Weight loss in the preoperative patient

There are times in life when we have to undergo surgery due to some problem or even prevention of physical damage. However, it is not a simple situation, there must be preparation. It is clear that there are “minor” operations. Which do not even require so many medical personnel or an operating room. But when you are going to go through such a serious process, you have to do everything possible to make sure everything goes well, during and after the procedure. Which includes taking special care of ourselves to reduce the chances of risk of infection or other complications. Many times the patient understands this part, but does not know how to proceed and many other things go through their mind that can also affect it. That is why, as a health professional, it is your duty to guide him through the correct eating plan and give him sufficient information. There are many types of operations. However, generally before proceeding to go into the operating room, certain things are required. One of them is weight loss. The reason why this requirement is so common, you may well have realized, is because of the percentage of overweight and obese people in this country. Well, today we will talk about the procedure and the appropriate way to treat the preoperative patient. But in order to talk about why and the appropriate procedure, it is necessary to look back a little. Why should the patient lose weight before a surgical procedure? Until a few years ago everything was based on trial and error and the personal evaluation and decision of each individual doctor. However, the scientific facts were demonstrated and a special procedure began to be carried out. cial for the treatment of said patient. The scientific basis was based on waiting for the patient to recover the physiological functions modified by the surgical and pharmacological aggression, based on the organic reserve. With minimal intervention throughout the perioperative process. ERAS Protocol The ERAS protocol (Enhanced Recovery After Surgery) has its origins in the 1990s, when two groups of researchers presented different proposals to improve the evolution of postoperative patients. Of which the Kehlet group stands out especially in Europe, specifically at the Hvidovre University Hospital in Denmark. Which proposes new and different strategies to make management more efficient and improve and thus the evolution in the perioperative period. And the Delaney group, which focused its research on improving the postoperative period. Specifically in the administration of diet and early mobilization. In this way, multimodal rehabilitation programs (RHMM), also called Fast-Track, emerged. Based on these principles, traditional measures in anesthetic/surgical practice such as prolonged preoperative fasting, mechanical preparation of the colon and the use of nasogastric tube for decompression are not recommended. On the other hand, it is demonstrated that practices such as intravenous analgesia for pain control, especially with opioids, delay in the start of feeding until the onset of subjectively assessed peristalsis, and bed rest are risk factors that favor an increase in hospital stay days and care costs. There is no routine pattern. It must be focused on each patient. AND It has been discovered that when modifying diet, the challenge is to identify, plan and provide a dietary plan that meets the specific needs of each patient. Taking certain aspects into account: Age Physical Evaluation Psychological Evaluation. Sociocultural aspects. (it is important to know what you eat) Moderate or low high degree of Fear. Psychological Factors – Fear: It is important to remember that a surgical intervention causes anxiety or stress, or worse, both things at the same time, which provoke physiological and psychological responses, the degree of which depends on several factors: To the unknown: This is the uncertainty or lack of knowledge about the surgical experience. To anesthesia: Fear of an unpleasant induction and unexpected events during its application, of waking up during surgery or even fear of feeling pain while the surgical procedure is being performed, which is also directly associated with fear of the unknown. Pain after surgery: One of the most common fears, the reason why many patients cannot fall asleep properly. To death: Despite scientific and technological advances, the patient naturally continues to have this fear before the operation. There is no completely safe surgical intervention or anesthesia and the patient knows it. Upon separation: The patient is separated from his family and work environment, knows that he will maintain a temporary disability and will not be able to attend or be part of social events and see his friends. To the alteration of life patterns: It is the fear of temporary or permanent disability. The patient stops doing his daily tasks and generates fear of not performing daily tasks again or of not being able to do them. resume your work or professional life, whether temporarily or permanently. Since “temporary” sometimes means a long time. Maybe years and this has a great mental impact. To the mutilation or loss of a part of the body: It must be considered that surgery may alter bodily integrity and threaten the image and sense of aesthetics. * Sometimes the patient requires special and appropriate attention, referring to their level of