POST-BARIATRIC SURGERY NUTRITIONAL REQUIREMENTS – Part 2 (Recommendation of macro and micronutrients and Nutritional Therapy)
In order to minimize nutritional complications and create conditions for greater long-term success, it is important to predict, prevent and correct nutritional changes in pre-post surgery, with careful monitoring and nutritional supplementation according to guidelines. Priorities are the nutritional education of the patient/family, aiming at good eating habits, within their lifestyle and socioeconomic and cultural conditions. Nutrients Regular follow-up with a specialized nutritionist is essential to facilitate adequate weight loss and to assess the intake of micronutrients that may be inadequate due to the gastric restriction of the gastric band (BG) and sleeve gastrectomy (GV) techniques; of gastric restriction and dysabsorption in gastric bypass (BGYR) and minor gastric restriction and major dysabsorption in biliopancreatic bypass (BPD) and duodenal switch (BPD-DS). The latter 2 carry greater risk for protein malnutrition and micronutrient deficiencies. In all techniques except BG, there are functional and hormonal changes involved in the control of hunger and appetite, food intake, satiety, metabolic glucose change and changes in intestinal hormones such as ghrelin, GLP-1 and PYY.
POST-BARIATRIC SURGERY NUTRITIONAL REQUIREMENTS – Part 1 (Nutritional Therapy in the evolution of diet and Dumping Syndrome)
Bariatric surgery is a form of treatment for morbid obesity (Body Mass Index – BMI – ≥ 40 Kg/m2) and, in patients with comorbidities such as diabetes mellitus from a BMI ≥ 35 Kg/m2. Bariatric diet protocols are defined by each surgical team and may vary in the progression of dietary consistency. However, they all share common nutritional goals such as: – Maximize weight loss and absorption of essential nutrients – Maintain adequate hydration – Avoid vomiting and dumping syndrome Nutritional guidance is based on a diet with minimal calories and high in essential nutrients, ensuring healing and minimizing loss of lean mass. The diet should reduce reflux, early satiety and dumping syndrome, at the same time increasing the expected weight loss for each period and, later, the maintenance of the acquired weight. Women who become pregnant should be monitored for adequate weight gain and specific supplementation, meeting the needs of the mother and fetus. Diet stage and progression The progression of diet consistency is based on post-surgical recommendation protocols. To improve the results, patients and family members already receive, in the preoperative period, a structured postoperative diet, with examples of menus and recommendations regarding the type of food, preparations, volume, in addition to basic notions of dietary technique.
Injury to the skin provides a unique challenge, as wound healing is a complex and intricate process. Acute wounds have the potential to move from the acute wound to chronic wounds, requiring the physician to have a thorough understanding of outside interventions to bring these wounds back into the healing cascade. Surgical enrichment/dressings are applications for wounds, burns, and ulcers. They should be regarded as supportive of healing; are desirable but not essential in an emergency. There are currently plenty of dressings available in the market to aid in wound healing. Before choosing a dressing for a specific injury, a physician must assess carefully the needs of the wound to understand which dressing would ensure maximum interest. Basically, there is nothing called best choice, and it is crucial that the merits/demerits of each dressing system be understood. This article has provided a framework to assist in dressing assessment. This article reveals measurement of wound healing and the functions of wound dressings. A variety of dressings and their respective details are detailed. Purpose of the study: Discussion and projection of wound healing by market available surgical supplies. The present review traces the history of dressings from its earliest inception to the current status and also discusses the advantage and limitations of the dressing materials.Findings: There is an overwhelming amount of wound dressings available in the market. Modern world and technology gave rise to various way of wound healing with enrichments. Almost all sorts of enrichments are available in surgical outlets, a few of them are confined to hospital settings. This implies the lack of full understanding of wound care and management. The point of using advanced dressings is to improve upon specific wound characteristics to bring it as close to “ideal” as possible. It is only after properly assessing the wound…
Perception and Expression of Emotions: Psychological Intervention With Hospitalized Patients With Diabetis in a Surgical Clinic
