The basic principles of therapeutic nutrition. Feeding seriously ill.
Basic principles of rational nutrition
The basic principles of therapeutic nutrition
Characteristics of the main healing tables
Installation of patients in hospital
Types of artificial nutrition, indications for its use
Possible problem Patient, for example:
Reduced appetite
Knowledge deficit about the appointed diet
Make a portion requirement
Conduct a conversation with the patient and his relatives about the medical table appointed by the doctor
Teach the patient with the principles of rational and medical nutrition.
Control of grocery gear, sanitation bedside tables and refrigerators, food storage time
Feed a seriously ill patient from a spoon and a row
Introduce a nasogastric probe
Implement artificial nutrition of the patient (on phantom)
Exercise the nursing process when you violate the satisfaction of the patient's need for adequate nutrition and fluid intake on the example of the clinical situation
Therapeutic tables / diet(Greek Δίαιτα - lifestyle, power mode) - a set of food treaties by a person or other living organism.
Power goal - give the body such food, which, after its digestion in the gastrointestinal tract, entering blood and tissue (suction) and subsequent oxidation (combustion) would lead to the formation of heat and vital energy (muscular, nervous).
Medicinal nutrition - This is primarily nutritional nutrition of a person who ensures its physiological needs in food substances and at the same time the method of treatment with nutrition from specially selected and cooked products, acting on the mechanisms of disease development - condition various systems and metabolic processes. In this regard, most diets used for a long time contain the norm of all foodstuffs.
Distinguish the following types of patient food:
Optiral (Natural) Food (Natural)
Artificial:
Enteral (probe) food - through the probe introduced into the stomach;
Through the rectum;
Parenteral - intravenous administration of nutrients, which is used when the probability supply is not possible;
Through Gastrostome
One of the basic principles of therapeutic nutrition of patients in the hospital is the power mode and balanced Food diet (quantity of food, providing the daily need of a person in nutrients and energy), i.e., compliance with a certain ratio of proteins, fats, carbohydrates, vitamins, minerals and water in the proportions fit for the human body.
So food diet healthy man must include 80-100 g of proteins, 80-100 g of fats, 400-500 g of carbohydrates, 1700-2000 g of water (including 800-1000 g in the form of drinking water contained in tea, coffee and other drinks), A certain balance of vitamins, trace elements, etc. In this case, the ratio of proteins, fats, carbohydrates and other ingredients in the patient's food diet may vary depending on the nature of the disease.
The most optimal for a healthy person is considered to be a four-time meal, in which the breakfast includes 25% of the entire food diet, the second breakfast is 15%, lunch - 35%, dinner - 25%. In some diseases, the power mode changes.
Therapeutic nutrition is built on 3 basic principles: sparing, corrective and substantive.
Gentle principle - This is mechanical, chemical and thermal spurs of the patient organ and system. The chemically gentle diet is prescribed patients with gastrointestinal diseases, if necessary, reduce their secretory and motor functions. At the same time, they exclude alcohol, cocoa, coffee, strong broths, fried and smoked meat. Prescribe products that cause weak secretion - butter, cream, dairy soups, vegetable puree.
Mechanical spares - Everything is in a ferret, mature form.
Thermal sparesachieved by culinary processing of products (boiled, for a couple. stew)
Chemical spares -the elimination of acute, marinades, canning products, seasonings, salt limit.
For example, as peptic disease Fried foods (meat, potatoes) patients suffer badly, and meat dishes, cooked for a pair and finely chopped, or vegetable purees are fine.
Corrigating principle It is based on a decrease or increasing in the food diet of a particular substance. So, with diabetes mellitus, the disease in which the carbohydrate exchange is dramatically disrupted, the restriction of carbohydrates is very important. On the contrary, with some diseases of the liver, the heart of the carbohydrate increases.
Limit the intake of fat for diseases of the liver, pancreas and obesity and, on the contrary, an increase in fat is shown in depleting infectious diseases, tuberculosis.
In some illnesses, there is a need for starvation for 1-2 days. These are the so-called unloading days. In this period, the patient is either completely starving, or only it is given fruits, milk or cottage cheese. Such food unloading has good effect in obesity, gout, ba. The table salt is limited in diseases of the heart and kidney, accompanied by edema, arterial hypertension. In the same cases, the liquid is limited. On the contrary, in poisoning, the dehydration of the body is increasing the introduction of fluid.
The replacement principle is aimed at introducing substances from food, in which the body lacks a disadvantage, as is done in avitaminosis, protein disadvantage (nephrotic syndrome).
In Russia, the research institute has developed schemes diet tableswho are adopted in all therapeutic institutions of our country.
Medical diet
Diet 1. Yabzh and Yabdk, chronic gastritis with an increased secretory function. Characteristic - mechanical, chemical, thermal gentle of the tract, restriction crash salt, substances that are long in the stomach (meat, fats). White crackers are allowed, white stale bread, milk, cream, eggs, butter, butter, mucous soups, eggs, vegetable and fruit juices, fresh cottage cheese, sour cream).
