When the patient undergoes esophagectomy, the GI is functional below the esopho-gastric anastomosis. Until the patient is able to consume orally after 5 to 7 days following the surgery, nutrition should be provided mainly through a feeding jejunostomy which has to be placed at the time of surgery. Usually a wide-bore tube is selected as clogging can be effectively avoided. Before actually receiving any oral intake, the patient’s healing should be thoroughly checked for any leakage in the GI tract.
If through examination a leakage is present, the patient should not be given any oral intake and the feeding through the jejunostomy should be continued. However, parenteral nutrition need not be started unless the patient develops postoperative ileus or is not tolerant towards enteral feeding. Patients are also at the risk of aspiration as their swallowing function is compromised. In such cases, the services of the speech therapist are required. Several tests such as swallow study and esophogram are required along with recommendations on the consistency of the food and the swallowing exercise that need to be performed.
Initially, there is a need for continuous infusion through the jejunostomy tube, but later cyclic infusions can be given. Once the patient is discharged, the food records need to be maintained by the patient (which includes calorie count, body weight, etc). Once the patient is able to maintain weight through oral intake, the jejunostomy tube can be removed. However, the process of shifting the patient from an enteral diet to oral intake would involve certain amount of weight loss. Most of the patients lost about 10 % of their BMI after the surgery.
One way of preventing this problem would be to continue with the jejunostomy tube when the patient is at home, and use it at night-times if required. Initially, the patient should be given a full liquid diet followed by a soft diet. The patient should be given frequent meals in smaller quantities, and gummy diets or gas-causing foods should generally be avoided. If the patient experiences too fast moving of the food into the small intestine, then several symptoms including nausea, vomiting, diarrhea, dizziness, etc, can develop. As the stomach is present in the chest, the individual should consume reduced quantities of food.
The patient should never lie flat after the meals and should sit upright for at least two hours, as the gastro esophageal sphincter muscles are absent. During sleep, it is important to keep the upper portion of the body at an angle of 30 degrees (Kight, 2008). Malnutrition is often a common symptom following gastrointestinal surgery. However, nurses frequently lack the knowledge of how to assess and manage the patient in treating malnutrition. Hence, nurses should be encouraged to include the diet management of the patient and be vital for the recovery of the patient.
Nurses seem to be a good link in improving the nutritional status of the patient, but need to be trained in this field (Aydin, 2008). Conclusion Nutritional Therapy is a very important aspect in managing patients suffering from GI cancers. Malnutrition is one of the important conditions associated with GI cancers before and after the treatment. To ensure that the nutritional problems are addressed, a nutritional diagnosis should be conducted through history, examinations, laboratory tests, etc. Once a diagnosis is established, a nutritional plan should be devised.
Nutrition should not center on what or how much the patient is consuming but needs to consider all the factors that would affect the nutrition and overcoming anticipated problems. Frequently, nurses are involved in managing the patients nutritionally. However, the nurses may lack the skills and knowledge. Nurses should be provided with the skills and knowledge required through training. Dieticians, nutritionists and speech therapists should also be involved in managing patients nutritionally who suffer from gastric cancer. Bibliography National Cancer Institute. Gastrointestinal Carcinoid Tumors Treatment (PDQ®). NCI Web site 2008.
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