Care seriously ill patients requires from nurse great patience, skill and mercy. Such patients are very vulnerable, often capricious in their desires, and impatient. All these changes do not depend on the patient himself, but are associated with the influence of the disease on the patient’s psyche and behavior. These should be regarded as symptoms of a serious illness. For a seriously ill patient, food and drink become especially important, often determining either recovery or progression of the disease. Poor nutrition several times increases the risk of developing bedsores, slows down recovery, and contributes to the progression of the underlying disease.
Seriously ill patients receive food in the ward. To do this, food is served on an individual tray, covered with lids so that it does not cool down during transfer (transportation on a cart). Feeding seriously ill patients is the responsibility of the ward nurse. These patients often have decreased appetite and require special approach, patience and attention. Before eating, all medical procedures should be completed and, to the extent possible, all natural functions should be completed. The nurse makes sure that the ward is clean and ventilated, and the patients are prepared for meals. The degree of nurse participation in feeding depends on the patient’s condition: some patients actively eat, and the nurse only helps move the table or seat them, change dishes, put away dishes; Other, very weak patients require constant assistance when eating.
Before you start feeding, it is necessary to carry out all medical procedures and carry out the patient’s physiological functions. After this, it is necessary to ventilate the room and help the patient wash his hands. A nurse can help the nurse with this. It is best, if the condition allows, to give the patient a semi-sitting position or raise the head of the head. If this cannot be done, then it is necessary to turn the patient's head to the side. A great help in feeding a seriously ill patient is a functional bed equipped with a special over-bed table. If there is none, then instead of a table you can use a bedside table. Cover the patient's chest with a napkin, and if necessary. put some oilcloth on it. Food should be semi-liquid and warm.
If a seriously ill patient has an appetite at hours not established by the regime, and all previous days he has refused food, ward sister must make an exception, “disturb” the daily routine and, if necessary, warm up food and feed the patient at night.
Feeding a seriously ill patient with a spoon
Target: feeding the patient.
Indications: inability to eat independently.
Preparation for the procedure:
1. Ask the patient about his favorite dishes and agree on the menu with the attending physician or nutritionist.
2. Warn the patient 15 minutes in advance that a meal is to be taken and obtain his consent.
3. Clear some space on the nightstand and wipe it, or move the bedside table and wipe it.
4. Assist the patient into a high Fowler's position.
5. Help the patient wash his hands and cover his chest with a napkin.
6. Wash your hands.
7. Bring food and liquid, food and drink intended for the day: hot dishes should be hot (60 0), cold - cold.
8. Ask the patient in what order he prefers to eat.
Executing the procedure:
9. Check the temperature of hot food by dropping a few drops onto the back of your hand.
10. Consider drinking (preferably through a straw) a few sips of liquid.
11.Feed slowly.
12. Name each dish offered to the patient.
l3.Fill the spoon 2/3 full with hard (soft) food.
14.Touch the lower tube with a spoon so that the patient opens his mouth.
15.Touch the tongue with the spoon and remove the empty spoon.
16.Give time to chew and swallow food.
17. Consider drinking after a few spoons of solid (soft) food.
18. Wipe (if necessary) the tubes with a napkin.
19. Suggest that the patient rinse his mouth with water after eating.
End of the procedure:
20. Remove dishes and leftover food after eating.
21.Wash your hands.
Feeding a seriously ill patient using a sippy cup
Target: feeding the patient.
Indications: inability to independently eat solid and soft food.
Equipment: sippy cup; napkin
Preparation for the procedure:
1. Tell the patient what dish will be prepared for him (after agreement with the doctor).
2. Warn the patient 15 minutes in advance that a meal is to be taken and obtain his consent.
3. Wipe down the bedside table.
4. Wash your hands.
5. Place the cooked food on the bedside table.
Performing the procedure:
6. Move the patient to the side or into the Fowler's position (if his condition allows)
7. Cover the patient’s neck and chest with a napkin.
8. Feed the patient from the sippy cup in small portions (sips).
End of the procedure:
9. Let the mouth be rinsed with water after feeding.
10. Remove the napkin covering the patient’s chest and neck,
11. Help the patient find a comfortable position
12.Remove leftover food.