development, personality, history and past experiences with health professionals and hospitals. This happens especially when there was an experience in the operating room in childhood. But why break down the psychological issue of fears so much? It is actually very simple, the pre- and post-operative patient with fear cannot actually do or see their normal life. They develop insecurity problems such as lack of self-esteem or even eating disorders such as hyporexia or, on the contrary, hyperorexia. It is vitally important to locate what kind of patient we are treating and know how to help the patient who is afraid. It is important to clarify all your doubts and create an environment of TRUST. Be patient, the patient does not have your scientific knowledge, do not forget that. Don’t think that their thoughts or problems are minor, silly or meaningless. This breaks the atmosphere of trust you are trying to generate. Don’t make the mistake of making the patient think you don’t care, or of ignoring them. Since if the patient notices your lack of commitment or interest, it will probably generate more fear and directly fear towards you or whoever is going to perform the surgery. And the patient may look for other options that meet their needs. Encourage the patient to express their feelings about the surgery to be performed. This will help as a mental and psychological discharge. It will make you feel liberated, calm and supported. Use tact (kindness) to communicate with genuine interest. It’s all in the tone in which we say things. Avoid expressing false expectations. Always try to provide realistic results. No matter how hard the truth is, you must be honest. How to approach the preoperative patient based on the ERAS protocol? Pre-admission counseling. Provide the patient with the necessary verbal and written information, indicating the process to be carried out from admission to hospital stay. Resolve all doubts that arise from said explanation. This reduces anxiety and in turn helps control pain. Avoid prolonged fasts. A 6-hour solid fast before the surgical procedure is normally recommended. Liquids can be drunk up to 2 hours before the procedure.* Carbohydrate loading. A light preoperative intake of carbohydrates is advisable. Which decreases the body’s catabolic response. Do not use premedication. A complete benefit has not been demonstrated with the use of preoperative anxiety medications. Prophylactic antibiotic management. A single dose of antibiotics is recommended prior to surgery that covers aerobic and anaerobic microorganisms. Thromboprophylaxis. Mechanical compression stockings must be used during surgery. Which has demonstrated an effective form of antithrombotic prevention. The fact of having gone through a preoperative event such as the one mentioned above, combined with situations of anxiety and stress, can cause an imbalance in the metabolism of individuals. Causing eating disorders. Such as weight loss or unbalanced eating food ada. Which can lead to early post-surgical complications. Which significantly affects the evolution of patients and the quality of recovery. That is why I am going to recommend a list of foods that you can recommend to keep the patient who is going to go through the surgical procedure healthy and well nourished. Recommended foods for a preoperative patient Almonds: Or in general walnuts, they are a good source of fats and good carbohydrates. Which are a great source of energy for the body. Almond Milk: Of course it contains energy as previously mentioned. However, almond milk is also a good option if you are lactose intolerant. Or if you are looking to vary or change the flavor of the milk. In addition to its delicious flavor, it does not fail to provide its benefits. Greek Yogurt: Another good way to get calcium and have strong bones. However, Greek yogurt also contains twice as much protein as normal yogurts. In addition to having much less sugar than the others. Egg: Generally used for a good breakfast. Which it is worth remembering is the most important meal of the day, since it is a great source of protein and good fats. In addition to having varied preparations and being able to include it in various dishes. Either as an ingredient or as a portion. Chicken Breast: It is the leanest part of the animal. So it is a super healthy source of protein, since it will not make you gain weight. On the contrary, chicken breast is considered one of those wonderful foods that, by simply consuming it, will make you burn calories. Which means: Helps you lose weight. Milk: Drinking milk daily is a good source of Calcium and protein. In addition to being delicious iosa and thus, you will be taking care of your teeth, your bones and you can safely include it in any part of the day. Salmon: Another wonderful source of protein. But also omega 3. Which will help you have healthy skin and hair. In addition to improving eyesight and taking care of your heart. These are just some foods, but giving them a list of information will not only give them confidence in all aspects, it will make them better prepared for the procedure and with a much more efficient and less risky recovery. Sources: http://www.elsevier.es/es-revista-cirugia-espanola-36-articulo-soporte-nutricional-perioperaría-S0009739X14000268 http://www.medigraphic.com/pdfs/rma/cma-2013/cmas131br.pdf http://www.pisa.com.mx/publicidad/portal/enfermeria/manual/4_5_2.htm