Pre-operative assessment of elective surgical patients

Patients due to undergo elective surgery who are not considered to be medically fit, may have their operation postponed or even cancelled. Not only will this result in significant anxiety for the person, but it will also have financial implications for the hospital, in terms of lost theatre time. In an attempt to prevent postponing or cancelling scheduled surgery, pre-operative assessment is essential to ensure that the patient is physically and emotionally prepared. This article examines the main components of pre-operative assessment and how addressing any problems before surgery can help to improve post-operative outcomes for patients.     

Pre-operative hemostatic assessment and management.

Excessive surgical bleeding can be predicted and then prevented in most patients with a recognised hereditary bleeding tendency or in those on anti-thrombotic therapy. However the clinical consultation of an individual patient can be challenging because the diagnosis can be unclear or a balance needs to be achieved between minimising bleeding without precipitating thrombosis. Laboratory testing does provide assistance in assessment of a bleeding tendency but it is not uncommon for the results to be inconclusive. Investigations such as the level of von Willebrand factor assays should be regarded as a continuous risk factor for surgical bleeding rather than defining a disease category. Appropriate replacement therapy prior to surgery is effective in preventing surgical bleeding. Aggressive anti coagulant therapy around the time of surgery in patients who usually are on warfarin more often lead to unnecessary haemorrhage rather than preventing further thrombosis. A risk assessment of both bleeding versus thrombosis for the particular operation is necessary to ensure the best outcome.     

The mini nutritional assessment

Older adults are especially vulnerable to malnutrition, which often goes undetected and increases the risks of illness and death. The Joint Commission has required U.S. hospitals to provide nutrition screening to all patients within 24 hours of admission, but that doesn't cover patients in other settings, nor is there a standardized assessment tool for finding malnutrition in older adults. The Mini Nutritional Assessment is an effective, easily administered tool designed to identify older adults who have or are at risk for developing malnutrition. It consists of 18 questions and can be completed in about 15 minutes. A short form, containing the first six questions, can be used for screening. For a free online video demonstrating the use of this tool, go to http://links.lww.com/A221.     

微型营养评价法用于80岁以上高龄患者营养评估

目的：探讨微型营养评价法（MNA）用于80岁以上高龄患者营养评估的效果。方法选取老干部病房80岁以上高龄患者120例,分别用台湾修订版 MNA 和原版 MNA 进行营养评估,并测定各项传统营养指标。结果台湾修订版 MNA 营养评估结果显示,营养不良患者37例（30．8％）,营养不良危险患者42例（35．0％）,两者比率均高于原版 MNA 的28．3％、33．3％,但差异无统计学意义（P ＞0．05）。台湾修订版 MNA营养评估的3个营养分组之间体质量指数（BMI）、小腿围（CC）、三头肌皮褶厚度（TSF）、血清白蛋白（ALB）、转铁蛋白（TRF）、前白蛋白（PAB）、血红蛋白（HB）、总淋巴细胞计数（TLC）比较差异有统计学意义（P ＜0．05）,三酰甘油（TG）、总胆固醇（TC）比较差异无统计学意义（P ＞0．05）,台湾修订版 MNA 和传统营养指标BMI、上臂围（MAC）、CC、TSF、ALB、TRF、PAB 有显著相关性（P ＜0．05）。结论台湾修订版 MNA 适用于80岁以上高龄患者营养评估,80岁以上高龄患者营养不良发生率较高,应当尽早进行营养干预。     

住院患者营养评估单的临床应用

目的 探讨住院患者营养评估单的临床应用效果。 方法 选取2016年1~6月(应用住院患者营养评估单前)住院患者的资料3 142例,选取2016年7~12月(应用住院患者营养评估单后)的住院患者资料3 565例。比较住院患者营养评估单应用前后住院患者营养风险评估率、营养支持率及护理人员满意度。 结果 应用住院患者营养评估单后患者营养风险评估率及营养支持率均高于应用前(χ²=285.16,P<0.001; χ²=4.235,P=0.040)、护理人员满意度也明显提高(χ²=14.436,P<0.001)。 结论 应用住院患者营养评估单对住院患者进行规范化营养管理,能够及时发现患者的营养不良风险,采取营养干预措施,改善患者临床结局,保证患者安全的同时也有助于优化护理流程,规范护理行为,提高护理人员的满意度。     

