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Evidence-Based Practices in Enteral and Parenteral Nutrition in Surgical Patients and Nursing Care

Yıl 2019, Sayı: 7, 714 - 731, 30.04.2019
https://doi.org/10.38079/igusabder.546979

Öz

Malnutrition is a major problem in surgery patients. Patients undergoing surgery face many physiological and metabolic changes that may affect nutritional status. Postoperative pain, nausea, vomiting, and anorexia may problem those performing even minor operations, but infection, wound healing and catabolism may create more difficulties for patients after major surgeries. These problems are more important for surgical patients with nutritional deficiencies. Patients who are undernourished have a high risk of postoperative complications and death. Malnutrition can adversely affect the functioning of many organ systems such as the gastrointestinal tract, kidneys, heart, and lungs. In these patients, muscle strength and immune function are also damaged and more vulnerable to infections. Wound healing, mobilization and postoperative recovery time are delayed. All these elements can cause to length of hospital stay, higher readmission rates, and rising healthcare costs. Nutrition can be administered orally, enterally and parenterally according to the patient's medical condition and needs. Enteral and parenteral nutrition should be provided if the oral route is not available. Early oral feeding is the preferred form of nutrition for patients in the postoperative period. Enteral nutrition is more preferred than parenteral nutrition as it protects gastrointestinal function and increases blood flow. It is every nurse’s duty to provide that patients take access to safe, proper and enough nutrition and fluids in postoperative time. In this review, evidence-based practices of enteral and parenteral nutrition before and after surgery and nursing care were evaluated. 

