- Internal Code :
- Subject Code : CHCPOL003
- University : Victoria University
- Subject Name : Nursing
Research and Apply Evidence to Practice
Table of Contents
Introduction.
Body.
Conclusion.
References.
Introduction to Fasting in Elective Surgical Patients
This particular study will be subjected to conduct a literature search to explore whether the protocols entailed in the workplace are based on the best evidence. The subjects the fasting protocol for surgery in a hospital. For every surgery that requires any kind of anesthesia, patients are made to fast to prevent the catastrophic complication of the food entering the lungs. This is normally prevented in awake people by our natural reflexes like a cough. In an unconscious or heavily sedated person, these reflexes are absent. The food may thus reach the throat from the stomach and then slide down the windpipe to the lungs. This produces one of the most dreaded kinds of infections of the lung called Aspiration Pneumonia. (The process of solids it liquids coming down the food pipe is called aspiration).
Body of Fasting in Elective Surgical Patients
As stated by Francisco, Batista and Pena (2015), it has been conferred in the article that a liquid diet is full of carbohydrates is beneficial for a patient to go under the operation table in 2 hours. It helps in a number of surgical procedures instrumental in providing benefits such as immunosuppressant prevention, reduced infection risk, health restoration of bowel functions, decrease in thirst sensation, nausea, hunger, as well as vomiting. Going further it aids in the attenuation of insulin resistance thus helping the muscles to maintain strength. There has been a decrease in hospital stay that is instrumental in improving trauma response. A cross-sectional study subjected with 65 patients (age ranging from 19 to 87 years, amongst which 74% were females) goes through an elective surgery associated with abdominal wall/digestive tract. In the preoperative period, the assimilation of hunger and thirst reports, along with the physical status that includes diabetes diagnosis helps in the determination of fasting time as well as the surgery or anesthesia type. The patient’s procedures as performed were of 47.69% cholecystectomy along with general anesthesia mostly used up to 89%. The common procedural approach was to start fasting since midnight in context to liquids as well as solids. 65 percent of patients receive Grade-II physical state.
The average fasting real-time was of 16 hours ranging from 9.5 to 41.58 which was considerably higher than those of the prescribed ones that are 11hours, ranging from 6.58 to 26.75. In the afternoon the patient was submitted to surgery and was made to fast for a longer time period than the ones with p < 0.001 were done in the morning. The hunger, as well as the thirst's intensity, increased with the fasting period in the postoperative session (p=0.010 and 0.027). The average postoperative fasting period was counted at 18.25h (3.33-91.83) as well as only 23.07 percent that restarted feeding the same day. Patients fasted for a prolonged time, even higher than prescribed time along with the intensity associated with the signs of discomfort. These include hunger as well as thirst which tend to increase over time. It is better to recover the well-being of the patients. It is also, necessary to follow and establish all the abbreviation protocols associated with preoperative fasting (Cestonaro et al. 2014).
During surgery, the process of anesthesia, as stated by Njoroge, Kivuti-Bitok and Kimani (2017), it is important for Preoperative fasting (POF) to ensure physiologically as well as precautionary measures. In spite of the shorter practice as recommended POF has been practiced from midnight. POF in context to clinical interventions is considered to be abstinence from all types of foods as well as liquids meant for a specific time period. It is to be carried out before anesthesia induction before the surgery’s commencement. The POF’s duration is dictated by the diet type of the patient considering his/her physical condition. It also considers the aspects of the surgery kind whether during an emergency or during an elective attempt amongst other existing factors. Some diets are easy to digest, allowing for rapid elimination from the stomach. Any slow-release type can stagnate and create congestion in the gastrointestinal tract. POF requires a critical emergency response that acts as a procedure for elective surgical interventions which is done with an empty stomach. Hence, are known to ensure physiological stability, with complications reduction during the hospital stay, along with the costs. The practice includes well-planned health information in the form of a composite package. It reflects the goal as well as the patient’s expectations. These, in turn, promote compliance as well as handles anxiety.
From this particular study, it can be conferred that for elective surgery patient reports that they are not allowed to consume clear fluids when experiencing thirst. The patient’s importance, as reported could consume antihypertensive medication with the presence of a clear fluid prior to the surgery. The patients seem to be knowledgeable as well as able to control the aspect of hypertension. It is further confirmed that, in scheduled surgery’s presence, a corroborated finding is depicted elsewhere. All the nurses are observed to be critical in the providing of preoperative fasting instructions along with the catering of care. It is furthermore stated that the patient knowledge level can be considered as in the form of a mirror reflection associated with the intervention’s quality (Tosun, Yava and Açıkel, 2015).
