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picture1_Lecture Ppt 80814 | Lecture 13  Nutrition In Surgical Patients


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File: Lecture Ppt 80814 | Lecture 13 Nutrition In Surgical Patients
lecture outline energy sources nutrition requirements diet advancement micronutrients for wound healing enteral versus parenteral nutrition case studies energy sources carbohydrates limited storage capacity needed for cns function yields 3 ...

icon picture PPT Filetype Power Point PPT | Posted on 08 Sep 2022 | 3 years ago
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         Lecture Outline
   Energy Sources
   Nutrition Requirements
   Diet Advancement
   Micronutrients for wound healing
   Enteral versus Parenteral Nutrition
     • Case studies
         Energy Sources
   Carbohydrates
    • Limited storage capacity, needed for CNS function
    • Yields 3.4 kcal/gram
    • Pitfall: too much=lipogenesis and increased CO2 production
   Fats 
    • Major endogenous fuel source in healthy adults
    • Yields 9 kcal/gm
    • Pitfall: too little=essential fatty acid (linoleic acid deficiency-dermatitis 
     and increased risk of infections
   Protein
    • Needed to maintain anabolic state (match catabolism)
    • Yields: 4 kcal/gm
    • Pitfall: must adjust in patient with renal and hepatic failure
       • Elevated creatinine, BUN, and/or ammonia
     Nutrition Requirements
   Healthy Adults
        • Calories: 25-35 kcals/kg
        • Protein: 0.8-1 gm/kg
        • Fluids: 30 mls/kg
   Requirement Change for the Surgical Patient
   Special Considerations
    • Stress
        • Injury or disease
        • Surgery
   Pre-hospital/pre-surgical nutrition
             Nutrition 
   The surgical patient…
     • Extraordinary stressors (hypovolemia, hypervolemia, bacteremia, 
      medications)
     • Wound Healing
        • Anabolic state, appropriate vitamins (A, C, Zinc), and adequate 
         kcals/protein.
   Poor Nutrition=Poor Outcomes
     • For every gram deficit of untreated hypoalbuminemia there is ~30% 
      increase in mortality
       Post-Operative Nutrition 
            Requirements
   Calories: 
     • Increase to 30-40 kcals/kg
     • Patient on ventilator usually require less 
        calories ~20-25 kcal/kg
   Protein:
     • Increase to 1-1.8 grams/kg
   Fluids: 
     • Individualized
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...Lecture outline energy sources nutrition requirements diet advancement micronutrients for wound healing enteral versus parenteral case studies carbohydrates limited storage capacity needed cns function yields kcal gram pitfall too much lipogenesis and increased co production fats major endogenous fuel source in healthy adults gm little essential fatty acid linoleic deficiency dermatitis risk of infections protein to maintain anabolic state match catabolism must adjust patient with renal hepatic failure elevated creatinine bun or ammonia calories kcals kg fluids mls requirement change the surgical special considerations stress injury disease surgery pre hospital extraordinary stressors hypovolemia hypervolemia bacteremia medications appropriate vitamins a c zinc adequate poor outcomes every deficit untreated hypoalbuminemia there is increase mortality post operative on ventilator usually require less grams individualized...

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