Diet 2. Chronic gastritis with reduced secretory function. Characteristic - Software and stimulating components, such as broths, wipes, meat, fish, but a pair, not a piece are allowed.
Diet 3. Dyskinesia colon with constipation. Characteristic - increased amount of plant fiber (black bread, cabbage, apples, beets, pumpkin) and liquid. The products causing rotting and fermentation in the intestines are excluded (a large amount of meat, simple carbohydrates).
Diet 4. Enteritis with diarrhea, pronounced dyspeptic phenomena. "Hungry", "intestinal" diet. Characteristic is a limitation of fats and simple carbohydrates (contribute to steamed and fermentation), sharp and spicy substances.
Diet 5. Chronic hepatitis, liver cirrhosis. 5p - pancreatitis. Characteristic - strong stimulants of the stomach, pancreas, fats, meat are excluded. "The liver loves warm and sweet." An increase in the diet of vegetables and fruits contributes to the unloading of the liver.
Diet 6. Gout and uric acid diathesis (accumulation of uric acid in the body), eritremia. Characteristic - exclude products rich in purine bases (meat, legumes, chocolate, cheese, spinach, coffee), are injected with leaning products (vegetables, fruits, berries, milk). Abundant drink Fluids contributes to the washing of uric acid.
Diet 7. Kidney diseases (glomerulonephritis, pyelonephritis, amyloidosis). Characteristic is a significant limitation of protein and salt, in some cases, liquids.
Diet 8. Obesity. Characteristic is a significant reduction in the general congement due to simple carbohydrates and fats. Introduction of unloading days (kefir, curd, apple). Exclude seasonings, reinforcing appetite, somewhat limit the amount of fluid (often increased blood pressure).
Diet 9. Sugar diabetes with a normal and reduced body weight (with obesity - diet 8). Characteristic - simple carbohydrates are significantly limited (replaced by sugar substitutes), to a lesser extent - fats.
Diet 10. Cardiovascular diseases. Characteristic is a restriction of intake salt and liquid, fats, fried meat, other products containing a lot of cholesterol (butter creamy, fat, sour cream, eggs). Increase the amount of plant fiber, bran.
Diet 11. Pulmonary tuberculosis. Characteristic - increased calorie content due to additional nutrition (milk, eggs, sour cream, meat). Increased vitamins (vegetables, fruits, greens).
Diet 12. Diseases nervous system and mental illness. Characteristic - limitation of exciting substances (coffee, tea, alcoholic beverages, sharp seasonings, spices, salinity, marinades). Introduction of therapeutic teas (with mint, melissa, hops cones).
Diet 13. Acute infectious diseases. Characteristic is an increased amount of protein, liquid and vitamins (taking into account sweating and elevated temperature).
Diet 14. Phosphaturia with alkaline urine reaction and the formation of phosphorous calcium stones. Characteristic - exclude obscure products (milk, cottage cheese, cheese), increase fluid consumption in order to flush phosphates.
Diet 15. Lack of testimony therapeutic diet and the normal state of the digestive organs. Physiological norm proteins, fats, carbohydrates, liquids, vitamins, minerals and dietary fibers.
Diet 0., "jewish". The first days after the operation on the stomach and intestines, disturbances of consciousness (strokes, cranial and brain injuries). Characteristic - Food is liquid or jelly-like (tea with sugar, decoction of rosehip, lemon juice and other fruits, jelly, jelly, mors, weak broth, rice decoction).
In order to prevent disruption of diet and regime, you need a nurse for the transfer of products with relatives of patients.
Standard diets
Order of the Ministry of Health of the Russian Federation No. 330-2003. "On measures to improve therapeutic nutrition in therapeutic and preventive institutions of the Russian Federation".
It is proposed to go to a new system of therapeutic tables / diets - the system of standard diets. The new diet system is based on the license system M.I. Pevzner and includes 5 options for standard tables / diets.
1. Basic version of the standard diet
The purpose of the destination:normalization of the secretory activity of the buse and intestinal tract, intestinal motorities, liver and gallbladder functions, creating conditions for the normalization of the metabolism of the body and the rapid removal of toxic exchange products (slags), unloading of cardio-vascular system, normalization of cholesterol and intermediate M on metabolism, increasing the resistance and reactivity of the body.
This diet replaces1, 2, 3, 5, 6, 7, 9, 10, 13, 14, 15 license dimensions.
Characteristic.Diet with the physiological content of proteins, fats and carbohydrates, enriched with vitamins and minerals, vegetable fiber. When the diet is prescribed, patients with diabetes are excluded (refined carbohydrates).
Exceptions in the diet:smelted seasonings, smoked confectionery products on a cream-based, fatty varieties of meat and fish, spinach, sorrel, garlic, legumes, strong broths, okroshka.
Method of cooking:in boiled form baked and pair. Diet:4-6 times a day, fractional.