Kaynakça

  • Koçhan E, Akın S. Hemşirelerin enteral ve parenteral beslenme uygulamalarına ilişkin bilgi düzeylerinin değerlendirilmesi. JAREN. 2018;4(1):1-14. doi: 10.5222/jaren.2018.001.
  • Sauer AC, Goates S, Malone A, et al. Prevalence of malnutrition risk and the impact of nutrition risk on hospital outcomes: results from nutrition day in the U.S. J Parenter Enteral Nutr. 2019:1-9. doi: 10.1002/jpen.1499.
  • Gillis C, Carli F, Phil M. Promoting perioperative metabolic and nutritional care. Anesthesiology. 2015;123(6):1455-1472. doi: 10.1097/ALN.0000000000000795.
  • Abunnaja S, Cuviello A, Sanchez JA. Enteral and parenteral nutrition in the perioperative period: state of the art. Nutrients. 2013;5(2):608-623. doi: 10.3390/nu5020608.
  • Torgersen Z, Balters M. Perioperative nutrition. Surg Clin North Am. 2015;95(2):255-267. doi: 10.1016/j.suc.2014.10.003.
  • Gonçalves LB, Jesus NMT, Gonçalves MB, Dias LCG, Deiro TCBJ. Preoperative nutritional status and clinical complications in the postoperative period of cardiac surgeries. Braz J Cardiovasc Surg. 2016;31(5):371-380. doi: 10.5935/1678-9741.20160077.
  • Wong S, Aly EH. The effects of enteral immunonutrition in upper gastrointestinal surgery: A systematic review and meta-analysis. Int J Surg. 2016;29:137-150. doi: 10.1016/j.ijsu.2016.03.043.
  • Pash E. Enteral nutrition: options for short-term access. Nutr Clin Pract. 2018;33(2):170-176. doi: 10.1002/ncp.10007.
  • Akça NK, Taşçı S. Beslenme ve ilişkili bozukluklar. In: Aslan FE, Olgun N, eds. Fizyopatoloji. Ankara: Akademisyen Tıp Kitabevi; 2017.
  • Kozeniecki M, Fritzshall R. Enteral nutrition for adults in the hospital setting. Nutr Clin Pract. 2015;30(5):634-651. doi: 10.1177/0884533615594012.
  • Ojo O, Brooke J. Recent advances in enteral nutrition. Nutrients. 2016;8(11):709. doi: 10.3390/nu8110709.
  • Pakyüz ÇS, Özbayır T. Mide ve duedonum hastalıkları. In: Karadakovan A, Aslan FE, eds. Dahili ve Cerrahi Hastalıklarda Bakım. 4. baskı. Ankara: Akademisyen Tıp Kitabevi; 2017.
  • Wang G, Chen H, Liu J, Ma Y, Jia H. A comparison of postoperative early enteral nutrition with delayed enteral nutrition in patients with esophageal cancer. Nutrients. 2015;7(6):4308-4317. doi: 10.3390/nu7064308.
  • Harvey SE, Parrott F, Harrison DA, Bear DE, Segaran E, Beale R. Trial of the route of early nutritional support in critically ill adults. N Engl J Med. 2014;371(18):1673-1684. doi: 10.1056/NEJMoa1409860.
  • Elke G, Zanten ARH, Lemieux M, et al. Enteral versus parenteral nutrition in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials. Crit Care. 2016;20(1):117. doi: 10.1186/s13054-016-1298-1.
  • Hallay J, Nagy D, Fülesdi B. Indications and practice of enteral nutrition. Orv Hetil. 2014;155(51):2028-2033. doi: 10.1556/OH.2014.30066.
  • Gürkan A, Gülseven B. Enteral beslenme: bakımda güncel yaklaşımlar. Anadolu Hemşirelik ve Sağlık Bilimleri Dergisi. 2013;16(2):116-120.
  • Sivrikaya SK, Eryılmaz A. Nutrisyonel destek ekibinde hemşirelik. Samsun Sağlık Bilimleri Dergisi. 2018;3(2):33-37.
  • Singer P, Blaser AR, Berger MM, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019;38(1):48-79. doi: 10.1016/j.clnu.2018.08.037.
  • Douglas L, Nguyen, MD. Guidance for supplemental enteral nutrition across patient populations. Am J Manag Care. 2017;23(12):210-219.
  • Tavares de Araujo VM, Gomes PC, Caporossi C. Enteral nutrition in critical patients; should the administration be continuous or intermittent? Nutr Hosp. 2014;29(3):563-567. doi: 10.3305/nh.2014.29.3.7169.
  • Girolamo FG, Situlin R, Fiotti N, Biolo G. Intermittent vs. continuous enteral feeding to prevent catabolism in acutely ill adult and pediatric patients. Curr Opin Clin Nutr Metab Care. 2017;(5):390-395. doi: 10.1097/MCO.0000000000000397.
  • McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically Ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2016;40(2):159-211. doi: 10.1177/0148607115621863.
  • Erdil F, Elbaş NÖ. Cerrahi Hastalıkları Hemşireliği. 7. baskı Ankara: Aydoğdu Yayınevi; 2016.
  • Triantafillidis JK, Papalois AE. The role of total parenteral nutrition in inflammatory bowel disease: current aspects. Scand J Gastroenterol. 2014;49(1):3-14. doi: 10.3109/00365521.2013.860557.
  • Gershengorn HB, Kahn JM, Wunsch H. Temporal Trends in the use of parenteral nutrition in critically Ill patients. Chest. 2014;145(3):508-517. doi: 10.1378/chest.13-1597.
  • Gosmanov AR, Umpierrez GE. Management of hyperglycemia during enteral and parenteral nutrition therapy. Curr Diab Rep. 2013;13(1):155‐162. doi: 10.1007/s11892-012-0335-y.
  • Ma J, Gao M, Pan P, et al. Hyperglycemia is associated with cardiac complications in elderly nondiabetic patients receiving total parenteral nutrition. Medicine (Baltimore). 2018;97(6):9537. doi: 10.1097/MD.0000000000009537.
  • McCulloch A, Bansiya V, Woodward JM. Addition of insulin to parenteral nutrition for control of hyperglycemia. JPEN J Parenter Enteral Nutr. 2018;42(5):846‐884. doi: 10.1177/0148607117722750.
  • Truong S, Park A, Kamalay S, et al. Glycemic control in adult surgical patients receivingregular insulin added to parenteral nutrition vs insulinglargine: A retrospective chart review. Nutr Clin Pract. 2019;1-8. doi: 10.1002/ncp.10252.
  • Boullata JI, Gilbert K, Sacks G, et al. A.S.P.E.N. clinical guidelines: parenteral nutrition ordering, order review, compounding, labeling, and dispensing. JPEN J Parenter Enteral Nutr. 2014;38(3):334-377. doi: 10.1177/0148607114521833.

Cerrahi Hastalarda Enteral ve Parenteral Beslenmede Kanıta Dayalı Uygulamalar ve Hemşirelik Bakımı

Yıl 2019, Sayı: 7, 714 - 731, 30.04.2019
https://doi.org/10.38079/igusabder.546979

