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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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