2. Option diet with mechanical and chemical gene
The purpose of the destination:moderate mechanical, chemical and thermal spares contribute to liquidation inflammatory process, normalization of functional state of organs gastrointestinal tract, reducing reflex excitability.
This diet replaces:1, 4, 5 license dimensions.
Characteristic.A diet with the physiological content of proteins, fats and carbohydrates, enriched with vitamins, minerals, with a moderate restriction of chemical and mechanical irritants of the mucous membrane of the receptor apparatus of the gastrointestinal tract.
Exceptions in the diet:sharp snacks, seasonings, spices, fresh bread, fatty varieties of meat and fish, cream, sour cream, legumes, crumbly porridge, strong broths.
Method of cooking:in boiled form, baked, steamed, rubbed and unzp.
Diet:5-6 times a day, fractional.
3. Option of diet with an increased amount of protein (high-protein)
The purpose of the destination:stimulation of protein synthesis into organ Moderate chemical gentle of the gastrointestinal bodies, kidney; Improving the immunological activity of the body, the activation of blood formation processes, stimulation of healing and reducing inflammation phenomena.
This diet replaces4, 5, 7, 9, 10, 11 license diet.
Characteristic:a diet with an increased amount of proteins, a normal amount of fats, complex carbohydrates and the limitation of easily durable carbohydrates. Restriction of chemical and mechanical stimuli stimuli and biliary tract.
Exceptions in the diet:fatty meat-dairy products, smoked and salty fish, legumes, confectionery on a cream-based, spices, carbonated drinks.
Method of cooking:in boiled form, baked, stew, steamed.
Diet:4-6 times a day, fractional.
4. Option of diet with reduced amount of protein (low-reflux)
The purpose of the destination:maximum spuriousness of the kidney function, increasing the diurea and improving the removal of nitrogen slags and non-surfacing products of the exchange from the body, creating favorable blood circulation conditions.
This diet replaces7 license plate.
Characteristic:protein limitation - 20-60 g per day.
Food without salt, enriched with vitamins, minerals, liquid no more than 1 liter. Milk add only to dishes.
Exceptions in the diet:sub-products, fish, sausage, sausages, alcohol, salt snacks, seasonings, beans, cocoa, chocolate.
Method of cooking:in boiled form, for a couple, not rubbed, not crushed.
Diet:4-6 times a day, fractional
5. Low-calorie diet version (low-calorie diet)
The purpose of the destination:warning and elimination with excess accumulation of adipose tissue in the body, normalization of protein, water, vitamin, fat and cholesterol exchange, recovery of metabolism, improved blood circulation condition, reduction of body weight.
This diet replaces:8, 9, 10 license dimensions.
Characteristic: Moderate reduction in energy value mainly due to fats and carbohydrates, elimination of simple sugars, restriction of animal fats, cooking Sopi (3-5 g per day). In the diet - vegetable fats, dietary fiber, liquid limit 800-1,500 ml.
Exceptions in the diet:sub-products, fish, sausage, smoked, mayonnaise, white bread, cream, sour cream, macaronin. Products, pickled and salty vegetables, raisins, finish figs, grapes.
Method of cooking:in boiled form, for a couple.
Diet:4-6 times a day, fractional.
This is introduced into the human body of nutrients using probes, fistula, as well as intravenous.
Indications for the use of artificial nutrition:
Difficulty swallowing (burn oral mucosa, esophagus),
Esophagus narrowing or obstruction
Stenosis of the gatekeeper (with ulcerative disease, tumor),
The period after the operation on the esophagus and the gastrointestinal tract,
Unfortunate vomiting,
Large liquid loss,
Psychosians with food failure.
Nutrition gastric probe Infrequently found in therapeutic offices. Manipulation is performed by a doctor or a well-trained average health career. There is a danger of food in airways With the development of aspiration pneumonia. Milk, cream, raw eggs, strong broths, glucose, cocoa and coffee with cream, fruit juices are used as foodstuffs.
With diet postoperative fistula Stomach Or the intestines will have to face a surgical clinic. The set of products is the same. Additionally allowed to enter crushed food productsDivorced by liquid: finely rubbed meat, fish, bread, crackers.
The third way of keeping food is application of nutrient enema. It is used in the disorder of swallowing, obstruction of the esophagus, with an unconscious state of the patient.
Nutrient enema is placed half an hour and hour after the cleansing enema. From the rectum is absorbed by water, saline solution, 5% glucose solution, 3-4% alcohol solution. The drip administration of these solutions is more often used. At the same time, the intestinal wall is not stretched and the intra-abdominal pressure does not increase, the peristalistic does not increase. With prolonged use of nutrient enema, irritation of the mucosa of the rectum may occur, which manifests calls to defecation or diarrhea.
Parenteral nutrition It is applied in cases where the oral pathway for the administration of nutrients is either impossible or untenable in functionality. Especially widely parenteral nutrition began to be applied in connection with the development of gastrointestinal surgery (after an operation on average for 5 days in patients, power is eliminated through the mouth).
