The patient can be assessed frequently and also the evaluation of the nursing or nutritional therapy can be performed. Any form of ineffective clinical management can be assessed using the self-monitoring skills of the patient. Studies have demonstrated that nutritional therapies are effective in such patients and nutrition can be better managed. The patient may experience certain amount of guilt whilst doing such monitoring activities. Counseling and psychotherapy can play a major role in such a circumstance (Giarelli, 2006).
However, nutritional management of the patient may not successful due to the negligent efforts of the patient, but more often would be the cause of the healthcare professionals that lack the necessary skills and knowledge to implement an effective nutritional program. In a study conducted by Aydin et al (2005) to determine the evaluation of patient’s nutritional status before GI surgery and the role nurses can play, it was found that malnutrition was occurring at a very high rate and in most cases the nurses did not have the knowledge and the skills to determine this nor solve the problem of the patient.
Frequently, nurses are not able to diagnose and treat malnutrition in patients hospitalized and requiring GI surgeries. GI cancer could be one of the causes requiring a GI surgery. The study has clearly shown that the nurses were unable to determine what actually ‘nutritional status’ was (which went far beyond mere consumption of fluids and food). Frequently, before any GI surgery, the patient would require intestinal cleaning and other procedures and precautions. Many of the nurses agreed that nutritional evaluation in fact was the responsibility of the dietician or the nutritionist.
Hence, it is important that the nutritionist and the dietician play a vital role in the nutritional management of the patients suffering from GI cancers. Any GI disease including GI cancer can cause a high rate of malnutrition. Besides, lower food intake, greater metabolism of the tumor, etc, can seriously affect the nutritional status. The SGA study found that out of the 121 patients who had GI cancer, 27 % were well nourished, 52 % were moderately nourished and 20 % were poorly nourished. In cancer the malnutrition rate was about 97 %, ranging from moderate to severe.
The weight loss rate occurs in cancer patients at a very fast rate. The chances of complications are also higher in patients who are seriously malnourished. Some of the common symptoms that could worsen the problems of the malnourished patient include appetite loss, nausea, vomiting, constipation, diarrhea, oral lesions, chewing problems, Dysphagia, etc. The muscular capacity of the malnourished patients is also lower due to loss of muscle mass (Aydin, 2005). There are special problems in some patients suffering from GI cancer.
Frequently, GI cancer patients (suffering from esophageal cancers) have to undergo esophagectomy. These patients suffer from severe Dysphagia following the removal of the esophageal tissues. Esophagectomy involves operating on the face, neck, chest and abdomen. There is a new anastomosis formed which requires the patient do not consume anything by mouth (nil per oral) for 5 to 7 days. Some patients may have also been administered chemotherapy or radiotherapy before undergoing surgery, in which case the nutritional symptoms may be even more severe.
As the patient is at a serious nutritional risk following esophagectomy, there is a need for nutritional interventions. Studies shown that the patients often require 5 to 7 days of nil per oral diet before surgery, followed by insertion of a feeding jejunostomy tube (for enteral feeding). Oral intake should be slowly done initially with liquid foods followed by soft diet. The feeding jejunostomy tube would ensure that the patient weight is normal as it can be used nocturnally at home (Kight, 2008).