Nutrition as a branch of medical science has always been thought of belonging the realms of dieticians and their kitchens. Little do surgeons realize that the recovery of a patient after a major surgical insult is more dependent on the internal resources of the body than on external factors like antibiotics, etc. A nutritionally deprived patient cannot mount an adequate response against infection and the surgical outcome is hence likely to be sub-optimal. Complications such as intestinal anastomosis leakage, wound dehiscence and overwhelming sepsis are more common in patients with malnutrition. Institution of proper nutrition therapy, at the correct time, along with antibiotics and other supportive therapy will often tip the balance in favor of the patient. Gone are the days when adequate nutritional support was synonymous with a special diet being sent up from the hospital kitchen. Newer modalities like parenteral nutrition and enteral tube nutrition have revolutionized nutritional s
of the Study
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
(Bozzetti et al.
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 (Park et al.
to Rautiainen et al.
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 (Smeltzer et al.
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.)
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 (Smeltzer et
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 (Smeltzer et 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. (Smeltzer et al.