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Nutrition of the MedicalSurgical Patient
Today’s Content
• Nutrition Therapy in the acute health-care
setting
– For medical patients
– For surgical patients
MEDICAL NUTRITION THERAPY IN
A HEALTH CARE SETTING
• Provided to:
– Aid in recovery
– To stabilize the health condition
– ↑ nutritional status
– Prepare for surgery
• ↓ surgical risk
• Help with healing
Involves:
• Physical assessment
• Nutritional assessment
– Usually done 24-72 hours after admission
• Labs
– Albumin
– Na, K
– Ca
– Hbg, Hct
Special Diets
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For patients with certain diseases
To prepare for special test
For surgery
To increase or decrease weight
Diets are modified:
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Texture
Calories
Specific nutrients
Seasonings
Consistency
Common diets seen in acute
care setting:
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NPO (nothing by mouth)
Clear liquid
Full liquid
Soft
Diet as tolerated
Regular diet
Other diets
NPO
• Nothing by mouth
– Before anethesia or after surgery until bowel
sounds return
• Most patients ok with NPO for several
days
• Some patients may require nutrition and
fluids per IV
Clear Liquid
• Next step after NPO
• How do we know when a patient is ready
for this next step?
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Bowel sounds
Passing flatus
Clear Liquid
• Supplies patient with:
– Fluid
– CHO (as sugar)
– 600 kcal/day
• Short term; about 24-36 hours
Clear Liquid
• Major goals of this diet:
– relieve thirst
– prevent dehydration
– minimize stimulation of GI tract
Clear Liquid
• Includes:
– Water
– Tea
– Coffee
– Clear broths
– Carbonated beverages
– Strained and clear juices
– Plain gelatin
Full liquid diet
• Next step after clear liquids
• Liquids or foods that turn to liquid at body
temperatur
• For patients with:
– GI problems
– Unable to tolerate solid or semisolid foods
– Post-surgery
Full liquid diet
• Low in:
– Iron
– Protein
– Calories
• High in
– Cholesterol
Full liquid diet includes:
• Clear liquids plus:
– Milk and milk drinks
– Puddings, custards
– Ice cream, sherbet, yogurt
– Vegetable juices
– Strained cereals
– Cream, butter, margarine
Soft diet (soft mechanical diet)
• Easily chewed and digested
• For patients who have difficulty chewing
and swallowing (ex: ______________)
• Also for some patients after surgery – from
clear to full liquid to soft diet
• Low-residue (fiber) diet containing very
few uncooked foods
• Can be modified  Pureed diet
Diet as Tolerated
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Regular
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For patients with no special needs
A balanced diet
about 2000 kcals
“light” diet – for postoperative patients not
quite ready for regular diet
Diets Modified for Disease
• Diabetes (ADA)
• Heart disease (prudent diet, low sodium)
• GI alterations (bland diets)
Prudent diet (low cholesterol
and sodium)
• To lower the LDL cholesterol levels and
sodium intake
• For heart disease, atherosclerosis,
hyperlipidemia
Which is prudent?
Sodium-restricted diet
• No added salt – 4-5 grams per day
allowed
• Mild sodium restriction – 2-3 gms/day
• Moderate sodium restriction – 1 gm/day
• Severe sodium restriction – 500 mg/day
• High sodium foods include:
– pickles, olives
– salted nuts
– soy sauce
– hot dogs, bacon, sausage
– processed cheese
– canned soups
– potato chips
– canned fish and meats
– luncheon meats, ham
– mustard and ketchup
Low sodium foods
High Fiber diet
• Includes:
– whole-wheat breads and cereals
– Bran
– Oatmeal
– fresh fruits and vegetables with skins
– and more!
NUTRITIONAL NEEDS OF SURGICAL
PATIENT
• Needs vary based on:
– Patient’s disease process
– Other chronic illnesses
– Baseline nutritional status
Immediate Preoperative Period
• NPO 8 – 12 hours before surgery
– Ensures empty stomach to prevent:
• Vomiting
• Aspiration
– Can impair patient’s ability to respond to
metabolic stress of surgery
Postoperative Nutrition
• Goal:
– Maintain current lean body mass
• Several factors to consider:
– Surgical procedure
– Expected time to resume oral intake
– Complications of surgery
– Preop nutritional status
Energy & Protein Requirements
• Most common nutritional deficiency after
surgery is protein
Energy & Protein Requirements
• Protein:
– Required to build new and maintain existing
body tissue
– Wound healing
– Control edema
– Bone healing
– Resistance to infection
Water
• Another essential nutrient after surgery
• Daily water requirements for surgical
patients:
– Uncomplicated = 2000-3000 cc/24 hours
– Complicated = 3000-4000 cc/24 hours
– Seriously ill with drainage = up to 7000 or
more cc/24 hours
Energy Needs
• 2800 kcals/day needed before protein can
be used in the body to repair tissue
Vitamins
• Vitamin C
• B- vitamins
– Provide coenzyme function
• Vitamin K
Minerals
• Potassium lost with tissue breakdown
• Other electrolyte losses
– Na and Cl
• Blood loss  iron loss
– H/H
How does a surgical patient
have nutritional needs met?
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IV infusing?
Eats as soon as possible?
Is this enough?
What if a patient has an NG tube for 3-5
days? How will that person’s nutritional
needs be met?
What do IV fluids provide?
• Simple IV fluids used routinely after
surgery:
– Provide: water, dextrose, electrolytes
– Do not provide many calories or fat
– Do not provide protein
If NPO for 5 days or more ….
• TPN (Total Parenteral Nutrition) is usually
started
– Higher amount of dextrose
– Amino acids
– Vitamins, minerals
– Lipids (fat emulsions) can be infused with
TPN
Routine Postoperative Diets
• Begun after adequate bowel function
returns:
– Flatus
– Bowel sounds present
• Begins with clear liquids
• Advanced to full liquids
• Soft/regular
Specialized Nutrition Support
• Used if oral diet is not tolerated
• Includes:
– Tube feeding (enteral)
– Parenteral nutrition
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Bowel obstructions
Unable to tolerate tube feedings
Ileus
Major upper GI bleed
Institutional Meal Concerns &
Considerations
• Mealtime is often major event of the day.
– Make food attractive
– Have patient brush teeth or rinse out mouth
– Comfortable room temperature
– Comfortable lighting
– Get rid of odors