Ethical dilemma that exists in pediatric settings

Sample Solution

nd laparoscopically, the overall healing time has increased significantly in both traditional and ERAS surgical procedures.6 Other components of traditional surgery are to increase urine output, therefore, intravenous fluids are administered liberally to output fifty milliliters an hour or more.7 Additional methods of output measures are the utilization of catheters, drainage of the surgical site, and a nasogastric tube to drain any bowel contents. The change in surgical methods from traditional to ERAS methods, like the removal of catheters and decreased medication administration, have been beneficial for those utilizing 80% of ERAS practices or more. However, there is still lots of resistance to change traditional practices because of the relative unknown potential effects of ERAS in surgical subsets that have not had ERAS preformed before.6

Surgery and Nutritional Status

Risk assessments are used upon admission for patients to assess the nutritional status. This is looking for the risk of malnutrition pre-operatively through two different assessment screenings. The patient has a BMI of under 18.5 kg/m2 meaning they are underweight, or the patient has experienced weight loss >10% in six months or >5% over one month and reduced BMI.8 It’s important to assess the patient for risk of malnutrition because it can be detrimental as a post-surgical outcome.6 This is especially true for larger surgeries where surgical stress leads to a catabolic and inflammatory state for the patient.7 Preoperative care and dietitian-led practices such as nutritional education and counseling to patients undergoing surgery through ERAS may be a suggested next step to establish adequate nourishment in patient populations prior to surgery, since that has the best optimal chances for a success.10 The largest concern nutritionally is at the patient is at risk for developing a nosocomial infection, therefore, increasing their needs for calories and protein due to additive stress on the bodies immune system.9 There are many factors that determine these needs such as age, clinical status, and weight, however, using preventable methods to increase optimal health and decrease nutritional risk is always in the patients best interest.9 Nutritional interventions such as early oral interventions and increased protein intake, as well as addressing any deficiencies post-operatively can be utilized to provide energy during acute catabolism from surgical stress. Grade A evidence from the ASPEN Guidelines suggests that in ERAS patients, traditionally oral intake or clear liquids should be initiated within hours after surgery to offset some of the surgical complications like loss of gut integrity seen in patient populations.8