DIET THERAPY FOR SURGICAL CONDITIONS, BURN PATIENTS

NUTRITION | Lecture o SOFT DIET

▪ Mastication process decreases because
DIET THERAPY FOR SURGICAL CONDITIONS of the mechanically soft food, like
mashed potato, oatmeal, congee.
BREAKS IN SKIN INTEGRITY ▪ As long as the patient won’t chew and
• Skin is the first line of defense. won’t aspirate, then it’s goooooood.
• If there’s a break in the skin (scab, wound), the patient is at risk o DIET AS TOLERATED
for infection. o CL → GL → Soft Diet → Diet as Tolerated
• Poor pre-operative nutritional status has been linked to an • IRON
INCREASE in post-operative complications, poorer surgical o Because of blood loss.
outcome. o Red meat, dark green leafy vegetables.
o If patient is malnourished/undernourished, the • PROTEIN
problem/complications will be seen post-surgery. o For muscle repair, tissue repair.
o As RNs, our goal is for our patient to be • VITAMIN C
nutritionally prepared. o Increase immune system because of the short
breech of the system.
SURGERY STAGES AND ITS DIET o Helps with collagen formation (skin integrity).

PRE-OPERATIVE DIET
• Goal of preparing, anticipating nutrition loss during and DIET THERAPY FOR BURN PATIENTS
after the surgery.
• Nothing Per Orem (NPO) at least 6H–8H prior to surgery. TYPES OF BURNS
o 6H if -scopes (endoscopy, etc.)
o 8H if Gastrointestinal, etc. THERMAL
o NPO to prevent aspiration for the anesthesia. • CONTACT
• Gastrointestinal Surgeries o Hot, solid object.
o Preoperative nutrition support for MALNOURISHED • FLAME
patients 7–14 days prior to surgery. o Direct contact with flame.
▪ Malnourished patients cannot be • SCALD
operated on the next day because of o Healed liquid.
this complication. o Usual burns in wards, especially in children.
▪ Sometimes they are put into enteral o Edema because of the shift in intracellular fluid to
nutrition to gain more weight faster. extracellular fluid.
o Low residue diets for scopes or visualization
▪ Doesn’t require fiber in the diet. NON-THERMAL
▪ “Don’t eat too much fruits and • CHEMICAL
vegetables because of fiber.” o Melting off of the epidermis using a certain
• You get the height and weight of the patient during the product in contact with the skin.
physical assessment for HCP to know the right amount of • ELECTRICAL
anesthesia for the surgery, as well as their BMI. o Outlets, gadgets, etc.
• RADIOACTIVE
o Breast radiation to prevent metastasis will have
the complication of radioactive burn.

CLASSIFICATIONS OF BURNS

POST-OPERATIVE DIET
• PROGRESSIVE DIET
o It will progress from NPO to the most basic diet,
which is clear liquid diet (CL).
o Water, clear broth, clear soup, as long as there’s
no milk in them.
o Since NPO pre-operative, peristaltic movement
decreases, which is why we need the CL.
o Auscultate for bowel sounds to determine the
peristaltic movement to tolerate the food.
▪ If present, you may give food.
▪ If absent, you shouldn’t give food.
o Flatus is the second sign
▪ Ambulate as tolerated.
▪ Milk can be given to the patient
already for general liquid diet (GL).
▪ Jelly can also be given.

EONDILLA, M. 2022
 DIET THERAPY FOR SURGICAL CONDITIONS, BURN PATIENTS

TOTAL BODY SURFACE AREA (%TBSA) NUTRITION THAT BURN PATIENTS NEED
• For burn patients, there is a higher risk in children because
they are more water than flesh. PROTEIN
• Water and important electrolytes are lost. • Lost in urine, wounds.
• Lost in increased gluconeogenesis
• FOOD SOURCES
o Lean meats: Beef, pork, chicken, salmon
o Eggs, Greek yoghurt, beans, lentils, chick peas,
almonds, legumes

VITAMIN C
• Increases collage formation.
• Immune system function.

IMPACT OF BURNS TO NUTRITION

• Burns produce TISSUE DESTRUCTION that results to
CIRCULATORY and METABOLIC alterations in the patient.
• First 24-48H replace fluids and electrolytes
o Based on the patient’s age, weight, height, and
extent of the burn.
o Parenterally replaced, not orally.
• Burn wounds heal ONLY when patient is in anabolic state.
o Anabolism vs. catabolism
o Builds muscle mass, ergo needs more energy.
o Giving of muscle mass, ergo needs less energy.

NUTRITIONAL GOALS FOR BURN PATIENTS

• Support role of skin as a barrier against bacteria, viruses.
• Meet accelerated nutritional needs.
o You need calories because of the energy
requirement. It isn’t unusual that these patients have
3,000 calorie-diets. VITAMIN A
• Prevent micronutrient deficiency. • Promotes epithelialization.
o Food sources, supplements, etc. • Immune system function.
o Given through parenteral feeding (TPN) • FOOD SOURCES
o 1,400 / 1,800 / 2,500 calories in one bag. o Green and orange vegetables
• Prevent Curling’s ulcer in large burns over 30% of body o Carrots, lettuce, tomato, etc.
surface area.
o CURLING’S ULCER – ulcers in the GI tract caused
by burns. Because of acidotic environment, which
causes the ulcers.
o They counteract the acidic environment by giving
an antacid (basic), like MgO.
• Manage hyperglycemia.
o Optimum level is 140 to 180mg because the
patient needs the energy.
o Insulin requirement also increases because of this.
• Feeding should start after patient has been hydrated.
o NGT or TPN
• Enteral feedings should be initiated to prevent ileus, stress
ulcers, and effect of catabolism.
o ILEUS – absence of bowel/peristaltic movement.
▪ Build-up of food in the intestines
because it’s not digested properly.
▪ No air pockets, therefore compact food.
o STRESS ULCERS – CURLING’S ULCER
▪ Because of the acidic environment and
counteracted by the antacids.

EONDILLA, M. 2022