Nursing management and prevention of malnutrition in the patient with head-neck cancer.

Abstract

BACKGROUND The nursing record is often devoid of tools for nutritional evaluation: detection of signs and symptoms, nutritional screening such as the Malnutrition Universal Screening Tool (MUST) and the Mini Nutritional Assessment (MNA), anthropometric parameters: such as weight; with these tools. Therefore, it is possible to frame the patient according to his nutritional status and establish the most appropriate care path. Inappropriate documentation can create a negative nutritional spiral that carries an increased risk of serious health-related complications. It also hinders follow-up. In the literature it emerges the importance of using dysphagia screening and nutritional status assessment, these must be introduced into the hospital routine to avoid the damage caused by dysphagia and malnutrition. The literature shows how nutritional risk affects the increase in mortality, morbidity, days of hospitalization and re-admission to hospital one year after discharge. Malnourished patients had a longer hospital stay than normally fed patients, used more drugs and underwent more diagnostic tests and finally greater mortality. Malnutrition, to treat it appropriately, would be enough to be detected with simple screening tools. AIM This study aimed to estimate the prevalence of hypoalbuminemia in hospidalized elders before treatment for free flap plastic surgery after intervention for head-neck cancer, their nutritional status and lenght of stay. METHODS Retrospective observational study with 28 patients with head and neck cancer who underwent free flap recostruction in hospital at the Galliera Hospital Genoa during two years from Jenuary 2017 to December 2018. Clinical and surgical procedure-related factors were retrieved from a database and analyzed. RESULTS 28 patients ( 19 men, 9 women) were included in this study. The mean age of the study population was 61 years (range, 18 to 80 yr). The mean BMI was 23.30 kg/m2 ( range, 17.53 to 30.9 kg/m2). The mean lenght of stay was 35 days ( range, 11 to 122 days). The mean of the level albumin was 3.34 g/dl ( range, 2.1 to 4.5 g/dl). One surgical mortality was noted. The data emerged from the survey report the values of albumin and lymphocytes decreasing compared to the entrance, an extremely significant figure is also that of the days of hospitalization, which almost double in presence of one or more complications. The comparison between the average value of the days of stay of the stitches in patients without complications and the mean value of the days of stay of sutures in patients with complications, with a percentage deviation of 51.96%. The difference in patients with a lower incoming plasma albumin level compared to the group with normal levels allowed comparative analyses with respect to outcomes. 13 patients demonstrated albuminemia levels below the threshold of normal input, 15 adequate levels. The 13 patients with different albumenemic libellus developed site infection with an increase in average hospitalization days of 49.92 days (st.dev 26.26) against an average of the other group of 22.80 days (st.dev 10.50) the difference was significant The two-tailed P value equals 0.0011; also the permanence of the stitches in site is different between the two groups with an average of 45.77 days (st.dev 20.31) against an average of the other group of 23.80 days (st.dev 6.20) The two-tailed P value equals 0.0003 CONCLUSIONS: The prevalence of hypoalbuminemia, and the nutritional status and the length of stay seems to be related. Thus, it is suggested that monitoring albumin levels should be done to evaluate the risk that the patient has to develop malnutrition and other complications during hospital stays.