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Preoperative Nutritional Care and Nutritional

Considerations
Preoperative care is the preparation and management of a patient prior to surgery. This care
includes physical and psychological preparation.

Purpose

Patients who are physically and psychologically prepared for surgery tend to have better
outcomes after surgery.

Preoperative teaching meets the patient's need for information regarding the operating
experience, which in turn may improve most fears the patient has.

Knowing what to expect after the surgery and enlisting the patient's input about goals and
expectations, often helps the patient manage better with postoperative discomfort and
decreased mobility.

Preoperative care is extremely important prior to any aggressive procedure, regardless of

whether the procedure is minimally offensive or major operation.

Precautions

There are no contraindications to preoperative care. Even in a growing situation, the patient
must be physically prepared and should be prepared psychologically to the degree possible,
as indicated by the patient's physical status.

Since some people want as much information as possible while others want only the
minimum

For some patients, receiving too much information increases their anxiety. If the patient is
insensitive, emotional and emotional preparation should be focused on the family.

Preoperative teaching must be individualized for each patient. Patients have different abilities
in understanding medical procedures, if printed materials are used for teaching, the nurse
must discover the patient's literacy level in order to provide appropriate material.

The health care professional must maintain a balance between communicating essential
information and meeting the patient's information needs.
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Description

Preoperative care involves many components and may be done the day before surgery, in the
hospital, or during the weeks before surgery on an case basis.

Many surgical procedures are now performed in a day-surgery setting and the patient is never
admitted to the hospital.

Physical preparation

Such laboratory tests as CBC, electrolytes, prothrombin time, activated partial thromboplastic
time, or urinalysis may be done.

An EKG should be done if the patient has a history of cardiac disease or is over 50 years of
age.

A chest X-ray should be taken if the patient has a history of respiratory disease.

The patient should be assessed for risk factors that might impair healing, such as nutritional
cheatings, steroid use, radiation or chemotherapy, drug or alcohol abuse, or such metabolic
diseases as diabetes.

The patient should also provide a list of all medications, vitamins, and herbal or food
supplements that they use.

Some patients may be next from a sleeping pill the night before surgery.

Skin preparation can take the form of cleaning with a special soap or hair removal from the
operating area.

However, as of this printing (in 2001), shaving hair is no longer recommended because
studies show that shaving the area may increase the chance of infection. Instead, adhesive
barrier blinds can contain hair growth on the skin around the incision.

Psychological preparations

Patients are often fearful or restless about having surgery. Health care workers can help
decrease anxiety by listening to the patient's concerns, and answering the patient's questions
honestly. This responsiveness’ can be especially beneficial for patients who are critically ill.
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The family needs to be included in psychological preoperative carefulness as much as the

patient. Now the hospital, pastoral care can be offered.

If the patient expresses a fear of dying during surgery, this concern should not be discounted.
IN some cases, the procedure may be postponed until the patient feels more secure. Children
may be especially fearful.

They should be allowed to have a parent with them .Children should also be encouraged to
bring a favorite toy or blanket with them on the day of surgery. Preparing the patient and
family psychologically helps them to cope better with the patient's postoperative course.

Informed consent

Obtaining the patient's or protector’s written consent for the surgery is a vital portion of
preoperative care. By law, the physician who will perform the procedure must explain the
risks and benefits of the surgery.

However, the nurse is often the person who actually observers the patient's signature on the
consent form. Patients who are mentally impaired, heavily sedated, or critically ill are not
considered legally able to give consent. Children under age 18 must have a parent or guardian
sign.

Surgery

Surgery is a medical specialty that uses operative manual and instrumental techniques on a
patient to investigate or treat a extreme condition such as disease or injury, to help improve
bodily functions or appearance or to repair unwanted rupture areas.

Types

Required surgery

Urgent surgery

Main classes of surgery

Major

Are usually extensive and warrant an overnight or extended stay in a hospital. Include wide
work such as removing an organ, altering the body anatomy. Patient require anesthesia or
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respiratory assistanc.Tissue procedures, transplant procedures, operations in abdomen, and

chest

Minor

Biopsies, repair of small cuts, wound, hemorrhoids are examples of minor surgery.

Now days there are many surgery options available depending on an individual’s diagnosis.
They were non-emergency and planned in advance. Most cosmetic surgeries such as breast
implants or nose jobs are elective. Women sometimes choose to have elective cesarean birth.

Precautions
Two Weeks Prior to Surgery

1. NO ASPIRIN, IBUPROFEN or medicines as it interferes with blood clotting.

2. Please stop all diet pills whether prescription, over-the-counter or herbal as many will
interfere with anesthesia and can cause cardiovascular concerns.

3. No “mega doses” of vitamin E, but a multiple vitamin that contains E is just fine.

4. NO SMOKING because nicotine reduces blood flow to the skin and can cause
significant complications during healing.

5. You may take Tylenol or generic forms of this drug. These do not interfere with blood
clotting or curing.

6. Start taking a multivitamin each day and continue taking through your recovery. The
healthier you are, the quicker your recovery will be.

Night before Surgery & Morning

of Surgery:
1. DO NOT eat or drink anything (not even water) after midnight the night before your
operation.