13.Wash your hands.
Administration technique and feeding the patient through a nasogastric tube. Determination of water balance.
Plan.
1. Technique for inserting a nasogastric tube. Feeding the patient through a nasogastric tube using a funnel, drip, using a Janet syringe.
2. Drinking regime; Helping the patient get enough fluids.
3. Determination of water balance.
4. Disinfection of used equipment.
Related questions:
1. Characteristics of diets.
2. Drawing up portion requirements
3. Distribution of food.
4. Feeding a seriously ill patient in bed: table setting,
5. Spoon feeding a seriously ill patient.
6. Feeding a seriously ill patient from a sippy cup.
Technique for inserting a nasogastric tube. Feeding the patient through a nasogastric tube using a funnel, drip, using a Janet syringe.
Insertion of a nasogastric tube (NGT)
Equipment: gastric tube with a diameter of 0.5-0.8 cm (the tube should be in freezer at least 1.5 hours before the start of the procedure; in an emergency, the end of the probe is placed in a tray of ice to make it stiffer); sterile Vaseline oil or glycerin; a glass of water 30-50 ml and a drinking straw; Janet syringe with a capacity of 20 ml; adhesive plaster (1 * 10 cm); clamp; scissors; probe plug; safety pin; tray; towel; napkins; gloves.
Preparation for the procedure
1. Clarify with the patient the understanding of the progress and purpose of the upcoming procedure (if the patient is conscious) and his consent to the procedure. If the patient is uninformed, clarify further tactics with a doctor.
2. Determine the half of the nose most suitable for inserting the probe (if the patient is conscious):
First press one wing of the nose and ask the patient to breathe with the other, closing his mouth;
Then repeat these steps with the other wing of the nose.
3. Determine the distance to which the probe should be inserted (the distance from the tip of the nose to the earlobe and down the anterior abdominal wall so that the last hole of the probe is lower xiphoid process).
4.Help the patient assume a high Fowler's position.
5.Cover the patient’s chest with a towel.
Executing the procedure
4.Wash and dry your hands. Wear gloves.
5. Liberally treat the blind end of the probe with glycerin (or other water-soluble lubricant).
6.Ask the patient to tilt his head back slightly.
7.Insert the probe through the lower nasal passage to a distance of 15-18 cm and ask the patient to tilt his head forward.
8.Add the probe into the pharynx along back wall, asking the patient to swallow if possible.
9.Immediately, as soon as the probe is swallowed, make sure that the patient can speak and breathe freely, and then gently advance the probe to the desired level.
10.If the patient can swallow:
Give the patient a glass of water and a drinking straw. Ask to drink in small sips, swallowing the probe. You can add a piece of ice to the water;
Ensure that the patient can speak clearly and breathe freely;
Gently advance the probe to the desired mark.
11.Help the patient swallow the probe, moving it into the pharynx during each swallowing movement.
12. Make sure the probe is correctly positioned in the stomach:
a) introduce about 20 ml of air into the stomach using a Janet syringe, while listening to the epigastric region;
b) attach the syringe to the probe; during aspiration, the contents of the stomach (water and gastric juice) should enter the tube.
13.If necessary, leave the probe on long time, cut the plaster 10 cm long, cut it longitudinally to a length of 5 cm. Attach the uncut part of the adhesive plaster to the back
nose Wrap each cut strip of adhesive tape around the probe and secure the strips crosswise on the back of the nose, avoiding pressing on the wings of the nose.
14. Close the probe with a plug (if the procedure for which the probe was inserted will be performed later) and attach it with a safety pin to the patient’s clothing on the shoulder.
Completing the procedure
15.Remove gloves. Wash and dry your hands.
16.Help the patient take a comfortable position.
17.Make a record of the procedure and the patient’s reaction to it.
18.Rinse the probe every four hours isotonic solution sodium chloride 15 ml (for a drainage probe, inject 15 ml of air through the outflow outlet every four hours).