Illness is a non-expected situation that the patient isn’t prepared for, resulting it may cause an instability between mind and body. The diabetes mellitus is a chronic metabolic dysfunction resulted from the deficiency of insulin secretion. This condition decreases life quality, and is one of the main causes of death, kidney failure and lower members’ amputation. As an intervention for this situation of fragility, surgery is constantly indicated, inducing emotions as agony, fear and anxiety, and even triggering fantasies. The anxiety caused by the possibility of a surgical intervention can affect the patient, if these emotions aren’t expressed and acknowledged. Thus, it is important to be aware about the patients’ emotional state, as there is a relation between their reactions, the surgery and the postoperative. Objective: Reflect about the psychological intervention as a place for perceiving and expressing emotions of hospitalized diabetic patients. Methodology: Experiment report taken from hospital psychology experience. Results and Discussion: Psychological intervention in chronic patients’ groups, as the diabetics, is an important resource in face off the difficulties for acknowledge and express the experienced emotions. Using images that shows some of the emotions that are part of the context, like fear, anxiety, anger, hope and gratitude, for example, helps the reflection about how these emotions can be manifested in hospitalization process. This technique permits comprehension under different ways to express emotions, and by the exchange of experiences, it is important to strengthen coping strategies. This intervention enables behavior change, converting the tension in relaxation and anxiety relief. Conclusion: The intervention in groups is an important resource to provide reflection about the experienced emotions, to enable these patients to comprehend that these emotions are part of them and must be recognized and externalized, providing a better understanding of the diagnostic, acceptance and adhesion to the treatment.
Introduction: Removal of the 3rd lower molars is nowadays a routine procedure in dentistry, but it is an action that can be damaged in the inferior alveolar (NAI) and lingual nerves, which are in association with the roots of the 3rd molars. Objective: To analyze causes, predisposing factors, symptomatology and treatment of NAI and Lingual paresthesia. Methodology: An integrative review was performed on the MEDLINE, LILACS and SCIELO databases, using the descriptors: Exodontia, Molares, Paresthesia. The inclusion criteria were: articles in Portuguese or English and published between 2013 and 2017. Result and Discussion: There were 637 articles related to the topic, 32 selected and 5 used as theoretical reference. Paresthesia is characterized by sensory loss of the affected nerve, resulting from iatrogenic injury or bacterial infections. The predisposing factors for this lesion range from the patient’s age, tooth root development, operator ability and teeth impaction. Weeks after surgery, the patient may report symptomatology related to NAI paresthesia as loss of lip sensitivity and on the affected side, altered sensitivity to cold, heat, pain, numbness, tingling and “pinching”. There may also be symptoms related to Lingual Nerve paresthesia as a burning sensation in the tongue, changes in taste and constant nibbling on the tongue. The treatment results from the regeneration of the injured nerve fibers. It usually does not require any iatrogenic intervention. However, it is used drugs (Cortisone and Vitamin B1), low intensity laser and microsurgeries for axonal regeneration. Conclusion: The frequency of 3rd molar extraction leads to a higher number of postoperative complications. Therefore, paraesthesia arises from lack of surgical planning, technical inability and incorrect instrumentation. Thus, detailed evaluations of complementary imaging (panoramic radiography and computed tomography) are of paramount importance, as well as prophylactic measures such as correct diagnosis, anatomical and technical knowledge of the professional, and adequate…
Introduction: When treating a diabetic patient, it is important to consider a number of factors, such as the patient’s blood glucose behavior and rate. Objectives: To approach as situations and behaviors of the dental surgeon towards the diabetic and to explain actions that will lead to success without patient care. Methodology: A bibliographic review was done in the virtual libraries SCIELO and PubMed, use the articles: “Diabetes and Dentistry” and “Conduct of diabetics in dentistry”. It was used as inclusion criteria for published articles from 2013 to 2017, in the Portuguese and English languages, which relate diabetes to dentistry and conduct of the dental surgeon. Results and Discussion: The survey resulted in 3,011 articles, 18 of which were separated by presenting a greater relation with the subject, but only five attendants to the inclusion criteria. The most common clinical sign in diabetic patients is hypoglycaemia, causing pallor, cold sweat, drowsiness, headache and others. In case of unconsciousness or dental surgeon, administer ampoule with 10 ml of 25% glucose solution intravenously. Hyperglycemic patients show signs and symptoms characteristic of metabolic ketoacidosis, such as the presence of a hetero-oesthetic should be referred to the doctor. The dentist should suspect undiagnosed cases, ask about polyphagia, polydipsia, polyuria, and weight loss. If so, refer to laboratory tests and doctor. Controlled diabetics may be treated in a similar manner to the non-diabetic patient. Prioritize short appointments early in the morning after a meal. Normal diet is advised in the diet. An antibiotic prophylaxis for certain passages can be made. Oppose the blocking anesthesia, avoiding solutions with vasoconstrictor based on adrenaline, because we promote the breakdown of glycogen into glucose, causing hyperglycemia. Conclusion: The dental surgeon must know the systemic associations of diabetics in order to serve them more safely in all clinical procedures.
