Identify the steps you would take to monitor Mr. McKinley's nutritional status postoperatively

Question

What will be an ideal response?

Answer 1

• Determine calorie needs post-surgery and adjust as stomach expands. Monitor how much patient is consuming or % of energy needs using a 24-hour recall or food diary. Volume should also be assessed since stomach capacity is reduced.
• Assess sugar intake. Patients should avoid concentrated sugars post-surgery, as it increases the risk of dumping syndrome.
• Determine if patient is complying with rules such as drinking liquid between meals instead of with meals.
• Assess any signs/symptoms of dumping syndrome that may be present, such as N/V, bloating, cramping, abdominal pain, or diarrhea. May need to consider intake/tolerance to lactose.
• Determine protein needs and make sure protein-dense foods are being consumed. Encourage high-protein snacks or supplements since protein is a major part of the healing process.
• Assess for vitamin and mineral deficiencies, particularly calcium, iron, B12 . B12 injections should be given and multivitamin supplementation is typically required for life.
• Assess weight loss per week. Patient should be recording changes in weight. Physical changes in skin and body contour should be evaluated. This is a big change in weight and patient will have to adjust clothing, etc. on a weekly basis to keep up with the weight loss. Calculations include: % weight loss, % IBW.
• Monitor diabetes, such as self-monitoring blood glucose practices, HbA1c values to see if they are improved with weight loss.
• Monitor lipid profile to evaluate any improvements or other changes in cholesterol, TG, LDL, HDL after weight loss. These are all risk factors for CAD, so these values should be closely monitored.
• Evaluate potassium levels; sudden changes in potassium can cause cardiac arrest and since his value was high, this may be something to monitor.
• Evaluate hydration status. As weight loss is dramatic, it is important for patient to stay hydrated.