2. If you are on regular medicines, please clear these with Doctor.

3. DO NOT apply any of the following to your skin, hair or face the morning of surgery
makeup, creams, lotions, hair gels, sprays, perfumes, powder, or deodorant. Using any of
these products will add bacteria to the skin and increase the risk of infection.

5. You may brush your teeth the morning of surgery but do not drink anything.
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6. DO NOT wear contacts to surgery. If you do wear glasses, bring your eyeglass case.

7. DO wear comfortable, loose clothes that do not have to be put on over your head. The
best thing to wear home is a button-up top and pull on pants. You will want easy-to-slip-on
flat shoes.

8. DO NOT bring any valuables or wear any jewels.

9. If you are not recovering at home, it is very important that we have the number where
you will be after surgery

Preoperative Nutritional Considerations

Objective

Nutritional assessment is an important component of the preoperative evaluation of surgical

patients. Patients at nutritional risk before surgery have an elevated risk of postoperative
complications. The goal of effective preoperative screening is to identify a high-risk patient
that ultimately decreases surgical morbidity. To that point, evidence suggests that providing
preoperative enteral nutrition to those at high risk reduces major postoperative morbidity by
50%.

Preoperative nutrition is a vital aspect of surgical care. The association between poor
nutritional status and repeatedly demonstrated for decade. The Joint Commission suggested
nutrition screening within 24 hours of admission on all inpatients followed by a complete
assessment for those considered high risk.

Traditional teaching in many surgical textbooks and training programs emphasized the use of
albumin as an important marker of nutritional status. Less than 3 is risk.

Nutritional risk and assessment in Preoperative Patients

Declining recent oral intake, an actual body weight of less than 90% of the ideal body weight,
BMI less than 18.5 or greater than 40, and weight loss greater than 5.0% in 1 month, 7.5% in
3 months, and 10% in 6 months indicate nutritional risk.
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Macronutrient Requirement in Preoperative Patients

 Additional 25 kcal/kg/day

 Carbohydrate ~70%

 Lipid 15-30%

 Protein 1.5-2.0g/kg/day.

Carbohydrates

Recommendation:

 100g carbohydrate the night before surgery

 50g carbohydrate the day of surgery

 Caloric Intake for:

 Mild stress, inpatient : 25-30 kcal/kg/day

 Moderate stress : 30-35 kcal/kg/day

 Severe stress. : 30-40 kcal/kg/day

 Preoperative carbohydrate loading often includes taking 800 mL of a 12.6% carbohydrate

beverage the night before surgery and 400 mL of a similar preparation 2 to 3 hours before
induction of anesthesia.
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Protein

In injured patient protein helps

 heal wounds

 support stress-induced acute-phase protein production

 account for the oxidative and catabolic losses produced from amino acid mobilization

Protein Intake varies among individuals. Patient should take 1-2 gm/kg/day.

Protein intake for:

 Mild stress : 1-1.2g/kg/day

 Moderate stress : 1.3-1.5g/kg/day

 Severe stress : 1.5-2.5g/kg/day

Fat

Omega-3 fatty acids (EPA, DHA) are polyunsaturated fatty acids that play a role in the
maintenance. Protein like meat, up to eight hours before surgery is suggested.

Minerals amount.

Nutrient Enteral route Parental route

Sodium 500mg 1-2mEq/kg

Potassium 2g 1-2mEq/kg

Calcium 1200mg 5-7.5mEq/kg

Magnesium 420mg 4-10mEq/kg

Two to three days before the surgery.

According to research, researcher discovered that even tiny amount of SGAS slows the
metabolism of certain anesthetic and muscle relaxants and increases recovery time following
surgery. Eat regular balanced diet with lean protein, such as chicken or fish , low dairy fat,
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whole grain and fruits and vegetable. Foods that are easily and quickly digested include fruit
juices and water and non-starchy vegetables.

Day before the surgery.

Patient should take enriched grains as these foods move through the digestive tract quicker
than their whole grain counterparts. A simple diet a day before surgery include a bowl of
cereal and orange juice for breakfast, chicken noodle soup with white dinner roll for lunch,
and chicken with mashed potatoes for dinner.

Patient can take clear liquid up to two hours before surgery. Approved liquids are water,
coffee, or tea without milk, fruit juices without pulp, soft drinks and sports drinker nausea
patient should not eat any solid food or dairy after midnight prior to surgery

Food to recommend

Fruits and beans, grains, oil, nuts, butter, milk and cheese, fish, beef, poultry and dairy
products

Avoid food

Alcohol, solid food, diary items. Etc.

Conclusion

• Nutrition is a powerful determinate of patient outcome

• The proper provision of nutrition is a component of basic patient care

References

1. McClave SA, et al. Guidelines for the provision and assessment of nutrition support
therapy in the adult critically ill patient: SCCM and American Society for Parenteral
and Enteral Nutrition (A.S.P.E.N. JPEN J Parenter Enteral Nutr 2018;33(3): 277–316

2. The Impact of Preoperative Underweight Status on Postoperative Complication and

Survival Outcome,Bochao Z,26 Jan 2019.