Introduction:Thoracic drainage aims to remove the collection of air or liquid accumulated in the pleural cavity. Although it is a relatively simple procedure, complications can occur due to little knowledge of respiratory physiology, the implementation technique of the drain, of care in maintaining the drainage system and his withdrawal. The appropriate management of thoracic drainage reduces the morbidity associated with the procedure. Knowing the complications related to the drain, their possible causes and how to prevent them, you can optimize the assistance. Objective: This article aims to discuss the nursing care and your importance since the insertion of the drain until your withdrawal. Methodology: It is an integrative review of literature, developed from published articles in databases Biblioteca Virtual em Saúde (BVS), National Library of Medicine (PUBMED) e SCIELO (Scientific Eletronic Library Online). Results and Discussion: 34 articles were found, in Portuguese and English languages. Of which 17 were available for reading. Of these, after selective reading, 7 relevant articles were selected, because it addressed specifically the theme. All articles addressed in nursing care related to the drain, with few theoretical subsidies and scientific evidence. Most articles highlighted in the elaboration of a protocol through the Systematization of Nursing Assistance (SAE) focused on this type of care. Nursing care involves the preoperative period up to the postoperative period. It includes guiding the patient, assisting the physician in the placement of the drain, performing post-surgical dressings, controlling the material circuit and clinical evaluation. Conclusion: The thorax tube requires some care mostly of nursing staff. In addition to performing routine care, the nursing should be attentive to changes in either the drainage pattern or the drain insertion site, since the nurse is the health professional in greater contact with the patient, being able to detect such alterations earlier.
Introduction: Liver transplantation is a complex procedure chosen for the treatment of patients with liver diseases that result in organ failure. The Nurse integrates a transplant team where activities such as planning, coordinating and supervising are developed according to the Federal Nursing Council. Objective: Describe the practice of the nursing students in the organ harvesting process for liver transplantation. Methodology: This is an experience report of a descriptive nature, experienced by nursing students in the Liver Transplants Academic League of Pernambuco during the first semester of 2017. Results and Discussion: The nursing students are scheduled to work together with the nurses of the team in the organ harvesting as follows: a pair of students is on notice until a donation is confirmed in a hospital of Recife. Thereafter, the couple and the nurse go to the hospital where the transplant will be done to collect all the necessary materials during the organ harvesting surgery. After that, they go to the hospital where the donor is to prepare and organize the operating room. During excision, 4 liters of organ preservation solution are used in a procedure called in situ perfusion. At the end of surgery, when the organ is removed, another 1 liter of solution is used in the stage called ex situ perfusion. After the organ is perfused, it is stored in sterile plastic bags with ice and saline solution and finally placed in a thermal box covered with ice so that it is preserved until it reaches the hospital where the transplant will finally be done. Conclusion: Through the insertion in the academic league, students have the opportunity to expand their knowledge and learn in practice, how the donation and the organ harvesting for transplantation work.