Öz

Yetersiz beslenme, cerrahi hastalarında büyük bir sorundur. Ameliyat geçiren hastalar beslenme durumunu etkileyebilecek birçok fizyolojik ve metabolik değişikliklerle karşı karşıya kalırlar. Ameliyat sonrası ağrı, mide bulantısı, kusma ve iştahsızlık küçük ameliyatlarda bile sorun yaratabilirken enfeksiyon, yara iyileşmesi ve katabolizma büyük ameliyatlardan sonra hastalar için daha önemli problem oluşturabilir. Bu sorunlar beslenme yetersizliği olan cerrahi hastaları için daha önemlidir. Yetersiz beslenen hastalarda ameliyat sonrası komplikasyon ve ölüm riski fazladır. Beslenme yetersizliği gastrointestinal sistem, böbrekler, kalp ve akciğerler gibi birçok organ sisteminin çalışmasını olumsuz yönde etkileyebilir. Bu hastalarda kas kuvveti ve bağışıklık fonksiyonu da zarar görür ve enfeksiyonlara karşı daha savunmasızdırlar. Yara iyileşmesi mobilizasyon ve ameliyat sonrası iyileşme süresi gecikir. Tüm bu faktörler hastanede kalış süresinin uzamasına, daha yüksek geri kabul oranlarına ve artan sağlık masraflarına neden olabilir. Hastanın tıbbi durumu ve gereksinimlerine göre beslenme oral, enteral ve parenteral yoldan uygulanabilir. Erken oral beslenme ameliyat sonrası dönemde hastalar için tercih edilen beslenme şeklidir. Oral yolun kullanılamadığı durumlarda enteral ve parenteral beslenme desteği sağlanmalıdır. Enteral beslenme gastrointestinal fonksiyonları koruduğu ve kan akımını artırdığı için parenteral beslenmeden daha fazla tercih edilmektedir. Ameliyat sonrası dönemde hastaların güvenli, uygun ve yeterli beslenmeye ve sıvılara erişmesini sağlamak her hemşirenin görevidir. Bu derlemede ameliyat öncesi ve sonrası dönemde enteral ve parenteral beslenmeye ilişkin kanıtlar ve hemşirelik bakımı değerlendirilmiştir. 

