Normally, the human body operates in a state of homeostasis .when the body experiences the trauma of surgery, severe burns or infections, this balance is upset. The body reacts in an attempt to restore itself to homeostasis. During it is a response to physical stress, the busy signals the endocrine system which activities are protective, hyper metabolic response.this increases energy output. The intensity of the response depends on the severity of the condition.
Proteins, fats and minerals are lost in the catabolic phase just when there is an increased need for them to rebuild tissue. When the condition includes hemorrhage and vomiting, these losses are compounded. Obviously, nutrition plays an important role in the lives of clients undergoing surgery or of those who suffer from burns or infections.
The surgical client
- Pre Surgery nutritional care: Surgery stresses the client regardless of whether it is elective or not. If the surgery is elective, the client’s nutritional status should be evaluated before surgery, and if the improvement is needed it should be undertaken immediately. A good nutritional status before surgery enhances recovery. Iron is necessary for blood building.
Calcium and phosphorus for bones, and the other minerals for the maintenance of acid-base, electrolyte, and fluid balance in the body. In the case of overweight, improved nutritional status includes weight reduction before surgery whenever possible. Excess fat is a surgical hazard the extra tissue increase the chances of infection, and fatty tissue tends to retain the anesthetic longer than other tissue.
- Post Surgery nutrition care: the post-surgery diet is Intended to provide calories and nutrients in mount sufficient to fulfill the client’s increased metabolic needs and to promote healing and subsequent recovery. In general, during the 24 hours immediately following major surgery, then most clients will be given intravenous solutions only. These solutions will contain water 5%to 10% dextrose, vitamins, and medications as needed. Obviously, until the client can take food there will be a considerable calorie deficit each day. Body fat will be used to provide energy and to spare body protein, but the calorie intake must be increased to meet energy demands as soon as possible. Because protein losses following surgery can be significant and because protein is especially needed then to rebuild tissue control edema avoid shock resist infection.
The Client Receiving Enteral Nutrition
There are three methods for administering tube feedings: continuous, intermittent and bolus.intermittent can mean to only administer tube feeding at night, with solid foods eaten during the day.if there’s food-drug interaction such as with phenytoin.
The daily calorie needs of the client are usually divided into six servings per day. These feedings are given over a 15 minute time span and followed by 25 to 60 ml of water, hence the admin plus.
Usually the feedings are administered by a pump. this mean means the feeding is continuous during a 16 to 24 ml hour period .sometimes the formula is given at half strength at a rate of from 30to50ml per hour. This rate may be increased by about 25 ml every four hours until tolerance has been established. Once the client tolerates the half-strength formula, a full-strength form is initiated at the appropriate rate. When clients are ready to return to oral feedings the transfer must be done gradually.
The Client With Burns
In case of serious burns, the loss If skin surface leads to enormous losses of fluids, electrolytes, and proteins. Water moves from other tissues to the burn site in an effort to compensate for the loss but this only compound the problem. This fluid loss can reduce the blood volume and thus blood pressure, as well as urine output.
If the client Is able to eat, oral feedings are advisable. Liquid commercial formulas may be used at first and solid-solid food maybe add during the second week after the burn. If the client unable to eat, tube feedings should be started immediately .in some cases, parenteral feeding is required. The food served should be those the client likes and is willing to eat.
Burn client’s needed a great deal of encouragement, and know they face a long, costly and painful hospital stay with the possibility of surgery.