The need for parenteral nutrition occurs in oncoboles, with severe injuries, extensive burns, indomitable vomiting (poisoning, acute gastritis), ulcerative or malignant stenosis of the gatekeeper, acute pancreatitis.
Artificial nutrition It is produced when normal nutrition through the mouth is difficult or impossible (some diseases of the oral cavity, esophagus, stomach). Artificial nutrition is carried out using the probe introduced into the stomach through the nose or mouth. (Fig. 18, b) Parenteral can be introduced, bypassing the digestive tract (intravenous-drip). Through the probe, you can enter sweet tea, morse, mineral water without gas, broths, etc. in the amount of 600-800 ml / day. Procedure artificial feeding performs a nurse as follows: they prepare a sterile slim gastric probe, syringe (with a capacity of 20 ml or syringe) or a funnel, 3-4 cup food. If there are no contraindications, the procedure is carried out in the patient's position sitting. If the patient cannot be planted or it is unconscious, the probe is introduced in the lying position. Lubricated by glycerol or vaseline Probe is introduced by 15-17 cm through the bottom nasal stroke into the nasophal, the patient's head slightly tilge forward, administered forefinger Hands in the mouth and, pressing them, enter the probe to the rear wall of the pharynx, promote it in the stomach. Making sure that the probe in the stomach, put on the free end of the probe, the funnel or syringe and small portions are poured into the food (20-30 ml). For artificial nutrition through the probe, milk, cream, raw eggs, loose oil, mucous and rubbed vegetable soup, Broths, juices, cocoa and coffee with cream, kissel, glucose solutions. The total one-time supply is 0.5-1 liters. After feeding, the funnel or syringe is removed, and the probe is left, fixing the patient on the head.
The need for special restrictions and (or) add-ons to the diet depends on the diagnosis. Apply in the form oral reception, probe or parenteral nutrition.When oral powered, food consistency varies from liquid to puree or from soft to solid; With probation and administration of parenteral recipes, their concentration and osmolality must be defined. Enteral nutrition is assigned when the oral path of introducing food is impossible or the gastrointestinal tract cannot be absorbed by the components of the food. Such situations are found in anorexia, neurological disorders (dysphagia, cerebrovascular disorders), malignant neoplasms. The enteral method is used by nastastral, the urban, ejunomal and gastrostomal probes, installed using endoscopic techniques. The use of plastic or polyurethane probes of small diameter is justified due to the low frequency of development of such complications, as Naphorriage, rhinitis, middle Otitis and the formation of strictures. There are various nutrient mixtures for probe food used in clinics, but they can be divided into two categories.
Fig. 18. A - feeding of hustling.
B - Feeding seriously ill through a gastrostomal probe.
Lightweight nutrient mixes.Consist of di- and tripipeptides and (or) amino acids, glucose oligosaccharides and vegetable fats or triglycerides with medium chains. The residue is minimal and an insignificant load on digestion processes is required. Such mixtures are used in patients with a shortened intestinal syndrome, partial intestinal obstruction, pancreatic failure, noise (nonspecific ulcerative colitis), radiation enteritis and intestinal fistulas.
Fully liquid nutritional mixes -a complex set of nutrients and are used in most patients with functioning gasts. Bible nutrition starts with introduction to the probe every 3 hours 50-100 ml of isotonic or slightly hypotonic nutritional mixture. This volume can be increased by a gradual addition of 50 ml per each feeding with normal tolerance to patients until the prescribed daily feeding volume is reached. The residue in the stomach should not exceed 100 ml 2 hours after feeding. With increasing volume, the following feeding should be delayed and measured the residue in the stomach after 1 hour. Permanent gastric infusion begins with the introduction of a diluted twice in the nutrient mixture at a rate of 25-50 ml / h. As patient is tolerated, the rate of infusion and the concentration of the nutrient mixture increases to the satisfaction of the necessary energy needs. The headboard bed of patients during feeding should be raised.
Complications with enteral nutrition method.
1.Diarey.
2. Stretching the stomach or delay in the stomach.
3. Aspiration.
4. Violation of the electrolyte balance (hypontatrimia, hyperosmolarness).
5. Overload.
6. Warfarin resistance.
7. Sinusit.
8. Ezophagitis.
Single-component nutrient solutions of proteins, carbohydrates and fats Can be combined to create mixtures designed to solve certain problems, for example, highly energy with low protein and sodium content for exhausted patients with cirrhosis, ascites and encephalopathy.
Parenteral nutrition. In cases where the patient cannot eat normally, or its condition deteriorates, it is necessary to use partial or complete parenteral nutrition. Indications for complete parenteral nutrition (PPP): 1) Patients with malfunction, which are not able to take normally or absorb food; 2) patients with regional enteritis when it is necessary to unload the intestines; 3) patients with a satisfactory condition of nutrition, which requires a 10-14-day abstinence from oral meals; 4) patients with a protracted room with the impossibility of feeding through the probe; 5) to carry out nutritional support for patients with enhanced catabolism caused by sepsis; 6) patients receiving chemotherapy that impedes a natural nutrition method; 7) with a prophylactic goal in patients with severe failure of nutrition before the upcoming surgical operation.
