In order to prevent the perioperative morbidity and mortality associated with malnutrition, evaluation of nutritional status early in the clinical course and throughout treatment is essential. The most cornmon nutritional deficiency is protein-calorie malnutrition, the least common is vitamin or mineral deficiency; multiple factors can contribute to either. The clinical examination may reveal obvious problems which lead to or result from nutritional deficits, i.e. poor dentition inhibiting oral intake; alopecia as a result of zinc deficiency. A review of current medical data and past medical history will identify conditions that influence nutritional status such as chronic or acute disease states, surgery, chemotherapy, radiation therapy, andlor medications with possible drug-nutrient interactions. Diet history allows for review of current oral intake with emphasis on eating habits and preferences, physical activity, and recent alterations in intake. Stressed or catabolic patients may develop total or partial starvation quickly, assessment of anthropometrics and somatic protein stores can determine severity of malnutrition. Severe weight loss over time can be categorized as follows: >2% in one week; >5% in one month; >7.5% in three months; and >10% in six months. Significant weight loss is considered to be loss of 10–20% of usual body weight.
KeywordsTotal Parenteral Nutrition Severe Weight Loss Central Venous Access Device Visceral Protein Nutrition Support Team
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