hnf41 presentation surgery

7/31/2019 Hnf41 Presentation Surgery

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Surgery (Gastrectomy withintestinal resection)

Gastrectomy is surgery to remove part orall of the stomach.

-If only part of the stomach is removed,it is called partial gastrectomy.

- If the whole stomach is removed, it iscalled total gastrectomy.


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The stomach connects the esophagus tothe small intestine, and functions to breakup food into small particles that can beabsorbed by the small intestine.


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In cases of chronic stomachproblems (such as ulcers), obesity orcancer, partial or total removal of thestomach may be indicated.


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An incision is made in the skinover the pyloric region of thestomach.


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The diseased portion of the stomach isremoved. The small intestine is attached tothe remainder of the stomach to maintain theintegrity of the digestive tract.


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

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


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Pre-operative

Diet Rx:

30 kcal/kgBW

30 x 54 = 1620 ~ 1600 kcal


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Sample Menu (Clear Liquid Diet)Meal Food items

Breakfast Coffee

GelatinFish broth (strained)

AM snack Fruit ice

Lunch TeaChicken broth (strained)

Orange gelatinApple juice (strained)

PM snack Ice popsicleMango juice

Dinner Grape juice (strained)

Bouillon (strained, fat-free)Lemon gelatin

Midnight Snack TeaGelatin


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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 ~ 120g

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


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Full liquid diet

If after hospital discharge, clear liquids aretolerated by the patient without:

- nausea - vomiting - pain - gas orbloating,

the patient is to move to full liquids.


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Sample Menu (Full Liquid Diet)Meal Food items

Breakfast MilkPureed strained lugaoSoft-cooked egg

AM snack Cream of corn soup (strained)Apple juice

Plain ice creamOrange gelatin

Lunch Onion soupPureed strained lugaoSoft-cooked eggLime gelatinTea


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Sample Menu (Full Liquid Diet)

Meal Food items

PM Snack Plain yogurtSoft custard

Dinner Pureed carrotsStrained rice gruelCreamed soup with chickenMango juice

Midnight Snack SherbetCereal beverage


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Dumping syndrome

Occurs when the contents of thestomach empty too quickly into thesmall intestine.

The partially digested food drawsexcess fluid into the small intestine

causing:

-nausea-cramping-diarrhea-sweating-faintnessand palpitations.

Dumping usually occurs after theconsumption of too much simple orrefined sugar in people who have had

surgery to modify or remove all or partof the stomach.


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InterventionObjectives 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 sweetsand sugars and limit intake of simplecarbohydrates. Avoid preparing very hot or coldliquids for the patient.

Ask the patient to stay away fromacidic foods.

The patient will attain his desirablebody weight.


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Post-gastrectomy diet

To prevent complications of dumpingsyndrome


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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


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Translate Diet Rx to ExchangeDiet Rx: 1700 kcal C155g P120g F70g

Food List No. ofexchange

CHO(g)

PRO(g)

Fat(g)

Energy(kcal)

Veg A

Veg B

Fruit

Milk

Sugar

Rice

Meat

Fat

TOTAL


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Distribute Exchange to Meals

FoodList

Breakfast AMSnack

Lunch PMSnack

Supper MidnightSnack

Total

Veg A

Veg B

FruitMilk

Sugar

Rice

Meat

Fat

TOTAL


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Monitoring and Evaluation

The patient should be checked for anysymptom of dumping syndrome.

A 24-hour food recall should be conductedto monitor the patients intake.

The patients weight will be obtained to

check if desirable body weight is achieved.


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References

MedlinePlus. Retrieved fromhttp://www.nlm.nih.gov/medlineplus/ency/article/002945.htm

MedlinePlus. Retrieved fromhttp://www.nlm.nih.gov/medlineplus/ency/imagepages/19830.htm

MedlinePlus. Retrieved fromhttp://www.nlm.nih.gov/medlineplus/ency/presentations/100022_1.htm
http://www.nlm.nih.gov/medlineplus/ency/article/002945.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002945.htmhttp://www.nlm.nih.gov/medlineplus/ency/imagepages/19830.htmhttp://www.nlm.nih.gov/medlineplus/ency/imagepages/19830.htmhttp://www.nlm.nih.gov/medlineplus/ency/presentations/100022_1.htmhttp://www.nlm.nih.gov/medlineplus/ency/presentations/100022_1.htmhttp://www.nlm.nih.gov/medlineplus/ency/presentations/100022_1.htmhttp://www.nlm.nih.gov/medlineplus/ency/presentations/100022_1.htmhttp://www.nlm.nih.gov/medlineplus/ency/imagepages/19830.htmhttp://www.nlm.nih.gov/medlineplus/ency/imagepages/19830.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002945.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002945.htm

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