A fundamentally PPP should provide an admission of 140-170 kJ (30-40 kcal) per 1 kg of body weight, while the amount of fluid injected should be 0.3 ml / kJ (1.2 ml / kcal) per day. To this quantity, volumes equivalent to the losses in diarrhea should be added, through one, during suction through the nasogastric probe and the drainage of the fistula.
In patients with oliginia, the basal amount of fluid flowing should be 750-1000 ml, the volume equivalent to the selected urine and other losses is added to it. If there are edema, sodium administration is limited to 20-40 mmol / day. A positive nitrogen balance is usually achieved by the introduction of 0.5-1.0 g of amino acids per 1 kg of body weight per day together with the infusion of non-energy components of non-peculiar nature. The maximum protein-saving effect of carbohydrates and fats falls on the power mode of 230-250 kJ (55-60 kcal) per 1 kg per day of the perfect body weight. To ensure sufficient non-dye calorie nutrition, carbohydrates and fats are administered with amino acids, applying a y-shaped tee for this. The mixture in which lipids provide half of energy needs, approaching the composition to a normal diet, does not cause hyperinsulinism, nor hyperglycemia and eliminates the need for an additional introduction of insulin. Complications,associated with the introduction of the catheter include: pneumothorax, thrombophlebitis, catheter embolism, hyperglycemia (with infusion hypertensive solution glucose). With long parenteral nutrition, dis-seminated candidiasis may develop. Hypokalemia, hypomagnemia and hypophosphatemia can lead to disorientation, cramps and coma. In the inadequate content of sodium acetate in the composition of the nutrient mixture, hyperchloremic acidosis may develop. Hypoglycemia may occur with a sudden termination of the PPP, its genesis is secondary, and caused by the relative excess of endogenous insulin. The infusion rate is gradually reduced over the course of 12 hours or a 10% dextrose solution is carried out for several hours.
Depending on the method of feeding, the following food forms of patients distinguish.
active nutrition - The patient takes food on its own. In actively nutrition, the patient is sitting on the table if it allows its condition.
passive nutrition - The patient takes food with the help of a medical sister. (severely ill feed nurse With the help of junior medical personnel.)
artificial nutrition - feeding patient with special nutritional mixtures through the mouth or probe (gastric or intestinal) or by intravenous drip injection of drugs.
Passive nutrition
When patients cannot eat active, they are prescribed passive nutrition. With a strict bed mode weakened and seriously ill, and, if necessary, patients in the elderly and old age assist in feeding has a nurse. With passive feeding, it follows with one hand to lift the patient's head together with the pillow, the other is to bring the mine with liquid food or a spoon with food. It is necessary to feed the patient with small portions, be sure to leaving the patient time for facing and swallowing; It follows it with the help of a sticker or from a glass using a special tube. Depending on the nature of the disease, the ratio of proteins, fats, carbohydrates may vary. Required water intake 1.5-2 liters per day. The regularity of nutrition with a sn clock interruption is important. The patient's body needs diverse and full-fledged nutrition. All restrictions (diet) should be reasonable and reasonable.
Artificial nutrition
Under artificial nutrition, the introduction of patient food (nutrients) enteral (Greek. Entera), i.e. Through the gastrointestinal tract, and parenterally (Greek. Para - near, Entera - intestines) - bypassing the gastrointestinal tract. Main readings for artificial nutrition.
Defeat language, pharynx, larynx, esophagus: edema, traumatic damage, injury, tumor, burns, scar changes, etc.
Swallowing disorder: after an appropriate operation, with a brain damage - violation of cerebral circulation, botulism, during crank-brain injury, etc.
Diseases of the stomach with its obstruction.
Coma. mental illness (Failure to eat).
Terminal Stage cachexia.
Procedure procedure:
1. Check the room
2. Process a sore hand (wash or wipe the wet warm towel)
3. Put on the neck and chest of the patient with the choppy napkin
4. Install on the bedside table (table) dishes with warm food
5. Give the patient a convenient position (sitting or half-sidet).
6. Select such a position to be convenient and patient, and a medical sister (for example, if there is a patient with a fracture or acute violation Brain circulation).
7. To feed with small portions of food, necessarily leaving the patient time for facing and swallowing.
8. Wake the patient with the help of a sticker or from a glass using a special tube.
9. Remove the dishes, a napkin (apron), to help the patient rinse your mouth, wash the arms (wipe) to him.
10. Put the patient to its original position. Protective nutrition of patients
Enteral nutrition is the type of nutritional therapy used in the impossibility of adequate to ensure the energy and plastic needs of the body naturally. In this case, nutrients are injected through the mouth or by means of a gastric probe, or through an intraishchee probe.
Main readings:
Logging, especially in the field of head, neck and stomach;
Decorations of CNS.
