The human body needs energy to maintain various life activities and physical activities, and the daily energy required by the human body is derived from carbohydrates, proteins and lipids in food. If the daily intake of human body is not enough, it will consume the energy stored in the body to maintain the need, and the long-term insufficient intake will lead to the body wasting, weakness and even death; therefore, whether the daily intake of energy and other nutrients meet the needs of individuals, especially the individual’s demand for energy and various nutrients during the recovery period of the disease is an important factor in the recovery of the disease.
Four steps in the nutrition therapy process.
Nutrition risk screening, nutrition assessment, nutrition therapy intervention, and nutrition monitoring.
Clinical nutrition support is the supply of various nutrients needed by patients by means of clinical treatment. As the saying goes, “Medicine and food have the same origin, medicine and food have the same root”, and there is also the saying that “three parts of treatment, seven parts of nourishment”, in which nutrition is one of them, nutrition support treatment and medicine have similarities and differences in the treatment of diseases. A good nutritional status can enhance immunity, improve tolerance and compliance to treatment, promote wound healing, reduce disease complications, shorten the course of illness, reduce mortality, reduce medical costs, etc. to improve the smooth recovery of disease.
Nutrition score.
Nutrition risk screening score is simple, quick and clinically guided.
Clinicians and dietitians decide the nutrition support mode based on the comprehensive assessment of nutrition risk screening score results, physical examination and various clinical examinations, etc. If necessary, clinicians, dietitians, nutrition specialist nurses and responsible nurses will work together to formulate the nutrition support plan to provide individualized interventions for clinical nutrition support treatment and care.
During hospitalization, medical and nutritional tests such as weight, body mass index, dietary intake and clinical examinations are monitored to monitor the effect of nutritional support and adjust the nutritional support program in time to promote the recovery of diseases.
Post-discharge monitoring Dietary guidance is provided by assessing the nutritional status of patients before discharge. Patients are encouraged to instruct themselves to monitor their weight every week and record it, as well as record their own conditions such as daily intake, appetite, gastrointestinal response, exercise, rest, etc., to facilitate the diagnosis of clinicians and nutrition doctors during the review.
After colorectal cancer surgery, the intestinal function is damaged to a certain extent. In the early postoperative period, clinicians provide parenteral nutrition support + oral fluid diet or enteral nutrition preparation orally according to the condition, and in some cases, parenteral nutrition support + oral fluid diet or enteral nutrition preparation orally only after gastrointestinal decompression to anal discharge and defecation, and gradually transition to semi-liquid diet + nutrition preparation supplementation, soft food and general diet, and comprehensive and balanced A comprehensive and balanced nutritional intake is conducive to disease recovery and improvement of body resistance and immunity. In the process of nutrition support, the nutrition monitoring by clinicians and nutrition doctors and the promotion and guidance of nutrition support and different diets by clinical nurses according to medical prescriptions are of great significance to the recovery of the disease.
Principles of postoperative meal allocation for colorectal cancer
1. Early postoperative colorectal cancer diet: parenteral nutrition support + fluid diet or oral enteral nutrition preparation.
2.Dietary structure Fluid diet is an unbalanced diet, which contains unbalanced nutrients and insufficient energy supply. Clinicians will mainly focus on parenteral nutrition in nutrition supply, and gradually transition the diet structure to fluid diet or enteral nutrition preparation to ensure the nutritional needs of the body.
3.Meal properties For fluid state, generally choose rice soup, enteral nutrition preparation, gradually transition to meat porridge soup, pork ribs porridge soup, diluted lotus root powder, vegetable juice, etc.
4.Meal requirements Gradually increase the intake, small amount of multiple meals, to avoid causing gastrointestinal dysfunction.
5.Contraindicated meals Before intestinal function is restored after intestinal surgery, gas-producing foods, such as milk, soy milk, cow’s milk, all non-fluid solid foods, foods containing more dietary fiber and foods that are too greasy and thick should not be used.
6.Medium-term postoperative diet of colorectal cancer: semi-liquid diet + oral enteral nutrition supplement
7.Meal structure Semi-liquid, between soft food and ordinary meal, with appropriate energy supply.
8.Dietary properties Semi-fluid, easy to chew and swallow, containing less dietary fiber, easy to digest and absorb.
9.Meal requirements Semi-fluid meals contain more water, therefore, the number of meals should be increased and attention should be paid to the diversity of meal varieties. Meals can be given as meat porridge, noodles, wontons, bread, steamed buns, cakes, dumplings, rolls, mashed meat, shredded chicken, fish pieces, chopped liver, steamed eggs, fruits and vegetable juice, etc. Intra-intestinal nutrition preparations should be supplemented between meals to ensure that the patient’s energy and nutrient needs are met while reducing the burden on the digestive tract.
