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Note Lecture 10c 18 March 2013 Surgery and Burns Surgery -patient should be well nourished prior to surgery-this gives better recovery -however, surgical patients are often malnourished due to anorexia, nausea, vomiting, burns, fever, malabsorption, and blood loss -surgical prep- range of actions include: -high calorie protein diet -enteral feeding -parenteral feeding Surgery -nothing by mouth (NPO) for a least 8 hours prior to general anesthesia due to risk of aspiration -oral intake is resumed after bowel sounds return- usually 24-48 hours after surgery -start with clear liquids to full liquids to soft or regular diet as tolerated post-op -usually a high protein high calorie diet is appropriate-this helps with healing Burns -hypermetabolism involved- why? -solution to hypermetabolism? -large quantities of nutrients leech through burn area -therefore fluid and electrolyte imbalances are a problem Burns -result in anorexia, pain, emotional trauma, weight loss and immune incompetence, malnutrition -nutritionally how are these overcome? Burns -after fluid and electrolytes are addressed and by hour 72 (if bowel sounds)- oral intake begins -if no bowel sounds by hour 96 then PPN or TPN Burns - regardless of routes of administration -Protein 1.5-3.0 g /kg body weight/day 20-25 % protein, 50 % carbohydrate, 25 % fat -Kcal- additional 40-60 kcal/kg body weight/day -high fluid intake –including more potassium, zinc and vitamins A and C (zinc, vitamins A and C for wound healing) and vitamins B1, B2 and B3 (in proportion to increased energy Table 29-1, p. 870 Table 29-2, p. 903 Table 29-3, p. 904 Cancer Dietary factors - cancer initiators - these dietary components start cancer -additives and pesticides are of particular but not exclusive concern here -stomach cancer particularly high in parts of world where pickled or salt cured foods that produce carcinogenic nitrosamines are consumed Cancer Dietary factors -alcohol associated with high incidence of some cancers, especially of the mouth, esophagus and liver in all persons and breast cancer(postmenopausal) in females -beer and scotch may contain nitrosamines -wine and brandy may contain urethane -urethane and nitrosamines are carcinogens -moderation is the key to prevention here Dietary factors –cancer promoters and inhibitors -cancer promoters accelerate the rate of progression of cancer once it has started - eg excess dietary fats -linoleic acid- has been suggested to promote -omega 3s have been suggested to prevent or delay cancer development Dietary factors-antipromoters Fruits and veggies as per Canada’s food guide -fibre speeds up gi transit time thus reducing carcinogen exposure -fruits and vegetables containing antioxidants that scavenge free radicals –such free radicals contribute to cancer -various phytochemicals activate enzymes that can destroy carcinogens Once cancer starts -do nutritional assessment and respond accordingly -early dietary intervention prepares body for stresses that lay ahead - AIDS Weight loss, diarrhea, seborrhea, eczema, fever, sweating-nutritional implications? Nutritional implications can further deteriorate patient’s health e.g. further immune response compromise Kcal requirement is increased compared to non-infected persons in good health Protein requirements 1-2 g/kg bw/day due to lean body mass loss and other protein losses AIDS Drugs can exacerbate nutritional difficulties (table) AIDS Fat – medium chain triglycerides(mct) (6-12 carbon fatty acids) for additional calories -lipase and bile not required for mct- therefore easier absorption AIDS Vitamins and Minerals recommendation-close to DRI-otherwise adverse interactions with antiretroviral drugs AIDS Feedings -small, numerous meals -liquid commercial preparations -antidiarrheals shortly before meals -high soluble fibre foods like oatmeal, cooked carrots, bananas, peeled apples and apple sauce may help slow transit time (diarrhea reduced perhaps)