Early oral nutrition is to be increasingly fractional method of nourishment for surgical patients. Negligence of any nutritional therapy bears the risk of underfeeding during the post-operative course after major or minor surgery.
Keeping in mind about malnutrition and underfeeding are risk factors for post-operative stumbling-block. Preliminary enteral feeding is predominantly relevant for any surgical patient at nutritional risk, especially for those come in for upper gastrointestinal surgery. The focus of this criterion is to cover nutritional characteristic of the Enhanced Recovery After Surgery (ERAS) concept and the special nutritional necessitate for patients undergoing major surgery, e.g. for cancer, and of those making headway to severe complications despite best perioperative nursing or care.
Key aspects of perioperative care include:
- Concatenation of nutrition into the overall management of the patient.
- Circumvention of long intervals of pre-operative fasting.
- Re-establishment of oral feeding as early as possible after surgical treatment.
- Begin nutritional therapy early, as soon as a nutritional risk becomes evident.
- Metabolic control e.g. of blood glucose
- Depletion of factors which aggravate stress-related catabolism or impair gastrointestinal function.
- Curtail time on paralytic agents for ventilator management in the post-operative period.
- Premature mobilization to facilitate protein synthesis and muscle function.
So as to make legitimate arrangements for the nutritional support of patients experiencing surgical treatment, it is basic to comprehend the essential changes in digestion and metabolism that happen because of injury, and that an undermined nutritional status is a risk factor for postoperative complexities.
1.1 Nutritional care guidelines for the surgical patient must include:
- A delineate nutritional and medical history that comprise body composition assessment.
- A nutrition intercession plan.
- An amendment of the intervention plan, where appropriate and applicable.
- Clear and precise documentation evaluation of nutritional and clinical denouement.
- Resistance exercise whenever feasible.
1.2 Preoperative Nutritional Guideline:
It is mandatory to gather the information on Nutritional “metabolic” risk and disease-related malnutrition. Evaluation before surgery means risk assessment according to pathophysiology. For clinical practice these data emphasize:
- Screening and assessment for lack of healthy sustenance and malnutrition (for example: NRS-Nutritional Risk Screening) on confirmation or first contact.
- Observation and documentation of oral feeding.
- Daily follow-up of weight and BMI.
- Nutritional counselling of patient.
“Metabolic conditioning” of the patient grapple on anticipation and treatment of insulin obstruction, which is additionally a measure to limit confusions after significant surgical procedure. Preoperative carbohydrates may reduce insulin resistance, prevent hypoglycemia and may turn down stress. Emphasizing on the magnitude of stress-induced inflammation and the propensity of the patient to generate an adequate host response that has led to the characteristics of “immunonutrition”. So-called “eco-immunonutrition” using pre- and probiotics target at the microbiome in the gut and the enhancement of mucosal immunity.
1.3 Surgery
To balance the magnitude of surgery with the ability of the human body to deal with the metabolic load may be a significant challenge for the surgeon. It refers to admissible co-morbidity with special regard to the cardiopulmonary capacity and the presence of inflammation in the body or even more suspected or non-suspected infection and sepsis. If the scope and risk of surgery are not customized to the capacity of the patient to generate an appropriate host response, there might be a high risk for anastomotic leakage, infectious/septic complications, and mortality.
The surgeon should apprehend the ability of the patient for relevant postoperative oral feeding. If considerable problems may be prognosticate, the operation offers a unique chance to create safe and secure access for long-term surgical nutrition guidelines.
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