CHAPTER ONE
INTRODUCTION
- Background of the Study
Nutritional modification plays a central role for a wide range of patients. Surgical patients’ nutritional status is believed to be an important factor determining surgical outcome. The ultimate aim of nutritional modification is to reduce the risk of negative protein balance by avoiding starvation, thereby preserving muscle, immune, and cognitive function and improving postoperative recovery (Bozzettiet al. 2016). Patients undergoing a surgical procedure face many metabolic and physiological challenges that may compromise nutritional status. In the case of most surgeries, patients are able to eat after surgery and do not need artificial nutrition. However, major operation or complications after surgery can delay the administration of oral nutrition. Nutritional requirement are often increased in such patients to aid healing of wounds and hypermetabolism related with postoperative recovery. Nurses are highly involved in tasks in connection with nutrition. They perform malnutrition or obesity risk screenings, assess the need for nutrition and specialized diet, order and distribute food with hospital assistants, help patients eat if necessary, get feedback from patients and they are aware of dietary guidelines (Parket al. 2012).
According to Rautiainenet al. (2012), there were more than 290 000 surgical patients in Finland in 2012; most of them were treated on orthopedic and gastroenterological wards. The word patient refers to individuals who get care. A Dictionary of Nursing defines surgery as a branch of medicine that treats conditions by operation or manipulation. Summarizing the two definitions, we can say surgical patients are individuals undergoing or recovering from surgery. In this work we concentrate on surgical hospital patients and exclude day-surgery patients. Nutrition means the intake of nutrients and their absorption by the body. Nutritional imbalance means having too much or too little of one or more crucial nutrients. If patients receive too few nutrients it can lead to malnutrition, while too much will result in over nutrition (Smeltzeret al. 2014).
International studies estimate the prevalence of malnutrition among surgical patients to be in the range 27–52%. Nutritional depletion or malnutrition has been proven to be a critical determinant in the development of postoperative complications in contributing to high morbidity and mortality following surgery. Poor nutrition is related to changes in body composition, tissue breakdown and weakened organ function, which result in the impairment of the immune system and muscle functions. Thus, patients lacking the access to good nutrition are at great risk of infections and cardiorespiratory complications. (Ward, 2013.)
Nutrition can be enteral or parenteral. Enteral nutrition is delivering nutrients to the intestines. In current surgical practices it is advised to encourage patients to eat normal food within 1-3 days after surgery. Not all the patients are able or allowed to eat after the surgery, in these cases tube feeding is introduced. Tube feeding refers to delivering nutrients via nasogastric and mesenteric tubes and also to gastrostomies (Smeltzeret al. 2014). The most common patient groups who require tube feeding are patients with gastrointestinal disorders, patients receiving cancer treatment, patients recovering from trauma, surgeries or severe illnesses, coma patients, mentally ill patients or patients with conditions affecting the mouth, neck, oropharynx or esophagus (Smeltzeret al. 2014). The European Society for Clinical Nutrition and Metabolism (ESPEN) Guidelines for adult parenteral nutrition states that enteral nutrition is usually contraindicated in case of bowel obstruction, malabsorption, multiple fistulas with high output, intestinal ischemia, severe shock and acute sepsis. Patients who are not able to achieve their calorie requirements within 7-10 days after surgery orally or enterally are recommended to receive parenteral nutrition. Parenteral nutrition is the other option to supply the body with nutrients. Parenteral nutrition means providing nutrients for the body via intravenous route. However, enteral nutrition is always considered first before introducing parenteral nutrition; yet there are some situations when intravenous nutrition becomes necessary. These are loss of 10% of body weight during an illness, not being able to take in food or drinks eternally within 7 days after a surgery or suffering from serious hyper catabolic conditions. (Smeltzeret al. 2014)