As stated by Abebe et al. (2016), the American Society of Anesthesiologists (ASA) was instrumental in defining preoperative fasting as in the form of a prescribed time period. It is before the procedure when patients are not allowed to intake liquids or solid food orally. ASA in support of framing more liberal preoperative fasting protocol and developed in the form of guidelines. The fasting period applies to patients of all ages who have to undergo all forms of elective procedures. Meals including fried foods or solids like meat prolongs the emptying time of the stomach and gastric congestion. Additional (8 hours or more) times are needed in context to these cases. On the other hand, this study addresses the longer preoperative fasting times than ASA’s recommendation. This particular preoperative must address the issues and challenges that are related to the relevant fasting policy. This paper alongside the mentioned ones is also held responsible for clarifying the recommendation associated with the fasting time related to the consumption of the liquid as well as the solid food. The planned surgery time needs to be checked before the administration relative to the fasting instruction as followed. The patients in the morning list (prior-to 12 pm) are allowed to consume solid meals before 6 hours. It is followed by making the patient sip on clear liquid 2 hours just before the planned procedure time. It is for those who are scheduled for the procedure in the afternoon and are listed in a list that is to be posted after 12.00 (Falconer et al. 2014).
The patient intended to go for surgery are needed to be fed with an allowed light meal. For example, the food that comprises toast along with clear liquid soup in the morning. It is within the morning for 6 hours and must wait to clear up the fluids even after 2 hours prior to the planned surgery. Nurses as well as doctors should engage themselves in the process of discouraging the traditional nil per oral. NPO as stated by Xu et al. (2017), are applied to the patients after midnight as well as works together in order to ensure that all forms of instructions are considered to be consistent and are along with the ASA guidelines. Alongside it, the patients need to understand all the mentioned directives in the form of a guideline.
Conclusion on Fasting in Elective Surgical Patients
In conclusion, it can be stated that the protocols conferred in the workplace of mine are the standard that is subjected to be followed elsewhere. It is very important that fasting protocol for surgery in a hospital is followed effectively as it is directly related to a healthcare user's health. The protocol followed at my workplace is evidence-based and subjected to the wellbeing of the healthcare user which can fully be understood through the evidential literature.
References for Fasting in Elective Surgical Patients
Abebe, W. A., Rukewe, A., Bekele, N. A., Stoffel, M., Dichabeng, M. N., and Shifa, J. Z. (2016). Preoperative fasting times in elective surgical patients at a referral hospital in Botswana. Pan African Medical Journal, 23(1). doi: 10.11604/pamj.2016.23.102.8863
Cestonaro, T., Schieferdecker, M. E. M., Thieme, R. D., Cardoso, J. N., and Campos, A. C. L. (2014). The reality of the surgical fasting time in the era of the ERAS protocol. Nutricion hospitalaria, 29(2), 437-443. DOI:10.3305/nh.2014.29.2.7025
Falconer, R., Skouras, C., Carter, T., Greenway, L., and Paisley, A. M. (2014). Preoperative fasting: current practice and areas for improvement. Updates in surgery, 66(1), 31-39. DOI 10.1007/s13304-013-0242-z
Francisco, S. C., Batista, S. T., and Pena, G. Das. G. (2015). Fasting in elective surgical patients: comparison among the time prescribed, performed and recommended on perioperative care protocols. ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo), 28(4), 250-254. doi: 10.1590/S0102-6720201500040008
Njoroge, G., Kivuti-Bitok, L., and Kimani, S. (2017). Preoperative fasting among adult patients for elective surgery in a Kenyan referral hospital. International Scholarly Research Notices, 2017. doi: https://doi.org/10.1155/2017/2159606
Tosun, B., Yava, A., and Açıkel, C. (2015). Evaluating the effects of preoperative fasting and fluid limitation. International Journal of Nursing Practice, 21(2), 156-165. doi:10.1111/ijn.12239
Xu, D., Zhu, X., Xu, Y., and Zhang, L. (2017). Shortened preoperative fasting for prevention of complications associated with laparoscopic cholecystectomy: a meta-analysis. Journal of International Medical Research, 45(1), 22-37. DOI: 10.1177/0300060516676411
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