Radiation and chemotherapy;
Gastrointestinal diseases;
Diseases of the liver and biliary tract;
Food in pre- and postoperative periods
Injury, burns, acute poisoning;
Infectious diseases - botulism, tetanus, etc.;
Mental disorders - neuropsychic anorexia, severe depression
II. Individual additive food
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Name of chambers (departments) |
Surnames Patients |
Food |
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Chamber 203. |
Zverev I.I. |
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Head of Depth. ________________ Diet.Sereta _________________
St.Med.serte ___________________ Tested
St.Med.serte reception
departments __________________
Honeystatistics _______________
(for a consolidated portion)
Types of artificial nutrition.
When the patient's normal feeding is impossible or difficult (some diseases of the oral cavity, esophagus, stomach) - food is injected into the stomach or intestines (rarely) artificially.
Artificial nutrition can be carried out:
Using the probe introduced through the mouth or nose, or through the gastrostomy.
Introduce nutrient solutions with the help of the enema (after the cleansing enema).
Enter nutrient solutions with a parenteral path (intravenously drip).
Remember!
In case of artificial nutrition, the daily calorie content of food is about 2000 calories, the ratio of proteins - fat - carbohydrates 1: 1: 4.
The patient receives water in the form of water-salt solutions on average 2 liters per day.
Vitamins add to food mixtures or administered parenterally.
Indications for the use of artificial nutrition:
Difficult to swallowing.
The narrowing or obstruction of the esophagus.
Stenosis of the gatekeeper.
Postoperative period (after surgery on the esophagus and the gastrointestinal tract).
Non-corrosive vomiting.
Large liquid losses.
Unconscious state.
Psychosians with refusal to eat food.
Basic nutrient mixtures and solutions.
Nutrition Recipes:
Liquid nutritional mixture: 200 - 250 ml of water + 250 g of dry milk + 200 g of sugar + 4 - 6 g of salts.
A mixture of sprinkling: 400 ml of warm milk + 2 raw eggs + 50 g of sugar + 40 ml of alcohol + a little salt.
Water saline solutions:
The concentration of salts in them is the same as in the blood plasma.
The simplest solution of water-salt 0.85% isotonic sodium chloride.
Ringer-Locke solution: NaCl - 9 g + kc - 0.2 g + CaCl - 0.2 g + HCO 3 - 0.2 g + glucose - 1 g + water - 1000 ml.
Planning the necessary assistance to the patient in the event of problems related to feeding.
Conduct a primary assessment of the patient's reaction when feeding (including artificial).
Psychological support to the patient with explanation methods, beliefs, conversations, so that the patient can keep his dignity.
Help the patient to cope with their feelings, give the opportunity to express their feelings, emotions about feeding.
Make sure there is an informed consent to feeding the patient.
Organize feeding, prepare everything you need.
Assist during food intake.
Strive to maintain comfortable and safe conditions when feeding.
Organize the patient's training and his relatives, if necessary, provide information on nutrition rules, feeding.
Evaluate the patient's response to feeding.
Establish monitoring the patient after feeding.
Feeding the patient through the gastric probe introduced into the mouth or nose (nasogastric).
As probes for artificial nutrition use lungs thin tubes:
a) Plastics
b) rubber
c) silicone
Their diameter is 3 - 5 - 8 mm, length 100 - 115 cm, on the blind end two side oval holes, and at a distance of 45, 55, 65 cm from the blind end - tags that serve as a reference point to determine the length of the probe administration.
Feeding a patient through a nasogastric probe with a funnel.
Equipment:
nutrient mixture (T 38 0 - 40 0 \u200b\u200bs)
water boiled 100 ml
thin rubber probe with a diameter of 0.5 - 0.8 cm
towel
slippet.
clean gloves
Tell a patient than to feed it (after agreeing with the doctor).
To warn him in 15 minutes. The fact that food is to be eaten.
Carry the room.
Help the patient take the high position of the Fauler.
Wash your hands, put on gloves.
Treat vaseline probe.
Through the bottom nose, enter the nasogastric probe, at a depth of 15 - 18 cm.
The finger of the left hand (in the glove) determine the position of the probe in the nasopharynk and press it to the rear wall of the pharynx so that he does not get into the trachea.
The patient's head slightly tilt forward and move the probe to the right hand middle third esophagus.
ATTENTION! If the air during the exhalation from the probe does not come out and the patient's voice is preserved, it means that the probe in the esophagus.
Connect the free end of the probe with funnel.
Slowly fill the funnel, which is obliquely at the level of the patient's stomach, nutrient mixture (tea, morse, raw eggs, mineral water without gas, broth, cream, etc.).
Slowly raise the funnel above the patient's stomach level by 1 m, holding it straight.
As soon as the nutrient mixture comes to the mouth of the funnel, omit the funnel to the patient's stomach level and overlook the probe by clamp.
Repeat the procedure using all the prepared amount of nutrient mixture.
Pour 50 to 100 ml of boiled water for washing the probe.
Disconnect the funnel from the probe and close the distal end cap.
Attach the probe to the patient's clothing with a safe pin.
