NUTRITION IN SURGICAL CONDITIONS: NUTRIENT REQUIREMENTS
Energy, protein, and ascorbic acid are major needs for rapid wound healing-and convalescence from surgery.
Energy
If the caloric intake is inadequate, protein will be used to supply energy rather than for wound repair and tissue building. Even very small amounts of glucose as in a parenteral feeding can have some protein-sparing effect. The caloric requirements are very high when there is fever or in patients with severe burns.
Protein
Protein is essential for normal wound healing, to protect the liver against possible injury, and to increase the resistance to infection. For well-nourished individuals a normal protein intake is adequate. When there has been malabsorption, or following severe injury, the protein need may be well over 100 gm daily.
Fluid-electrolyte balance
Each day a significant amount of fluid is lost from the body. Ordinarily this is replaced not only by beverages but also by the food intake. In surgical procedures the losses are further increased through exudates, hemorrhage, and vomiting. The intake is usually decreased because of inability to eat.
Fluid and electrolyte imbalances must be corrected prior to surgery because of the great risks that accompany dehydration and acidosis. Fluids are given orally and parenterally as indicated. Subsequent to surgery parenteral fluids are given until the patient can take satisfactory amounts of fluids and food by mouth. The nurse should note the total intake and excretion of fluid.
Vitamins
Ascorbic acid is especially important for wound healing. The surgeon sometimes prescribes a supplement in addition to the vitamin С provided by the diet. Vitamin К is also of special concern. Failure to synthesize vitamin К in the intestine may occur when antibiotics are given; or the liver may be unable to convert vitamin К to prothrombin. Either deficiency increases the likelihood of abnormal bleeding. When the caloric requirements are greatly increased, as in burns, there is a corresponding increase in the need for B-complex vitamins.
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GENERAL HEALTH
