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The stomach connects the esophagus to the small intestine, and functions to break up food into small particles that can be absorbed by the small intestine.
In cases of chronic stomach problems (such as ulcers), obesity or cancer, partial or total removal of the stomach may be indicated.
An incision is made in the skin over the pyloric region of the stomach.
The diseased portion of the stomach is removed. The small intestine is attached to the remainder of the stomach to maintain the integrity of the digestive tract.
The patient will be on nasogastric tube suction to keep the stomach empty and at rest after surgery.
After several days and when the stomach starts to function normally again the tube will be removed and the patient will begin ingesting clear liquids and gradually progress to a full and normal diet.
Assessment
Anthropometric:
The patient stands 53. The patients desirable body weight (DBW) is 54 kg.
Pre-operative
Diet Rx:
30 kcal/kgBW 30 x 54 = 1620 ~ 1600 kcal
Breakfast
AM snack Lunch
PM snack Dinner
Midnight Snack
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 ~ 120 g 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
AM snack
Lunch
Midnight Snack
Dumping syndrome
Occurs when the contents of the stomach empty too quickly into the small intestine.
The partially digested food draws excess fluid into the small intestine causing: -nausea-cramping -diarrhea -sweating -faintness and palpitations. Dumping usually occurs after the consumption of too much simple or refined sugar in people who have had surgery to modify or remove all or part of the stomach.
Diagnosis
Altered GI function related to intestinal resection as evidenced by medical history and dumping syndrome symptoms displayed
Objectives Short-term:
Intervention
Plan Prescribe a diet: 1700 kcal C155g P120g F70g Follow prescribed diet for post-gastrectomy. Provide enough rest for the patient. Provide foods high in protein. Provide foods rich in Vitamin B12, iron, folate and calcium.
The patient will meet his daily nutritional requirements. The patient will recover from the surgery.
Provide six small meals daily. Limit the patients fluids to about 4 ounces (1/2 cup) during meals. Provide drinks 30 to 45 minutes before eating and 1 hour after eating.
Intervention
Objectives Plan
Encourage the patient to rest or lie down for 15 minutes after a meal. Advise the patient to avoid sweets and sugars and limit intake of simple carbohydrates. Avoid preparing very hot or cold liquids for the patient. Ask the patient to stay away from acidic foods.
Post-gastrectomy diet
To prevent complications of dumping syndrome
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
Meat
Fat TOTAL
Sugar
Rice Meat Fat TOTAL
References
MedlinePlus. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/a rticle/002945.htm MedlinePlus. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/i magepages/19830.htm MedlinePlus. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/p resentations/100022_1.htm