Help the patient take a comfortable position.
Wash the hands.
Feeding the patient through a nasogastric probe using a genre syringe.
Equipment:
syringe Jan- with a capacity of 300 ml
syringe 50 ml
phonendoscope
nutrient mixture (T 38 0 - 40 0 \u200b\u200bs)
water boiled warm 100 ml
Translate the patient to the Fauler's position.
Carry the room.
Heat the nutrient mixture on a water bath to T 38 0 - 40 0 \u200b\u200bC.
Wash your hands (you can put on gloves).
Enter a nasogastric probe (if it is not introduced in advance).
To dial the genuine mixture in the genuine (assigned quantity).
To impose a clamp on the distal end of the probe.
Connect the syringe with the probe by lifting it 50 cm above the patient's body so that the piston handle is pointing upwards.
Remove the clamp from the distal end of the probe and provide a gradual current of the nutrient mixture. With the difficulty of passing the mixture, use the piston of the syringe, shifting it down.
Remember! 300 ml of nutrient mixture should be administered for 10 minutes!
After emptying the syringe, the probe is climb (so as not to flow).
Above the tray to disconnect the syringe from the probe.
Attach to the probe syringe gense with a capacity of 50 ml with boiled water.
Remove clamp and rinse probe under pressure.
Disconnect the syringe and close the distal end of the probe.
Attach the probe to the patient's clothing with a safe pin.
Help the patient take a comfortable position.
Wash hands (remove gloves).
Make a record of feeding.
Feeding the patient using the probe introduced into the stomach, through the gastrostomy.
Prescribed with obstruction of the esophagus and stenosis (narrowing) of the gatekeeper. In these cases, a funnel is attached to the free end of the probe through which small portions (50 ml) 6 times a day Entered the stomach heated liquid food. Gradually, the volume of injected food increases up to 250 - 500 ml, and number of feedings reduce up to 4 times.
Sometimes the patient is allowed to independently chew food, then it is bred in a glass of liquid, and already in a diluted form poured into a funnel. With this embodiment, the reflex excitation of the gastric secretion is preserved. Feeding through gastrostom is used both in hospital and home conditions. In the latter case, you need to train relatives for feeding and washing the probe.
Feeding through gastrostomy.
Equipment:
funnel (Syringe Jana)
capacity with food
water boiled 100 ml
Wipe the bedside table.
Tell the patient than to feed it.
Carry the room.
Wash your hands (better if the patient will see it), you can put on gloves.
Put cooked food on the bedside table.
Help the patient take the position of the Fauler.
Save the probe from clothes. Remove the clamp (plug) from the probe. Attach the funnel to the probe.
ATTENTION! It is desirable to start feeding from tea (water) to free the probe from the mucus that has accumulated between feedings.
Pour cooked food into funnel with small portions.
Rinse the probe with warm boiled water through genuine genie (50 ml) or immediately through a funnel.
Disconnect the funnel, close the probe with a plug (overlook the clip).
Make sure the patient feels comfortable.
Wash the hands.
Useful practical advice.
After applying, the probe rinse in tanks for washing with one of the disinfecting solutions, then soaked in another container with a des.razor at least 60 minutes, then rinse the probe with running water and boil in distilled water for 30 minutes from the moment of boiling. So that sterile probes are not dried and not crackdown, they are stored in 1% solution boric acidBut before use again rinsed with water.
After feeding the patient through the probe, introduced through the nose or gastrostom, should leave the patient at least 30 minutes in the middleside position.
Washing the patient to whom the probe is introduced through the nose, use only a towel (mitten), moistened with warm water. Do not apply cotton wool or gauze napkins for this purpose.
For the convenience of the patient, the external end of the nasogastric probe can be strengthened (tie) on his head so that it does not interfere with it (the probe can not be removed during the entire period of artificial feeding, about 2 to 3 weeks).
You can check the position of the nastrocastral probe in the stomach:
over the tray, impose a clamp on the distal end of the probe (so as not to the contents of the stomach);
remove the plug from the probe;
dial in syringe 30 - 40 ml of air;
to attach the syringe to the distal end of the probe;
remove the clamp;
to put on the phoneneoscope, put it with a membrane to the area of \u200b\u200bthe stomach;
enter the air from the syringe through the probe and listen to the sounds in the stomach (if there are no sounds, you need to pull out, shift the probe).
Parenteral nutrition.
Prescribe patients with phenomena of obstruction of the digestive tract, with the impossibility of normal nutrition (tumor), as well as after operations on the esophagus, stomach, intestines, etc., as well as in exhaustion, weakened patients during the preparation for the operation. For this purpose, drugs containing protein hydrolysis products are used - amino acid hydrolysis products (hydrolyzine, protein casin hydrolyzate, fibronosol), as well as artificial amino acid mixtures (alvezin new, levamine, polyamine, etc.); fat emulsions (lipofundine, intralipide); 10% glucose solution. In addition, up to 1 l of electrolyte solutions, vitamins of group B, ascorbic acid are introduced.
