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Nutrition Management post Bowel

Resection
Natalie Brasch
Aramark Dietetic Intern, 2015-2016

Overview of Patient
Disease Description
Nutrition Care Process
Assessment
Diagnosis
Interventions
Monitoring and Evaluation

Conclusion
Image: http://www.andeal.org/files/Image/Figure%201.2%20NCP.jpg

Etiology and Pathology


Colonic perforation requires immediate
treatment
Intestinal contents leak into the abdominal
cavity, causing serious infection
Common causes:

Chronic constipation
Ulcers
Increased colonic pressure
Disease-related perforation:
Appendicitis, cancer, Crohns Disease, diverticulitis,
gallbladder disease, peptic ulcer disease, ulcerative colitis
Image: http://www.theseanbarkesclinic.co.uk/information-conditions/digestive-gastro-intestinal/diverticulitis/

Treatment
Neoplasty of colon

Mild-to-moderate cases
Surgical repair of the hole
Resection of punctured area

Placement of temporary colostomy or ileostomy for drainage


Surgical resection of sigmoid colon
Creation of end colostomy
Antibiotics

Rare, mild cases


Image: http://www.colorectal-cancer.ca/en/ostomy/

Outcome is based on

Severity
Length of time perforation is present before treatment

Complications
Infection

Abdominal abscess, peritonitis


Sepsis
Malabsorption

Poor prognosis, high mortality

Medications:
Medication

Function

Rationale

Morphine

Narcotic, analgesic

Pain

Levothyroxine

Thyroid hormone

Anabolic effects; growth & development

Insulin

Glycogen synthesis

High blood glucose

Lasix

Loop diuretic

Fluid retention

Solu-Medrol

Steroid

Can treat inflammation

Lovenox

Anticoagulant

Reduce risk of blood clots

Propofol

Sedative

Relaxation, decreases consciousness,


decreases memory of events

Fentanyl

Narcotic

Pain

Protonix

Proton Pump
Inhibitor

Decreases acid produced by the stomach

Must meet at least


recommended by the Academy
for malnutrition diagnosis

Goals of treatment for patients post bowel resection:


Return patient to stable physical and respiratory status
Control patients pain and avoid infection
Assess gastrointestinal function to evaluate healing

Bowel sounds
Flatus
Bowel movement
NG drainage

Initiate feeding, progressing to a regular diet as tolerated


Ensure adequate provision and absorption of nutrients
Provide continued nutrition education and support

Recommendations for future practice include:


Attempt to better determine causality in the
relationship among rheumatoid arthritis, chronic
steroid use, and GI complications
Initiate the nutrition care process immediately in
bowel resection patients
Provide multidisciplinary efforts for recovery

More research is needed to address provision of


nutrition support post bowel resection
Timing of feeding initiation
Specific formularies and supplements for enhanced

recovery