Organised By
Organised By
BACKGROUND
The initiation of feeding through Jejunostomy is the best way for major surgery of laparotomy because small bowel would be normally functioning compared to gastric and colonic. However, Parenteral Nutrition will be needed if complications arise.
CLIENT HISTORY
Mr. TGM is 46 years old Chinese man. He was married. He had been diagnosed with Gastric Adenocarcinoma that was then admitted for a Subtotal Gastrectomy. He has the underlying of End Stage Renal Failure, Gout, Hypertension and Triple-vessel disease. He underwent the Percutaneous Coronary Intervention in 2015.
ASSESSMENT
He is overweight with BMI of 28.2kg/m2. He has no edema neither difficulty of breathing. He has full GCS but looks tired. He recorded high value in all renal profiles because of end stage renal failure, low level of haemoglobin and the albumin. SGA was scored with Grade B during the follow-up visit. Dietary intake achieved only 496.5kcal/day and 21.9g/day through Jejunostomy continuous administration.
NUTRITION DIAGNOSIS
Enteral Nutrition Administration Inconsistent with needs related to physiological causes (Major Operation) as evidence by dietary intake. Energy: 496.5 kcal/day at 6.6 kcal/IBW and protein 21.9g/day at 0.29g/IBW.
OBJECTIVE & NUTRIENT PRESCRIPTION
Goal;
1. To provide adequate energy and protein intake in order to prevent any weight loss and complications of surgery.
Energy prescribe: 2 244kcal/day (30 kcal/IBW/day) (ASPEN,2006)
Protein : 89.8g/day (1.2g/IBW/day) (ASPEN, 2010)
OUTCOME & FOLLOW UP
Complication was arisen once the feeding rate was increased. Patient recorded with high gastric volume that reflects the anastomosis leakage. TPN was administered for 6 days. The gastric volume successfully decreased and anastomosis leakage resolved. The EN was restarted. However, the patient was overfed that later, results in hypergylcemia.
DISCUSSION
Post-Pyloric tube feeding is administered to the patient with Major laparotomy as anastomosis in stomach, small bowel will be more vulnerable compared to the lower gastrointestinal region. (Stroud, Duncan, Nightingale, 2003)
Parenteral Nutrition is administered to the patient who has high intestinal output to maintain continuous adequacy of nutrition (ESPEN, 2009)
Overfeeding may lead to other complications including hyperglycemia (ESPEN, 2006)
LEARNING POINTS/ TAKE HOME MESSAGES
1. Sufficient intake of energy and protein enhance healing and prevent any weight loss.
2. Overfeeding may associated with worse outcome.