Note. Caring for a probe left in place for a long time is the same as caring for a catheter inserted into the nose for oxygen therapy.
Section 3. Technologies for the provision of medical services
when feeding the patient
FEEDING A SERIOUSLY ILL PATIENT WITH A SPOON
CONTRAINDICATIONS: inability to perform chewing and swallowing movements (diseases of the oral cavity, esophagus).
EQUIPMENT: prepared dish; spoon; a glass of boiled water and a tray; napkin; straw;
1. Introduce yourself to the patient. Warn the patient 15 minutes in advance that a meal is to be taken and obtain his consent.
2. Ventilate the room, make room on the nightstand or move the bedside table. Wipe the surface of the table (bedside table) with a rag moistened with a disinfectant solution.
3. Place the patient in a high Fowler position. Help the patient wash their hands and cover their chest with a tissue.
5. Bring food and liquids intended for eating and drinking (according to the diet): hot dishes must be at an appropriate temperature of 60 o C, cold dishes - 20 o C.
5. Ask the patient in what order he prefers to eat. Check the temperature of hot food by dropping a few drops onto the back of your hand.
6. Offer to drink (preferably through a straw) a few sips of liquid, which reduces dry mouth and makes chewing solid food easier.
8. Feed slowly: name each dish offered to the patient;
Fill the spoon 2/3 with hard (soft) food; touch with a spoon lower lip for the patient to open his mouth, touch the tongue with the spoon and remove the empty spoon;
Give the patient time to chew and swallow food; Offer a drink after a few spoons of hard (soft) food.
9. Invite the patient to rinse the mouth with water after eating.
10. Remove dishes and leftover food after eating. Wipe the table (bedside table) with a rag moistened with a disinfectant solution twice with an interval of 15 minutes.
3. Wash and dry your hands.
FEEDING A PATIENT USING A SIPPLE
PURPOSE: satisfying the patient's nutritional needs.
INDICATIONS: inability to eat independently.
CONTRAINDICATIONS: inability to swallow (diseases of the oral cavity, esophagus).
EQUIPMENT: sippy cup; cooked dish; napkin;
a glass of boiled water, a tray;
2. Warn the patient 15 minutes in advance. about the upcoming meal, obtain his consent. Ventilate the room.
3. Tell the patient what dish has been prepared for him.
4. Wash and dry your hands (it is better if the patient can see this).
5. Place cooked food (according to the diet) on the bedside table.
6. Move the patient onto his side or into the Fowler's position (if his condition allows).
7. Cover the patient’s neck and chest with a napkin. Feed the patient from a sippy cup in small portions (sips)
8. After feeding, have the patient rinse the mouth with water.
9. Remove the napkin. Help the patient find a comfortable position. Remove food debris and disinfect.
10. Wipe the table (bedside table) with a rag moistened with a disinfectant solution twice with an interval of 15 minutes.
11.Wash and dry your hands.
PERFORMANCE FEATURES:
When feeding a child from a sippy cup, the nurse should lift the child's head with her left hand to prevent choking. Force-feeding a sick child is unacceptable, as this can lead to vomiting and worsening of his condition.
FEEDING THE PATIENT THROUGH A NAZOGASTRAL TUBE
(the patient is conscious)
PURPOSE: satisfying the patient's nutritional needs. INDICATION: inability to eat independently.
EQUIPMENT: sterile: tray, tweezers, nasogastric tube with plug, Janet syringe, 10-20 ml syringe; glycerin, gloves; napkins; adhesive plaster; towel; nutrient mixture (38 - 400C), boiled water 100 ml; tray for waste material;
1. Introduce yourself to the patient. Explain the course of the upcoming manipulation, obtain informed consent
2. Tell the patient what dish has been prepared for him.
3. Prepare equipment (the probe must be in the freezer for at least 1.5 hours before the procedure).
4. Determine the most suitable half of the nose for inserting the probe: first press one wing of the nose and ask the patient to breathe, then repeat these actions with the other wing of the nose.
5. Determine the distance to which the probe should be inserted: using the formula: patient’s height in cm – 100;
Measure the distance from the tip of the nose to the earlobe and down to the xiphoid process.