Kaynakça

  • Koçhan E, Akın S. Hemşirelerin enteral ve parenteral beslenme uygulamalarına ilişkin bilgi düzeylerinin değerlendirilmesi. JAREN. 2018;4(1):1-14. doi: 10.5222/jaren.2018.001.
  • Sauer AC, Goates S, Malone A, et al. Prevalence of malnutrition risk and the impact of nutrition risk on hospital outcomes: results from nutrition day in the U.S. J Parenter Enteral Nutr. 2019:1-9. doi: 10.1002/jpen.1499.
  • Gillis C, Carli F, Phil M. Promoting perioperative metabolic and nutritional care. Anesthesiology. 2015;123(6):1455-1472. doi: 10.1097/ALN.0000000000000795.
  • Abunnaja S, Cuviello A, Sanchez JA. Enteral and parenteral nutrition in the perioperative period: state of the art. Nutrients. 2013;5(2):608-623. doi: 10.3390/nu5020608.
  • Torgersen Z, Balters M. Perioperative nutrition. Surg Clin North Am. 2015;95(2):255-267. doi: 10.1016/j.suc.2014.10.003.
  • Gonçalves LB, Jesus NMT, Gonçalves MB, Dias LCG, Deiro TCBJ. Preoperative nutritional status and clinical complications in the postoperative period of cardiac surgeries. Braz J Cardiovasc Surg. 2016;31(5):371-380. doi: 10.5935/1678-9741.20160077.
  • Wong S, Aly EH. The effects of enteral immunonutrition in upper gastrointestinal surgery: A systematic review and meta-analysis. Int J Surg. 2016;29:137-150. doi: 10.1016/j.ijsu.2016.03.043.
  • Pash E. Enteral nutrition: options for short-term access. Nutr Clin Pract. 2018;33(2):170-176. doi: 10.1002/ncp.10007.
  • Akça NK, Taşçı S. Beslenme ve ilişkili bozukluklar. In: Aslan FE, Olgun N, eds. Fizyopatoloji. Ankara: Akademisyen Tıp Kitabevi; 2017.
  • Kozeniecki M, Fritzshall R. Enteral nutrition for adults in the hospital setting. Nutr Clin Pract. 2015;30(5):634-651. doi: 10.1177/0884533615594012.
  • Ojo O, Brooke J. Recent advances in enteral nutrition. Nutrients. 2016;8(11):709. doi: 10.3390/nu8110709.
  • Pakyüz ÇS, Özbayır T. Mide ve duedonum hastalıkları. In: Karadakovan A, Aslan FE, eds. Dahili ve Cerrahi Hastalıklarda Bakım. 4. baskı. Ankara: Akademisyen Tıp Kitabevi; 2017.
  • Wang G, Chen H, Liu J, Ma Y, Jia H. A comparison of postoperative early enteral nutrition with delayed enteral nutrition in patients with esophageal cancer. Nutrients. 2015;7(6):4308-4317. doi: 10.3390/nu7064308.
  • Harvey SE, Parrott F, Harrison DA, Bear DE, Segaran E, Beale R. Trial of the route of early nutritional support in critically ill adults. N Engl J Med. 2014;371(18):1673-1684. doi: 10.1056/NEJMoa1409860.
  • Elke G, Zanten ARH, Lemieux M, et al. Enteral versus parenteral nutrition in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials. Crit Care. 2016;20(1):117. doi: 10.1186/s13054-016-1298-1.
  • Hallay J, Nagy D, Fülesdi B. Indications and practice of enteral nutrition. Orv Hetil. 2014;155(51):2028-2033. doi: 10.1556/OH.2014.30066.
  • Gürkan A, Gülseven B. Enteral beslenme: bakımda güncel yaklaşımlar. Anadolu Hemşirelik ve Sağlık Bilimleri Dergisi. 2013;16(2):116-120.
  • Sivrikaya SK, Eryılmaz A. Nutrisyonel destek ekibinde hemşirelik. Samsun Sağlık Bilimleri Dergisi. 2018;3(2):33-37.
  • Singer P, Blaser AR, Berger MM, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019;38(1):48-79. doi: 10.1016/j.clnu.2018.08.037.
  • Douglas L, Nguyen, MD. Guidance for supplemental enteral nutrition across patient populations. Am J Manag Care. 2017;23(12):210-219.
  • Tavares de Araujo VM, Gomes PC, Caporossi C. Enteral nutrition in critical patients; should the administration be continuous or intermittent? Nutr Hosp. 2014;29(3):563-567. doi: 10.3305/nh.2014.29.3.7169.
  • Girolamo FG, Situlin R, Fiotti N, Biolo G. Intermittent vs. continuous enteral feeding to prevent catabolism in acutely ill adult and pediatric patients. Curr Opin Clin Nutr Metab Care. 2017;(5):390-395. doi: 10.1097/MCO.0000000000000397.
  • McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically Ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2016;40(2):159-211. doi: 10.1177/0148607115621863.
  • Erdil F, Elbaş NÖ. Cerrahi Hastalıkları Hemşireliği. 7. baskı Ankara: Aydoğdu Yayınevi; 2016.
  • Triantafillidis JK, Papalois AE. The role of total parenteral nutrition in inflammatory bowel disease: current aspects. Scand J Gastroenterol. 2014;49(1):3-14. doi: 10.3109/00365521.2013.860557.
  • Gershengorn HB, Kahn JM, Wunsch H. Temporal Trends in the use of parenteral nutrition in critically Ill patients. Chest. 2014;145(3):508-517. doi: 10.1378/chest.13-1597.
  • Gosmanov AR, Umpierrez GE. Management of hyperglycemia during enteral and parenteral nutrition therapy. Curr Diab Rep. 2013;13(1):155‐162. doi: 10.1007/s11892-012-0335-y.
  • Ma J, Gao M, Pan P, et al. Hyperglycemia is associated with cardiac complications in elderly nondiabetic patients receiving total parenteral nutrition. Medicine (Baltimore). 2018;97(6):9537. doi: 10.1097/MD.0000000000009537.
  • McCulloch A, Bansiya V, Woodward JM. Addition of insulin to parenteral nutrition for control of hyperglycemia. JPEN J Parenter Enteral Nutr. 2018;42(5):846‐884. doi: 10.1177/0148607117722750.
  • Truong S, Park A, Kamalay S, et al. Glycemic control in adult surgical patients receivingregular insulin added to parenteral nutrition vs insulinglargine: A retrospective chart review. Nutr Clin Pract. 2019;1-8. doi: 10.1002/ncp.10252.
  • Boullata JI, Gilbert K, Sacks G, et al. A.S.P.E.N. clinical guidelines: parenteral nutrition ordering, order review, compounding, labeling, and dispensing. JPEN J Parenter Enteral Nutr. 2014;38(3):334-377. doi: 10.1177/0148607114521833.
Toplam 31 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Klinik Tıp Bilimleri
Bölüm Makaleler
Yazarlar

Dilruba Çelebi Bu kişi benim 0000-0001-5734-5147

Emel Yılmaz 0000-0002-5127-6651

Yayımlanma Tarihi 30 Nisan 2019
Kabul Tarihi 9 Nisan 2019
Yayımlandığı Sayı Yıl 2019 Sayı: 7

Kaynak Göster

JAMA Çelebi D, Yılmaz E. Cerrahi Hastalarda Enteral ve Parenteral Beslenmede Kanıta Dayalı Uygulamalar ve Hemşirelik Bakımı. IGUSABDER. 2019;:714–731.

Cited By








Pediatrik Onkoloji Hastalarda Beslenme
Adnan Menderes Üniversitesi Sağlık Bilimleri Fakültesi Dergisi
https://doi.org/10.46237/amusbfd.587378

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