Keast and Orsted wittily state, “Best practice requires the assessment of the whole patient, not just the hole in the patient. All possible contributing factors must be explored.”
QUICKER RECOVERY –ROLE OF NUTRITION• Tissue repair results in increased cellular activity, which causes an intensified metabolic demand for nutrients.• Nutritional deficiencies can impede wound healing, and several nutritional factors required for wound repair may improve healing time and wound outcome.
Factors which Impede Tissue Healing hypoxia, infection, tumors, metabolic disorders such as diabetes mellitus, the presence of debris and necrotic tissue, certain medications. a diet deficient in protein, vitamins, or minerals. In addition, increased metabolic demands are made by the inflammation and cellular activity in the healing wound, which may require increased protein or amino acids, vitamins, and minerals
Phases of wound healingWound Hemostasis Inflammatory Proliferative Remodeling
NUTRITION IN HEALING• Wounding•• Hemostasis• Drugs, herbs, vitamins, amino acids, or minerals that effect blood-clotting• mechanisms should be avoided prior to surgery.• Inflammatory Phase• Vitamin A – enhances early inflammatory phase• Bromelain and adequate protein intake – prevent prolonging inflammatory phase• Vitamin C – enhances neutrophil migration and lymphocyte transformation• Proliferative Phase• Vitamin C – necessary for collagen synthesis• Calcium, Magnesium , Phosphorus• Glucosamine – enhances hyaluronic acid production• Vitamin A – promotes epithelial cell differentiation• Zinc – required for DNA synthesis, cell division, and protein synthesis•• Remodeling• Protein deficiency – inhibits wound remodeling•
Patient Recovery and healing – Nutrition components• 1. Glutamine• This is an amino acid (one of the building blocks of protein) that generally comes in a tasteless powder form. It can be mixed into water or juice. Use about 1/4 teaspoon of powder for each dose, two to three times daily. Glutamine supplementation can start as soon as a patient can eat solid foods, which generally means about 12-14 hours post-surgery.• 2. Omega-3 fatty acids• The best source of omega-3s is natural, which should be taken daily. This should wait till about two to three days after surgery to ensure it does not interfere with normal blood clotting. Patients can eat flaxseeds , walnuts and pumpkin seeds as they are also sources of omega-3s.• 3. Probiotics• Lately, probiotics are getting lots of attention as friendly bacteria that help keep bad bacteria and fungi under control. when these colonies are disrupted (for example, by antibiotic use), it can cause intestinal problems Patients can eat yogurt daily (which contains friendly acidophilus and/or lactobacillus bacteria), or take a probiotic supplement. Dont consume probiotics within two hours of an antibiotic. If the patient is on intravenous antibiotic, wait until she transitions to oral antibiotics.
• 4. Antioxidants• Best consumed in food; studies suggest that antioxidants in a tablet/ capsule dont work in a capsule form , possibly because they work synergistically with other flavanoids and chemical compounds present in the natural state . Consume lots of fruit and veggies, especially dark leafy greens, citrus, berries and cherries.• 5. Fiber• Painkiller medications tend to cause constipation,so keep fiber intake high with whole grains and fruits/veggies, plus a psyllium supplement (such as Metamucil) if things are really slow.• 6. Protein• Other amino acids besides glutamine are involved in wound healing and tissue regeneration, so ensure an adequate intake of easy to digest protein: lentil soups and steamed sprouts , eggs or egg whites , low-fat dairy and soy products.• 7. Glucosamine sulfate• Glycosamingens are well established in the literature for the repair of connective tissue. Aim for approximately 1500 milligrams daily.• 8. Turmeric• Turmeric is a potent antioxidant, anti-inflammatory, and antibiotic that is getting a lot of attention lately in research. It can be taken in capsule form.••••
Research establishes the benefits of Post Surgical Nutrition Support• Nutritional support leads to improved nutritional status and clinical outcome in severely depleted patients . Studies of postoperative nutritional support have demonstrated reduced morbidity and reduced length of hospital stay . There is also evidence that artificial nutritional support in malnourished patients is cost effective by reducing the costs associated with length of stay and morbidity and improved quality of life • References(11) Beier-Holgersen SR, Boesby S: Influence of postoperative enteral nutrition on post surgical infections.• Gut 1996, 39:833-5. Pubmed Abstract(12 ) Askanazi J, Starker PN, Olsson C, Hensle TW, Lockhart SH, Kinney JM, Lasala PA: Effect of immediate post-operative nutritional support on the length of hospitalisation.• Ann Surg 1986, 203:236-9. Pubmed Abstract(13) Robinson G, Goldstein M, Levine G: Impact of nutritional status on DRG length of stay.