6. Help the patient assume a high Fowler's position.
7. Cover the patient's chest with a towel.
8. Carry out hand hygiene (it is better if the patient sees this), put on gloves.
1. Using sterile tweezers, place the probe and syringe on a sterile tray.
2. Spray the blind end of the probe generously with glycerin over a non-sterile tray.
3. Ask the patient to tilt his head back slightly.
4. Insert the probe through the lower nasal passage to a distance of 15-18 cm. The natural bends of the nasal passage make it easier to insert the probe.
5. Ask the patient to bring his head to a natural position. The possibility of further insertion of the probe is provided.
6. Help the patient swallow the probe, moving it into the pharynx during each swallowing movement to the desired level.
7. Make sure that the patient can breathe freely, speak clearly, and the voice is not changed.
8. Check the correct position of the probe: you need to open the cap, attach the syringe, and pull the syringe plunger towards you. If gastric contents appear, then the probe is in the stomach.
9. Draw the required amount of nutritional mixture into the Zhane syringe. Attach the Janet syringe to the probe and gradually introduce the nutrient mixture by pressing on the piston or raising the syringe above the level of the stomach. Close the plug.
10. Fill the Janet syringe with 50-100 ml of boiled water and inject it through the probe.
11. Disconnect the Janet syringe from the probe and close the distal end of the probe with a plug.
12. If necessary, leave the probe for a long time, attach it with an adhesive tape to the back of the nose, and to the patient’s clothing with a safe pin. Help the patient find a comfortable position.
13. Remove used equipment and disinfect it. Remove gloves. Wash and dry your hands. Make a record of the results of the manipulation and the patient's reaction.
3. Rinse the probe every 4 hours with 15 ml of isotonic sodium chloride solution. For the Salem drainage probe, inject 15 ml of air through the outflow (blue) port every 4 hours, which ensures patency of the probe.
FEEDING A PATIENT THROUGH GASTROSTOMY
PURPOSE: satisfying the patient's nutritional needs.
INDICATION: inability to eat independently.
EQUIPMENT: sterile: tray, tweezers, container for tweezers, gloves, soft probe (rubber, plastic or silicone), funnel or Janet syringe;
Container with food (food should be high-calorie, liquid or semi-liquid, warm; the volume of food introduced starts with 50 ml 6 times a day, then gradually the volume is increased to 250-500 ml 4 times a day); boiled water 100 ml;
1. Wipe the bedside table with a rag soaked in a disinfectant solution.
2. Inform the patient about the upcoming feeding, the composition and volume of food, feeding method, and obtain consent.
3. Carry out hand hygiene with an antiseptic, put on gloves (it is better if the patient sees this).
4. Place cooked food (according to the diet) on the bedside table. It is advisable to give part of the food (for example, bread) to the patient through the mouth: the patient will chew thoroughly and then spit the chewed bread into a funnel with the rest of the food. Stimulation of appetite and preservation of the function of the salivary glands.
2. Unfasten the probe from clothing and remove the clamp (plug) from the probe - if the fistula has not yet formed. Insert a probe into the gastric fistula - if the fistula has formed. Attach a funnel to the probe.
3. Pour cooked food into the funnel in small portions, adhering to your own food intake rate. The natural speed of food intake is ensured.
4. Rinse the probe with warm boiled water using a Janet syringe.
5. Close the probe (clamping it with a clamp) - if the fistula has not yet completely formed, disconnect the funnel and remove the probe - if the fistula has formed.
6. Examine the skin around the gastrostomy and assess the condition of the dressing. Prevention of maceration of the skin around the gastrostomy.
1. Remove and disinfect used equipment.
2. Wipe the bedside table with a rag moistened with a disinfectant solution twice with an interval of 15 minutes.
3.Remove used gloves and disinfect them. Wash and dry your hands.
Feeding seriously ill patients with a spoon
Indications:
Equipment: dishes for feeding.
