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what happens during physical stress
Body signals endocrine system, activates self protective hypermetabolic (higher than normal metabolism) response; increases energy output
why does body need sufficient nutrients, fluids and calories asap after trauma
replace losses, build and repair tissue and return body to homeostasis
presurgery nutritional care
extra protein, carbs, vits and minerals
protein for
wound healing and tissue building
carbs for
energy after surgery
b vits for
increased metabolism
vit a and c and zinc for
wound healing
vit d for
calcium absorption
vit k for
proper blood clotting
iron for
blood building
calcium and phosphorus for
bones
other minerals for
maintenance of acid, fluid and electrolyte balance
diet after midnight the night before surgery
npo (nothing by mouth)
why is food withheld before surgery
so stomach has no food that can be regurgitated and inhaled into lungs during surgery
post surgery nutritional care
first 24 hrs, intravenous only; from clear liquid diet to regular diet; food 1-4 days after surgery
adult estimated calorie requirement
35-45 calories/kg
max calories form intravenous solutions
400-500
peristalsis evidence
bowel sounds
dumping syndrome
nausea and diarrhea caused by food moving too quickly from stomach to small intestine; follows gastric surgery
diet to prevent dumping syndrome
restrict carbs because they leave stomach faster, limit fluids, dont overload stomach
enteral nutrition
feeding by tube directly into the clients digestive tract
tube feeding
feeding by tube directly into the stomach or intestine or via a vein
usually tube feeding for less than 6 weeks is administered through
nasogastric tube; tube leading from nose to stomach for tube feeding
tube feeding for more than 6 weeks
requires an opening (ostomy)
gastrostomy
opening in stomach
jejunostomy
opening in intestine
polymeric formulas
commercially prepared formulas for tube feedings that contain intact proteins, carbs and fats; REQUIRE DIGESTION
elemental or hydrolyzed formulas
contain products of digestion of proteins, carbs and fats; FOR CLIENTS W LIMITED ABILITY TO DIGEST OR ABSORB NUTRIENTS
modular formulas
customized; supplements to other formulas
intermittent tube feeding
tf at night; food at day
bolus tube feeding
parental nutrition
giving nutrients through veins if gi tract isnt working; tpn = total parental nutrition; dextrose amino acid fat solution; catheter is inserted into vein
phlebitis
inflammation of the vein
thrombosis
blockage; blood clot
sepsis
infection of the blood; caused by infection at the site of the catheter
burn client diet
fluid and electrolytes immediately; need way more energy (high protein high cal), liquid to solid
client w infection
More protein, minerals, calories, vits, fluids
Thrush
caused by high doses of antibiotics; year infection of mucous membranes lining the mouth and tongue
Opportunistic infections
Only affect people with unhealthy immune systems
HIV
Weakens immune system
Aids
Incurable; fatal
HIV nutrition problems
PEM and decreased appetite