more potassium,
zinc and vitamins A and C (zinc, vitamins A
and C for wound healing) and vitamins B1, B2
and B3 (in proportion to increased energy
Table 29-1, p. 870
Table 29-2, p. 903
Table 29-3, p. 904
Cancer
Dietary factors - cancer initiators
- these dietary components start
cancer
-additives and pesticides are of particular but
not exclusive concern here
-stomach cancer particularly high in parts of
world where pickled or salt cured foods that
produce carcinogenic nitrosamines are
consumed
Cancer
Dietary factors
-alcohol associated with high incidence of some
cancers, especially of the mouth, esophagus and
liver in all persons and breast cancer(postmenopausal) in females
-beer and scotch may contain nitrosamines
-wine and brandy may contain urethane
-urethane and nitrosamines are carcinogens
-moderation is the key to prevention here
Dietary factors –cancer promoters and inhibitors
-cancer promoters accelerate the rate of
progression of cancer once it has
started
- eg excess dietary fats
-linoleic acid- has been suggested to
promote
-omega 3s have been suggested to
prevent or delay cancer
development
Dietary factors-antipromoters
Fruits and veggies as per Canada’s food guide
-fibre speeds up gi transit time thus reducing
carcinogen exposure
-fruits and vegetables containing antioxidants
that scavenge free radicals –such free
radicals contribute to cancer
-various phytochemicals activate enzymes that
can destroy carcinogens
Once cancer starts
-do nutritional assessment and respond
accordingly
-early dietary intervention prepares body for
stresses that lay ahead
-
AIDS
Weight loss, diarrhea, seborrhea, eczema, fever,
sweating-nutritional implications?
Nutritional implications can further deteriorate
patient’s health e.g. further immune response
compromise
Kcal requirement is increased compared to
non-infected persons in good health
Protein requirements 1-2 g/kg bw/day due to lean
body mass loss and other protein losses
AIDS
Drugs can exacerbate nutritional difficulties
(table)
AIDS
Fat
– medium chain triglycerides(mct) (6-12 carbon
fatty acids) for additional calories
-lipase and bile not required for mct- therefore
easier absorption
AIDS
Vitamins and Minerals
recommendation-close to DRI-otherwise adverse
interactions with antiretroviral drugs
AIDS
Feedings
-small, numerous meals
-liquid commercial preparations
-antidiarrheals shortly before meals
-high soluble fibre foods like oatmeal, cooked
carrots, bananas, peeled apples and apple
sauce may help slow transit time (diarrhea
reduced perhaps)