2.1. Intervention
nausea, thirst, anxiety, liver cancer, vomiting, malnutrition
LIVER CANCER, ADVERSE REACTIONS, COMPLICATIONS, MALNUTRITION
In this study, all patients received different enteral nutrition interventions, while all other procedures remained the same. The control group received routine care, which included nutritional risk screening (NRS2002) by the responsible nurse upon admission and dietary education for patients with nutritional risk. The Nutritional Risk Screening is a valid and reliable tool used to assess the risk of malnutrition in hospital patients.The research group implemented a 3H nutrition management program, guided by the documents explored in Nutrition Support Team (NST) and the current practice guidelines for nutritional care of liver cancer patients. Thirteen clinical nursing specialists and nutrition specialists were consulted to develop the final intervention protocol. The specific steps of the program were as follows:Step 1: NST establishment. The team consisted of 2 physicians, 2 dietitians, 1 pharmacist, 2 experienced nurses (who had been in charge of nurses and had more than 5 years of work experience), and 1 core member from the hospital’s nutrition academic team. All team members are employed by Shandong Provincial Hospital. The roles of the NST included NRS2002, regular monitoring of nutritional status, formulation and modification of nutritional treatment plans, placement and maintenance of nutritional treatment pathways (e.g., gastric tubes, nutritional tubes), monitoring and treatment of patient complications and adverse reactions, dietary guidance, education, research development, and continuous quality improvement. Each team member had assigned responsibilities, but there was collaboration and communication among them.Step 2: Home intervention. Patients expected to undergo liver cancer surgery were assessed for nutritional risk using the NRS2002 tool during consultation with nutritionists at the outpatient department. Patients with no nutritional risk were admitted to the hospital for elective surgery. For patients with a nutritional risk, dietary plans were developed by the NST based on their nutritional status. These plans primarily consisted of oral nutritional supplements (ONS). ONS is formulated as food for specific medical purposes, typically containing a balanced blend of macronutrients (e.g., protein, carbohydrates, and fats) as well as micronutrients (e.g., vitamins and minerals), which provide balanced nutrients to meet the needs of the body for nutrients.Step 3: Hospital intervention. Upon admission, the nurse conducted NRS2002 and provided dietary education. Preoperative patients were recommended a light, easily digestible liquid and semiliquid diet. The target intake of energy is 25 to 30 kcal/(kg·d), and the target protein is 1.2 to 1.5 g/(kg·d). Carbohydrate intake was given in separate oral doses of 355 mL of 12.5% solution between 5 a.m. and 6 a.m. on the day of the operation, with an additional 355 mL administered 2 to 4 hours before surgery in divided doses. After 6 hours of being awake following anesthesia, water intake could begin with approximately 20 mL, followed by 50 to 100 mL every 2 to 3 hours. A liquid diet was started 24 hours after surgery, and 100 to 150 mL of ONS was given every 2 to 3 hours, aiming for a total intake of 500 to 750 mL that day. The intake was gradually increased by 50 ml every 2 to 3 hours based on patient tolerance. After 48 to 72 hours, a semiliquid diet was resumed. Once anal exhaust occurred, patients resumed a normal diet. The NST collaborated with the nutrition department to develop personalized diets for patients and established a dietary activity record table. Regular nutrition-related lectures were held by the nutrition team to improve compliance among patients and their families, explain the importance of enteral nutrition, address dietary misconceptions, and answer questions. Many patients and their families have dietary misconceptions. For example, some patients and their families may be influenced by traditional Chinese beliefs that consumption of fish and shrimp possesses stimulating properties, which may hinder wound healing. Nevertheless, fish and shrimp possess a wealth of high-quality protein and a diverse range of trace elements that are easily absorbed and utilized by the human body. Similarly, patients often experience a pronounced thirst and hunger following emergence from anesthesia, which is exacerbated by heightened levels of anxiety expressed by their loved ones. Consequently, premature administration of excessive postoperative supplements may arise, resulting in symptoms such as abdominal distension, nausea, and vomiting.Step 4: Home intervention. On the day of discharge, patients were reassessed for nutritional risk. Nutritional therapy continued after discharge for patients at risk of malnutrition or those who required perioperative intervention but did not meet their energy needs through oral routes. The therapy primarily involved ONS, which were added 3 times a day in addition to regular meals.Step 5: Follow-up. A comprehensive doctor-nurse-dietitian follow-up support system was established, and a WeChat group was created. The patients were monitored for a duration of 2 weeks post-discharge. Patients were instructed to maintain a diet diary, recording food intake information for each meal and regularly uploading it once a day. Team members reviewed the information daily and provided personalized guidance as needed. Patients had a follow-up review 2 weeks after discharge.