10, Avoid meals At this time, hard and undigestible foods such as rice, steamed dumplings, large pieces of meat, large pieces of vegetables, fried pastry, nuts and fried foods should not be consumed; strong and stimulating condiments should not be used.
11.Late postoperative and discharge diet for colorectal cancer (according to medical prescription) General diet + oral enteral nutrition preparation supplement.
12.Dietary structure is ordinary diet, the same as normal people’s usual diet. Energy and various nutrients must be adequately supplied, and the dietary structure should be in line with the principle of balanced diet. The food varieties in the diet should be diversified, coarse and fine, cooked in a reasonable way, with full color and aroma. The diet can be made of rice, noodles, flour, lean pork, beef, chicken, fish and shrimp, etc. The vitamins, minerals and dietary fiber can be supplemented with various vegetables, fruits and nuts to ensure balanced intake of nutrients.
13.Meal distribution requirements The energy is distributed among three meals, 25%-30% for breakfast, 40% for lunch and 30%-35% for dinner. If the intake is insufficient, add meals between three meals or use enteral nutrition preparation to supplement.
14.Contraindicated meals Food of chili, garlic, mustard, excessively hard food (walnuts, raw peanuts, dried almonds, etc.), especially patients with intestinal stoma should pay attention to eat little or no food.
Diarrhea diet after colorectal cancer surgery
1. During the acute diarrhea period, fasting and intestinal rest should be provided to supplement the body’s nutritional needs through parenteral nutrition and prevent electrolyte imbalance, and after diarrhea is relieved, liquid, semi-liquid, soft food and common diet should be gradually provided.
2, chronic diarrhea patients should be given a low-fat diet + oral enteral nutrition preparations to supplement, poor intestinal function tolerance, if necessary, parenteral nutrition supplement, gradually to be liquid, semi-liquid, soft food, ordinary diet.
3, diarrhea patients forbidden to eat foods containing high fat, fried and thick condiments, nuts and high-fiber vegetables.
4.Foods should be low-fiber, low-fat and lactose-free, such as refined rice, refined noodles and lean pork, which are mainly boiled or steamed.
Diet for constipation after colorectal cancer surgery
The dietary structure should be the same as normal diet. Energy and various nutrients must be adequately supplied, and the dietary structure should be based on the principle of balanced diet, with appropriate increase of dietary fiber.
Dietary fiber can improve the intestinal flora, maintain the ecological balance in the body and facilitate the synthesis of certain vitamins; its water-absorbing and swelling properties are conducive to increasing the volume of surimi, stimulating gastrointestinal motility and promoting defecation. It includes soluble dietary fiber (pectin, gum, algal polysaccharides, some hemicellulose), insoluble dietary fiber (cellulose, lignin, some hemicellulose). Dietary fiber mainly from plant foods, too much too little intake of dietary fiber are not healthy, large doses of dietary fiber can cause bloating, generally recommended appropriate intake of 25-35g / day, that is, 400 ~ 500g of fruits and vegetables and the right amount of coarse grains per day. Such as cereals, beans bran, bean bark contains a large amount of cellulose, hemicellulose and lignin; oats and barley contain a large amount of dietary fiber; lemon, citrus, apple, pineapple, bananas and other fruits and cabbage, peas, broad beans and other fruits and vegetables contain more pectin. Others such as fresh lychee, enoki mushrooms, spinach, dried shiitake mushrooms, dried fungus, kelp, etc. also contain more dietary fiber.
Different constipation dietary choices
1, constipation caused by slow intestinal peristalsis can increase the amount of dietary fiber in the diet, replace fine food with coarse food, eat more vegetables and fruits with skin, such as oats, barley, boiled rice + brown rice, cabbage, peas, fava beans, golden needle nun, apples with skin, bananas, etc.
2, gastrointestinal diseases, constipation caused by the use of laxatives for too long should be less slag diet, be soft, smooth, low-fiber diet to reduce intestinal irritation, such as eggs, cakes, buns, tender meat, fish, milk, cream, etc., forbidden to eat vegetables and fruits with more dietary fiber.
3, constipation caused by mechanical or paralytic intestinal obstruction or tumor compression of the intestine caused by incomplete or complete intestinal obstruction is mainly the clinical removal of the cause, incomplete obstruction to be liquid diet, complete intestinal obstruction, fasting according to medical advice.