Surgery

Nutritional Care Plan

Surgery (Gastrectomy with intestinal resection)

Gastrectomy is surgery to remove part or all of the stomach. -If only part of the stomach is removed, it is called partial gastrectomy. - If the whole stomach is removed, it is called total gastrectomy.

Surgery (Gastrectomy with intestinal resection)

Depending on what part of the stomach was removed, the intestine may need to be re-connected: - to the remaining stomach (partial gastrectomy) - or to the esophagus (total gastrectomy)

The stomach connects the esophagus to the small intestine, and functions to break up food into small particles that can be absorbed by the small intestine.

In cases of chronic stomach problems (such as ulcers), obesity or cancer, partial or total removal of the stomach may be indicated.

An incision is made in the skin over the pyloric region of the stomach.

The diseased portion of the stomach is removed. The small intestine is attached to the remainder of the stomach to maintain the integrity of the digestive tract.

The patient will be on nasogastric tube suction to keep the stomach empty and at rest after surgery.

After several days and when the stomach starts to function normally again the tube will be removed and the patient will begin ingesting clear liquids and gradually progress to a full and normal diet.

Assessment
Anthropometric:
The patient stands 53. The patients desirable body weight (DBW) is 54 kg.

Pre-operative
Diet Rx:
30 kcal/kgBW 30 x 54 = 1620 ~ 1600 kcal

Sample Menu (Clear Liquid Diet)

Meal Food items

Breakfast

Coffee Gelatin Fish broth (strained)

Fruit ice Tea Chicken broth (strained) Orange gelatin Apple juice (strained) Ice popsicle Mango juice Grape juice (strained) Bouillon (strained, fat-free) Lemon gelatin Tea Gelatin

AM snack Lunch

PM snack Dinner

Midnight Snack

Post-operative
Diet Rx: 32 kcal/kgBW 32 x 54 = 1728 ~ 1700 kcal TER: 1700 kcal 54 (DBW) x 2.2 (high CHON) = 118.8 ~ 120 g 120 x 4 = 480 (CHON calories) 1700 (TER) 480 = 1220 (Non CHON calories) 1220 x 0.55 = 671 4 = 167.75 ~ 170 g 1220 x 0.45 = 549 9 = 61 ~ 60 g Diet Rx: 1700 kcal C170g P120g F60g

Full liquid diet

If after hospital discharge, clear liquids are tolerated by the patient without: - nausea - vomiting - pain - gas or bloating, the patient is to move to full liquids.

Sample Menu (Full Liquid Diet)

Meal Breakfast Food items Milk Pureed strained lugao Soft-cooked egg Cream of corn soup (strained) Apple juice Plain ice cream Orange gelatin Onion soup Pureed strained lugao Soft-cooked egg Lime gelatin Tea

AM snack

Lunch

Sample Menu (Full Liquid Diet)

Meal PM Snack Dinner Food items Plain yogurt Soft custard Pureed carrots Strained rice gruel Creamed soup with chicken Mango juice Sherbet Cereal beverage

Midnight Snack

Dumping syndrome
Occurs when the contents of the stomach empty too quickly into the small intestine.
The partially digested food draws excess fluid into the small intestine causing: -nausea-cramping -diarrhea -sweating -faintness and palpitations. Dumping usually occurs after the consumption of too much simple or refined sugar in people who have had surgery to modify or remove all or part of the stomach.

Diagnosis
Altered GI function related to intestinal resection as evidenced by medical history and dumping syndrome symptoms displayed

Objectives Short-term:

Intervention
Plan Prescribe a diet: 1700 kcal C155g P120g F70g Follow prescribed diet for post-gastrectomy. Provide enough rest for the patient. Provide foods high in protein. Provide foods rich in Vitamin B12, iron, folate and calcium.

The patient will meet his daily nutritional requirements. The patient will recover from the surgery.

Micronutrient deficiencies will be prevented. Long term:

Symptoms of dumping syndrome will be prevented.

Provide six small meals daily. Limit the patients fluids to about 4 ounces (1/2 cup) during meals. Provide drinks 30 to 45 minutes before eating and 1 hour after eating.

Intervention
Objectives Plan

Symptoms of dumping syndrome will be prevented.

Encourage the patient to rest or lie down for 15 minutes after a meal. Advise the patient to avoid sweets and sugars and limit intake of simple carbohydrates. Avoid preparing very hot or cold liquids for the patient. Ask the patient to stay away from acidic foods.

The patient will attain his desirable body weight.

Post-gastrectomy diet
To prevent complications of dumping syndrome

Calculations
TER: 1700 kcal
54 (DBW) x 2.2 (high CHON) = 118.8 ~ 120 g 120 x 4 = 480 (CHON calories) 1700 (TER) 480 = 1220 (Non CHON calories) 1220 x 0.50 (low CHO) = 610 4 = 152.5 ~ 155 g 1220 x 0.50 = 610 9 = 67.78 ~ 70 g Diet Rx: 1700 kcal C155g P120g F70g

Translate Diet Rx to Exchange

Diet Rx: 1700 kcal C155g P120g F70g
Food List Veg A Veg B Fruit Milk Sugar Rice No. of exchange CHO (g) PRO (g) Fat (g) Energy (kcal)

Meat
Fat TOTAL

Distribute Exchange to Meals

Food List Veg A Veg B Fruit Milk Breakfast AM Snack Lunch PM Snack Supper Midnight Snack Total

Sugar
Rice Meat Fat TOTAL

One-day Sample Meal Plan

Meal/ Time Food List Milk Rice Lunch Fruit Veg A Meat (LF) Rice 1 2 No. of exchange 1 1 1 1 Banana, lakatan Sample Menu Ripe Papaya Evaporated milk HH Measure 1 cup Wt (g) Breakfast Fruit

Tinolang Manok Chayote Sili leaves

Chicken breast Rice, boiled 1 cup

Monitoring and Evaluation

The patient should be checked for any symptom of dumping syndrome. A 24-hour food recall should be conducted to monitor the patients intake. The patients weight will be obtained to check if desirable body weight is achieved.

References
MedlinePlus. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/a rticle/002945.htm MedlinePlus. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/i magepages/19830.htm MedlinePlus. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/p resentations/100022_1.htm