Pre-operative preparation III

Poisoning in animals is, sadly, not an uncommon occurrence, and whilst many accidental exposures may not result in significant clinical effects or signs of intoxication, there are some substances that pose a significant hazard to pets and where physical deterioration can be very rapid indeed. Speedy responses may be crucial. Ensuring that both the recording of as complete a case history as possible, as well as the initiation of appropriate decontamination, triage and specific treatments is important to ensure cases are managed efficiently and optimally. This article attempts to provide a basic check-list for such eventualities.     

Malnutrition and pressure ulcers: nutritional assessment tools

Good nutrition is essential throughout life and often patients have a poor understanding of what a balanced diet comprises. Nurses need to have a good comprehension of malnutrition. Where malnutrition is evident it can be resolved by working with the patient to encourage a healthy diet. One way to improve patient nutrition is by a nutrition audit of patient food. Numerous nutritional assessment tools exist which help to identify a patient's nutritional status. No nationally standardized nutritional assessment tool exists and there is a danger of assessment methods becoming as proliferate as pressure ulcer risk assessment tools. A solution to this problem may be to use a pressure ulcer risk assessment tool with a nutritional risk assessment tool such as the Burton Score. Pressure ulcers and malnutrition have been demonstrated to be strongly correlated with each other. Malnutrition is not just present in hospitals but also in nursing homes. A solution to this problem is to use nutritional tools to highlight nutritional deficiency in a patient's diet not only in hospitals but also in the community and in nursing homes.     

Nurses' positive attitudes to nutritional management but limited knowledge of nutritional assessment in Korea

Background:  Nurses' involvement in nutritional management has received greater emphasis as an accountable factor for the nutritional status of patients. Studies have shown that there are deficiencies in awareness of the importance of nutritional assessment and limited nutritional knowledge in nurses.
Aim:  The purpose of this study was to investigate nutritional attitudes and knowledge of nurses working in the hospital environment.
Methods:  A questionnaire survey was conducted. It is focused on nutritional management with regard to assessment of nutritional status and implementation of nutritional care. Nurses were recruited from the university hospital in Seoul, Korea.
Findings:  A majority of nurses had positive attitudes towards patients' nutritional status and had a high desire to receive nutritional information. However, they had limited knowledge of nutrition, especially nutritional assessment criteria which are basic to the evaluation of patient's nutritional status. Nurses did not perform the nutritional assessment appropriately in practice.
Conclusions:  These findings suggest that nurses have limited nutritional knowledge and they use nutritional assessment criteria poorly in clinical settings. This study provides a framework for developing nutritional management programmes and a standardized protocol for nutritional assessment.     

营养评定问卷与人体测量学方法评价社区退休居民的营养状况

背景随着年龄的增长,营养不良高危状态和营养不良发生率将显著增高;特别是老年人的营养状况已成为公共卫生的重点观察项目.目的应用迷你型营养评定(mini nutritional assessment,MNA)结合人体测量学方法评价社区退休居民的营养状况.设计以诊断为依据的横断面研究.地点、对象和方法2002-05上海市某社区退休居民115名接受MNA问卷调查和人体测量学检测.主要观察指标接受调查的115名上海某社区退休居民MNA总分、腰围、臀围、身高、体质量、体质量指数(body massindex,BMI)、中臂围、三头肌皮褶厚度(triceps skinfold,TSF)、中臂肌围等调查结果.结果①平均MNA总分为25.2±2.7,其中24名(21%)受试者MNA总分低于23.5,属营养不良或营养不良高危人群.②应用腰围、腰臀比和BMI评估,肥胖检出率分别为54%,62%和65%.③根据中臂围、TSF和中臂肌围评估,中至重度营养不良的发生率分别为2%,19%和2%.④MNA总分与多项人体测量学指标显著相关.结论社区退休居民中营养过剩和营养低下共存,必须加强营养干预;MNA问卷在中国人营养状况评价中具有一定的实用价值.