Preparing for feeding:
1. Warn the patient 15 minutes in advance that a meal is to be taken and obtain his consent.
2. Ventilate the room, make room on the nightstand or move the bedside table.
3. Help the patient assume a high Fowler's position.
4. Help the patient wash his hands and cover his chest with a tissue.
5. Wash your hands.
6. Bring food and liquids intended for eating and drinking: hot dishes must be hot (up to 60º).
7. Ask the patient in what order he prefers to eat.
8. Check the temperature of hot food by dropping a few drops onto the back of your hand.
Feeding:
1. Offer to drink (preferably through a straw) a few sips of liquid.
2. Feed slowly:
· name each dish offered to the patient;
· fill the spoon by ⅔ hard (soft) food;
· touch the lower lip with a spoon so that the patient opens his mouth;
· touch the spoon to the tongue and remove the empty spoon;
· Allow time to chew and swallow food;
· offer a drink after a few spoons of hard (soft) food.
3. Wipe your lips (if necessary) with a napkin.
4. Invite the patient to rinse his mouth with water after eating.
End of feeding:
1. Remove dishes and leftover food after eating.
2. Wash your hands.
Feeding with a sippy cup
Indications: inability to eat independently.
Equipment: sippy cup, napkin, nutrient solution.
Preparing for feeding:
1. Wipe down the bedside table.
2. Tell the patient what dish will be prepared.
3. Wash your hands (it will be better if the patient can see this).
4. Place the cooked food on the bedside table.
Feeding:
1. Move the patient onto his side or into the Fowler's position (half-sitting, half-lying, if his condition allows).
2. Cover the patient’s neck and chest with a napkin.
3. Feed the patient from the sippy cup in small portions (sips).
Note: During the entire feeding procedure, food should be warm and look appetizing..
End of feeding:
1. Let the mouth be rinsed with water after feeding.
2. Remove the napkin covering the patient's chest and neck.
3. Help the patient find a comfortable position.
4. Remove leftover food.
5. Wash your hands.
Insertion of a nasogastric tube
(the patient can help the nurse, the behavior is adequate)
Indications: determined by the doctor.
Preparation for the procedure:
1. Explain to the patient the process and essence of the upcoming procedure (if possible) and obtain the patient’s consent to perform the procedure.
2. Preparation of equipment: sterile gastric tube with a diameter of 0.5-0.8 cm; sterile glycerin, a glass of water 30-50 ml and a drinking straw; Janet syringe, adhesive plaster (1x10 cm); clamp; scissors; probe plug; phonendoscope, safety pin; tray; towel; napkins; clean gloves.
3. Determine the most appropriate method of inserting the probe: first press one wing of the nose and ask the patient to breathe, then repeat these actions with the other wing of the nose.
4. Determine the distance to which the probe should be inserted (the distance from the tip of the nose to the earlobe and down the anterior abdominal wall so that the last hole of the probe is below the xiphoid process or height - 100 cm.
5. Help the patient assume a high Fowler's position.
6. Wash your hands. Wear gloves.
Performing the procedure:
1. Moisten the blind end of the probe with water or glycerin.
2. Ask the patient to tilt his head back slightly.
3. Insert the probe through the lower nasal passage at a distance of 15-18 cm.
4. Ask the patient to straighten his head to a natural position.
5. Give the patient a glass of water and a drinking straw. Ask to drink in small sips, swallowing the probe. You can add a piece of ice to the water.
6. Help the patient swallow the probe, moving it into the pharynx during each swallowing movement.
7. Ensure that the patient can speak clearly and breathe freely.
8. Gently advance the probe to the desired mark. If the patient is able to swallow, offer him or her to drink water through a straw. As the patient swallows, gently advance the probe.
9. Make sure that the probe is located correctly in the stomach: inject about 20 ml of air using a Janet syringe, while listening to the epigastric region, or attach the syringe to the probe: during aspiration, the contents of the stomach (water and gastric juice) should flow into the probe.
10. If necessary, leave the probe for a long time: cut the patch 10 cm long, cut it in half 5 cm long. Attach the uncut part of the adhesive plaster to the probe and secure the strips crosswise on the back of the nose, avoiding pressing on the wings of the nose.