Means for parenteral nutrition enter drip intravenous. Before administration, they are heated in a water bath to the body temperature (37-38 0 s). It is necessary to strictly observe the rate of administration of drugs: hydrolysin, protein hydrolyzate casein, fibronosol, polyamine in the first 30 min. They are injected at a speed of 10 - 20 drops per minute, and then with good tolerability, the speed of administration increases to 40 - 60.
Polyamin In the first 30 min. Entered at a speed of 10 - 20 drops per minute, and then - 25 - 35 drops per minute. Faster administration is inappropriate, since excess amino acids are not absorbed and removed from the urine.
With a more rapid introduction of protein preparations, the patient may experience heat, face hyperemia, breathing difficulty.
LipofundinS. (10% solution) are administered in the first 10 - 15 minutes at a speed of 15 - 20 drops per minute, and then gradually (for 30 minutes) increase the rate of introduction to 60 drops per minute. Introduction 500 ml of the drug should last about 3 - 5 hours.
Control questions for independent work of students
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Methodical instructions for independent work on the academic discipline of OP. 03. "Age Anatomy, Physiology and Hygiene" in the specialty of secondary vocational education (SPO) 050144 "Pre-school education" (in-depth training) correspondence.
Methodical instructionsHygiene »4.complex lectures for self studies Discipline PM.01. "Medico ... regeneration, reproduction, genetic transmission information, adaptation to the conditions of external ... mixed and artificial food - Organization nutrition Children from the year ...
Methodical recommendations for independent training of cadets and listeners on the discipline "Physical preparation" Krasnodar
GuidelinesIt provides permanent information The body is about everyone ... Besides rational nutrition and special nutritious ... for self studies Combat techniques .................................................................... 79 5. Methodical recommendations for independent ...
In medical nutrition in many diseases, especially with gastric, fractional power is used by small portions. In response to small irritation of the sick stomach, there is more digestive juices than in response to a larger load. Sometimes, for example, during a fever, it becomes necessary to enter food not at normal time, and then, when the patient feels better and is able to eat, even at night. In this case, the power is carried out fractionally, mainly liquid and semi-liquid food that does not contain coarse plant fiber to spend the patient's forces as much as possible and does not disrupt his rest. The finished food prepared by no more than 1 hour before the shipment is delivered to handouts and buffets in pre-well-washed with boiling water thermos, as well as dishes with tightly closing covers. Special containers transport sauces, fats, ready-made food, bread and semi-finished products. It should be strictly observed the terms and conditions for the storage and implementation of finished food.
20. Diet. Artificial nutrition
Under artificial nutrition understand the introduction of patient food into the body
enteral
Main readings for artificial nutrition.
Defeat language, pharynx, larynx, esophagus: edema, traumatic damage, injury, tumor, burns, scar changes, etc.
Swallowing disorder: after the corresponding operation, with brain damage -
the warming of cerebral circulation, botulism, during crank-brain injury, etc.
Diseases of the stomach with its obstruction.
Coma.
Mental disease (rejection of food).
Terminal stage of cachexia.
Enteral nutrition- The type of intrastable therapy used at the impossibility of adequate to ensure the energy and plastic needs of the body naturally. In this case, nutrients are injected through the mouth or by means of a gastric probe, or through an intraishchee probe.
Parenteral nutrition(Feeding) is carried out by intravenous drip
administration of drugs. Technique of administration is similar to intravenous administration of drugs
Depending on the method of feeding, the following food forms of patients distinguish.
Active nutrition - the patient takes food independently.
Passive nutrition - the patient takes food with a medical sister. (
zhelda feeds medical sister with the help of junior medical personnel.)
Artificial nutrition - feeding patient with special nutritional mixtures
through the mouth or probe (gastric or intestinal) or by intravenous drip administration
drugs.
21. Correction of the patient through the gastrostomy.
If the patient had obstruction of the esophagus (tumor, scars, injuries), then for the salvation of his life, it is imposed on the gastric to the gastric, through which the patient is powered. need:
prepare dishes with warm liquid and semi-liquid food;
put a patient;
remove the napkin closing the inlet, clamp from the tube from the rubber tube;
in the hole of the tube insert a glass funnel, raise it up, slightly tilt to prevent the possibility of leakage of food from the stomach;
pour into a funnel nutritional composition or food, fired by patients;
after the food mixture leaves the funnel, pour tea into it or infusion of a rose rose for washing the tube and to avoid rotting residues in it;
remove the funnel and place it in a special container with a disinfectant solution;
put on the end of the rubber tube a sterile napkin and a clamp to fix the loop from the bandage so that the tube does not come out of the stoma. The funnel can be poured any crushed food substancesDivorced liquid. You can enter finely rubbed meat, fish, purified from bones, milk, bread, crowns. Patients can chew food themselves, collect it into a mug and give the sister to subsequent introduction of it through the gastrostomy. In this case, the sick-chewed food should be divorced by the necessary amount of liquid.
