DAILY ONLINE ASSIGNMENTS

SURGERY YEAR 3: SESSION 2019 2020

ASSIGNMENT 3: SURGERY YEAR 5

Q 1: List the methods of nutritional support available for surgical patients. Briefly describe
any FOUR complications of total parenteral nutrition (TPN).

INSTRUCTIONS:

1. Please check your assignments by 10am daily.

2. Your responses must not exceed 500 – 700 words.
3. Use Calibri size 11 fonts for all answers.
4. You may add one illustration or a table to enhance your answer.
5. You must credit the source from which you create your answers – at the end.
6. All answers must be sent through email to me at this email address:
pranab@mahsa.edu.my.
7. Deadline for receiving responses is by 2pm daily.
8. Those students who send in their answers after 2pm will be considered as being absent.
9. Please mark your responses with your name, BMS number and date at the beginning of your
answers.
10. I will post the answers daily on the LMS – on the very next day for you to compare with your
responses.

JEEVANTHANY ANGELA
BMS15091718

ANSWER:
List of the methods for nutritional support available for the surgical patients are enteral and
parenteral feeding. Enteral feeding consists of oral feeding, sip feeding,nasogastric tube feeding and
fine-bore tube insertion,gastrotomy and jejunostomy . parenteral feeding done via perioheral
venous access or central venous access.

Total parenteral nutrition (TPN) is a method od feeding that bypasses the gastrointestinal tract(GIT)
yet gives optimum nutrition for the patient. However there are few complications which are
associated with TPN. Firstly,chronic deficiency syndrome which comes under the category of
nutrional deficient. TPN only gives certain essential nutritient and cause deficiency for other
nutrients and leading to chronic deficiency syndrome. This chronic deficiency syndrome is due to
metabolic abnormalities resulted from TPN. Secondly, the infection due to catheter. Cathether
related sepsis is one of the common issues faced due to TPN. During cathether insertion , the
patient is exposed or prone to get infection thus strong aseptic technique is required to be practiced
to avoid this. Infection must be suspected if there is fever,metabolic acidosis, thrombocytopenia or

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 DAILY ONLINE ASSIGNMENTS
SURGERY YEAR 3: SESSION 2019 2020

glucose instability.Thirdly, pneumothorax due to line insertion.This is one of the most common line
insertion complication which commonly occurs during the with subclavian lines insertion. If less
skillful staff perform this could lead to pneumothorax. Patient usually present with the symptoms of
shortness of breath or pain. If this occurs, a chest drain should be placed for drainage then
immediately the line should be removed. X-ray is used to determine the pneumothorax. Fourthly,
refeeding syndrome. Refeeding syndrome can be a life-threatening complication in the first days
after the start of feeding in severely malnourished patients who was previosuly on TPN. Clinical
manifestations are non-specific and can include arrhythmias, muscle weakness, signs of respiratory
and/or cardiac failure, oedemas, lethargy or seizures. It occurs due to derangement of serum
electrolytes such as phosphate, potassium, or magnesium. Vitamin deficiency and water retension
also occurs.

Refence:
 Remillard, Rebecca & Martin, R. (1990). Nutritional support in the surgical patient. Seminars in
veterinary medicine and surgery (small animal). 5. 197-207.
 David R. Thomas , MD, St. Louis University School of Medicine, (2011)Total Parenteral Nutrition
(TPN)