End of the procedure:
- Cover the probe with a plug (if the procedure for which the probe was inserted will be performed later) and attach it with a safety pin to the patient's clothing on the chest.
- Help the patient find a comfortable position.
- Remove rubber gloves, immerse them in a container with 3% chloramine solution for 60 minutes, then dispose of them as Class B waste.
- Wash the hands.
- Make a record of the procedure and the patient's reaction.
Feeding the patient through a nasogastric tube
using a Janet syringe
Indications: trauma, damage and swelling of the tongue, pharynx, larynx, esophagus, swallowing and speech disorders, unconsciousness, refusal to eat due to mental illness.
Contraindications: peptic ulcer stomach in the acute stage.
Equipment: Janet syringe 500 ml, clamp, tray, phonendoscope, nutritional mixture (t 38-40ºС), warm boiled water 100 ml, sterile gastric tube d=0.3-0.5 cm.
Performing the feeding procedure:
1. Insert a nasogastric tube according to the nasogastric tube guidance algorithm. If the probe was inserted in advance, check the correct position of the probe.
2. Tell the patient what he will be fed.
3. Draw the nutrient mixture into Zhane’s syringe.
4. Place a clamp on the distal end of the probe. Connect the syringe to the probe, raising it 50 cm above the patient’s head so that the piston handle is directed upward.
5. Remove the clamp from the distal end of the probe and ensure a gradual flow of the nutritional mixture. If it is difficult to pass the mixture, use the syringe plunger, moving it down.
6. After emptying the syringe, clamp the probe with a clamp.
7. Above the tray, disconnect the syringe from the probe.
8. Repeat paragraphs. 3-7 before using the entire prepared amount of nutritional mixture.
9. Connect boiled water to the Janet probe. Remove the clamp and wash the probe under pressure.
10. Disconnect the syringe and close the distal end of the probe with a plug.
11. Help the patient take a comfortable position.
12. Wash your hands.
13. Make a record of the procedure and the patient’s reaction.
Feeding a patient through a nasogastric tube using a funnel
Indications: trauma, damage and swelling of the tongue, pharynx, larynx, esophagus, swallowing and speech disorders, unconsciousness, refusal to eat due to mental illness.
Contraindications: gastric ulcer in the acute stage.
Equipment: Janet syringe, clamp, tray, towel, napkins, clean gloves, phonendoscope, funnel, nutritional mixture (t 38-40ºC), boiled water 100 ml, sterile nasogastric tube d = 0.3-0.5 cm.
Preparation for the procedure:
1. Insert a nasogastric tube according to the nasogastric tube guidance algorithm.
2. Wash your hands.
3. Tell the patient what he will be fed.
4. Check the correct position of the probe:
· Place a clamp on the distal end of the probe above the tray;
· draw 30-40 ml of air into the syringe;
· attach the syringe to the distal end of the probe;
· remove the clamp;
· put on a phonendoscope;
· place the head of the phonendoscope over the stomach area;
Inject air from a syringe through the probe;
· Apply a clamp to the distal end of the probe and disconnect the syringe.
5. Attach a funnel to the probe.
Performing the procedure:
1. Pour the nutrient mixture into a funnel located obliquely at the level of the patient’s stomach.
2. Slowly raise the funnel 1 m above the level of the stomach, holding it straight.
3. As soon as the nutrient mixture reaches the level of the funnel, lower the funnel to the level of the patient’s stomach and clamp the probe with a clamp.
4. Repeat paragraphs. 1-3 using the entire prepared amount of nutritional mixture.
5. Pour 50-100 ml of boiled water into the funnel.
End of the procedure:
1. Disconnect the funnel from the probe and close the distal end of the probe with a plug. Attach the probe to the patient's clothing with a safety pin.
2. Help the patient take a comfortable position.
3. Wash your hands.
4. Make a record of the procedure and the patient’s reaction.
- Before starting to feed a patient lying on the bed, it is necessary to transfer him to a semi-sitting position, if necessary, placing a pillow for comfort. After which you should move the bedside table to the patient and give him time to prepare for meals.
- The area of the patient's neck and chest must be covered with a towel, eliminating the possibility of food getting on them. The temperature of liquid foods is checked by applying a few drops of liquid to the wrists.
- For feeding liquid food, you need to use a special sippy cup if the patient is not able to consume the food himself. For these purposes, it is possible to use a regular small-volume teapot.
- Food that has a semi-liquid composition should be given to the patient from a spoon.
- Before you start feeding, you should ask the patient in what order he intends to take food. The patient should not talk while eating, as if careless, food particles can enter the respiratory tract.
- The patient should not be forced to eat the entire amount of food if he does not want to. The home nurse should give him a break, then warm up the food and resume feeding.
Feeding a seriously ill patient with a spoon and sippy cup
- The patient should prepare a bedside table in advance so that food can be easily placed in front of it.
- Bring the patient into a semi-sitting position, raising the head edge of the bed and placing a pillow in the back and head area.
- The patient's hands must be washed.
- The patient's chest and neck should be covered with a towel or napkin to prevent food from getting into these areas.
- The person feeding should also wash their hands and then bring the food, carefully placing it on the bedside table. It is worth noting that the temperature of liquid food should be approximately fifty degrees.
- The feeding process should proceed slowly. Before giving a patient a particular dish, it is necessary to name it; bring a spoon to the patient’s mouth, lightly touching it to the lower lip so that he opens his mouth; wait until the patient chews and swallows the contents of the spoon; After giving the patient a few spoons of food, it is necessary to inquire whether he needs to drink;
- Any remaining food on the patient's lips should be removed with a napkin.
- Return the patient to the original position by removing the pillows and leveling the bed.
Indications: inability to eat independently.
I. PREPARATION FOR MANIPULATION:
1. Ask the patient about his favorite dishes and agree on the menu with the attending physician or nutritionist.
2. Warn the patient 15 minutes in advance that a meal is coming and obtain his consent
3. Ventilate the room, clear some space on the nightstand, wipe it, or move the bedside table and wipe it
4. Tell the patient what dish is prepared for him
5. Wash your hands
II. PERFORMANCE OF MANIPULATION.
1. Assist the patient into the Fowler's position (if there are no contraindications)
2. Help the patient wash his hands, comb his hair, and straighten his clothes.
3. Cover the patient’s neck and chest with a napkin.
4. Move the bedside table to the patient’s bed and set the table.
5. Arrange food plates according to the patient's wishes. If motor skills are impaired, place non-slip napkins under the plates. If coordination is impaired, use utensils with a protective rim or other utensils recommended by a specialist in rehabilitation medicine.
6. Offer the patient to use cutlery, including special utensils for patients with impaired motor functions.
7. Use if necessary assistive devices for the forearm, making it easier to raise the hand to the level of the mouth (for example, movable supports for the forearm; support belts worn over the head); prosthetic or orthopedic devices.
8. Observe the feeding process; efficiency of chewing and swallowing.
9. Replace plates as necessary.
10. Give a small sip of water and ask him to rinse his mouth.
11. Dry the patient's lips with a tissue
If the patient requires active feeding
1. Raise the head end of the bed
2. Ensure that food prepared for the patient has a homogeneous consistency.
3. Move the bedside table to the patient’s bed and set the table.
4. Raise the patient’s head with one hand; the other, bring the spoon to the patient’s mouth (with hemiparesis, food is brought from the healthy side).
5. Feed the patient from a spoon in small portions or from a sippy cup in small sips (meals - hot (60°C), cold (15°C))
6. Support the patient's head during chewing and swallowing.
7. Give the patient water on demand or every 3-5 spoons of food. Liquid is given using a spoon or sippy cup.
III. ENCLOSURE OF MANIPULATION.
1. Remove the napkin from the patient's chest
2. Help the patient lie down
3. Remove dishes and leftover food after eating
4. Wash your hands
Target: patient nutrition.
Indications: determined by the doctor.
Contraindications: determined by the doctor.
I. PREPARATION FOR MANIPULATION.
1. Prepare equipment:
§ sterile thin probe diameter 0.5 cm,
§ Vaseline,
§ Janet funnel or syringe,
§ liquid food 600 – 800 ml (tea, fruit drink, broth, egg) or special drugs(enpits)
§ syringes with a volume of 20-50 ml
§ phonendoscope
§ gloves are clean
II. PREPARATION FOR MANIPULATION
Introduce yourself to the patient (if the patient is conscious), inform the patient about the upcoming feeding, composition and volume of food, feeding method, obtain consent
- Place the patient in a semi-sitting position.
- Place a towel on the patient's chest.
- Wash and dry your hands.
- Determine the distance to which the probe should be inserted (height in cm minus one hundred, or from the tip of the nose to the ear and to the xiphoid process).
- Treat the end of the probe (15 cm) with Vaseline.
- Insert the probe through the lower nasal passage to a depth of 15–18 cm (head tilted back).
- Determine its location in the nasopharynx.
- Tilt your head slightly forward and push the probe with your right hand until middle third esophagus.
- Instruct the patient to continue swallowing the tube into the stomach with water.
- Check that the probe is positioned correctly
· attach the syringe to the probe and aspirate the stomach contents. If signs of bleeding appear, stop the procedure.
install a phonendoscope on the front abdominal wall patient in the projection of the stomach and introduce 20 ml of air. When the probe is in the stomach, characteristic gurgling sounds will be heard).
- Secure the probe with an adhesive tape on the back of the nose.
- Clamp the probe with a clamp, placing the free end of the probe in the tray.
II.PERFORMANCE OF MANIPULATION.
1. Fill the Janet syringe with liquid food (T 30-35º C).
2.Connect the syringe with gastric tube, hold the syringe with your left hand by the cone, with the piston handle pointing upward.
3. Remove the clamp.
4. Right hand slowly introduce cooked food.
5. Rinse the probe with water (from another syringe). When feeding the patient dairy foods, the tube should be washed every 2 hours. Otherwise, pathogenic microflora may develop in the probe.
6. Disconnect the syringe.
III. END OF MANIPULATION.
1. Close the free end of the probe with a plug.
2. Attach the probe to your clothing with a pin.
3. Make sure the patient is comfortable.
4. Remove everything unnecessary.
5. Remove gloves. Wash your hands.
nasogastric tube care
Equipment- 150 ml syringe (Janet syringe), phonendoscope, vacuum suction device, tray, glycerin, saline solution or special solution for rinsing, non-sterile gloves, sterile gauze pads, container for rinsing the catheter, plaster, spatula
Preparation for the procedure:
Introduce yourself to the patient
1. Explain the purpose and course of the upcoming procedure,
2. Determine whether he experiences any discomfort from the probe (if the patient is conscious) and determine the need for changes.
3. Treat hands hygienically and dry
4. Wear gloves.
Performing the procedure:
1 Inspect the insertion site for signs of irritation or pressure.
2 Check the location of the probe: ask the patient to open his mouth to see the probe in the pharynx.
3 Connect a syringe with 10-20 cc. cm (10 cc for children) of air to the nasogastric tube and introduce air, while listening to sounds in the epigastric area with a stethoscope (gurgling sounds).
4 Clean the external nasal passages with moisturized saline solution gauze napkins.
5 Apply Vaseline to the mucous membrane in contact with the probe (with the exception of manipulations associated with oxygen therapy.
6 Every 4 hours, perform oral care: moisturize the mouth and lips.
7 Every 3 hours (as prescribed by a doctor), rinse the probe with 20-30 ml of saline solution. To do this, connect a syringe filled with saline solution to the probe, slowly and carefully introduce the liquid into the probe; Carefully aspirate the liquid, pay attention to it appearance and pour into a separate liquid.
End of the procedure:
1 Remove the patch and re-stick it if it comes off or is very dirty.
2 Disinfect and dispose of used materials. Treat the phonendoscope membrane with a disinfectant or antiseptic.
3 Remove gloves and place them in a container for disinfection
4 Treat hands hygienically and dry.
5 The probe should be washed with the head end raised.
Basic manipulations
