Artificial nutrition types of indications. Feeding the sick
Natural nutrition (through the mouth) in some diseases is insufficient or impossible, and in such cases it is necessary to temporarily apply artificial nutrition of patients as an additional, and sometimes the only way to eat. Nutrients can be administered through a thin tube or fistula into the stomach or small intestine, through an enema into the rectum and parenterally - subcutaneously and intravenously.
Feeding the patient through a tube. Indications:
- extensive traumatic injuries and swelling of the tongue, pharynx, larynx and esophagus;
- violations of the act of swallowing due to paralysis or paresis of the swallowing muscles in diseases of the nervous system;
- unconscious state of the patient;
- refusal of food in mental illness.
In all these diseases, normal nutrition is either impossible or undesirable, as it can lead to infection of wounds or ingestion of food into the respiratory tract, followed by inflammation or suppuration in the lungs.
Through the probe, you can enter any food (and drugs) in liquid and semi-liquid form, after rubbing it through a sieve. Vitamins must be added to food. Usually milk, cream, raw eggs, broth, slimy or pureed vegetable soup, jelly, fruit and vegetable juices, dissolved butter, coffee, tea, cocoa are usually introduced.
For feeding prepare:
- a thin gastric tube without an olive or a transparent PVC tube with a diameter of 8-10 mm;
- a funnel with a capacity of 200 ml with a tube diameter corresponding to the diameter of the probe, or a Janet syringe;
- 3-4 glasses of food. A mark should be made on the probe in advance, to which it is going to be inserted: into the esophagus - 30-35 cm, into the stomach - 40-45 cm, into the duodenum - 50-55 cm. The instruments are boiled and cooled in boiled water, and the food is heated.
The probe is usually inserted by a doctor. After inserting the probe, a funnel is attached to its outer end, cooked food is poured into it and injected in small portions. Then drink is introduced in the same way. After feeding, the funnel is removed, and the probe, if possible, is left for the entire period of artificial nutrition. The outer end of the probe is folded and fixed on the patient's head so that it does not interfere with him.
Feeding the patient through the surgical fistula. When food is obstructed through the esophagus due to its narrowing, a gastric fistula is made. When narrowing the pylorus, a fistula is made into the small intestine. A rubber tube is inserted into the fistula - drainage - and left there permanently or inserted each time before the introduction of food and removed after the end of feeding. The outer end of the drainage tube is connected to a funnel into which the nutrient mixture is poured.
For artificial nutrition of patients through an operating fistula or fistula, as well as for feeding through a tube, liquid and semi-liquid food is used. In addition, there are many recipes for nutritional mixtures containing milk, eggs, sugar, alcohol, vegetable oil, yeast, etc.
The volume of each portion of the mixture and the frequency of feeding depend on the time elapsed after the imposition of the fistula. The first time the patient is fed 5-6 hours after the operation, introducing 50-100 ml of the nutrient mixture. During the first week, the same amount of food is administered every 2 hours. In the second week, the volume of each portion is increased to 150-200 ml, and the intervals are up to 3 hours; in the third week, 250-500 ml of the nutrient mixture is administered every 4 hours (4 feeding per day).
When food is introduced through the fistula, reflex excitation falls out. gastric secretion from the oral cavity and the enzymatic action of saliva is excluded. This can be remedied by having the patient chew pieces of solid food thoroughly and spit it into a funnel connected to the fistula's drainage tube. Liquid is added to the funnel, and the food mixture enters the stomach. You can teach the patient to independently feed and expand the range of products and dishes by transferring him to table number 15.
Feeding through the fistula should be carried out carefully, so that food does not contaminate the edges of the food opening. After each feeding, the skin around the fistula is toileted, lubricated with Laccapa paste and a dry sterile dressing is applied.
parenteral nutrition- the introduction of nutrients bypassing the gastrointestinal tract: subcutaneously, intravenously and intramuscularly. This method is used more often as an additional food, less often - as the only possible one. It cannot completely replace natural nutrition, but for a period of 10-20 days it can satisfactorily provide the body's needs for fluid and essential nutrients.
The need for parenteral nutrition occurs with intestinal obstruction, with diseases of the gastrointestinal tract, accompanied by indomitable vomiting and profuse diarrhea, and in the postoperative period after operations on the esophagus, stomach and intestines.
For parenteral nutrition, solutions of salts, vitamins, glucose (5-10-20-40%), plasma and preparations from it (albumin and protein), heterogeneous serum, blood, protein hydrolysates, aminopeptide, aminocrovin, high-calorie fat emulsions (intralipid, lipofundin).
Saline solutions are administered drip, intravenously and subcutaneously in an amount of up to 2 liters per day, alone or together with glucose, blood and blood substitutes.
Solutions of protein hydrolysates and amino acids are administered more often intravenously, less often - subcutaneously slowly, drip, 20 drops per 1 minute, heated to body temperature.
Using the solutions listed above, it is possible to introduce a sufficient amount of liquid and salts, 50-70 g of protein, 100-200 g of glucose to the patient during the day.
Nutrient enemas. In the rectum, only isotonic (0.9%) sodium chloride solution, 5% glucose solution, 3-4% solution of purified alcohol are absorbed. The introduction of these solutions is used in cases where it is impossible to enter the liquid through the mouth, for example, with indomitable vomiting.
Most often, the first two solutions are administered by drip method in an amount of up to 2 liters per day. It is possible to inject these liquid solutions simultaneously with a rubber balloon, 100-150 ml 2-3 times a day. To help the patient keep the injected solution, you need to add 5 drops of opium tincture to it. The patient should lie still until the solution is absorbed.
Depending on the method of eating, the following forms of nutrition of patients are distinguished.
active nutrition- the patient takes food on his own. With active nutrition, the patient sits down at the table, if his condition allows.
passive power- the patient takes food with the help of a nurse. (Seriously ill patients are fed by a nurse with the help of junior medical staff.)
artificial nutrition- feeding the patient with special nutrient mixtures through the mouth or tube (gastric or intestinal) or by intravenous drip of drugs.
Passive power
When patients cannot eat actively, they are prescribed passive nutrition. with strict bed rest, the weakened and seriously ill, and, if necessary, patients in the elderly and senile age, a nurse provides assistance in feeding. with passive feeding, one should raise the patient's head with a pillow with one hand, and bring a drinker with liquid food or a spoon with food to his mouth with the other. you need to feed the patient in small portions, be sure to leave the patient time to chew and swallow; it should be watered with a drinking bowl or from a glass using a special tube. depending on the nature of the disease, the ratio of proteins, fats, carbohydrates may vary. Required intake of water 1.5-2 liters per day. The regularity of meals with a 3-hour break is important. the patient's body needs a varied and nutritious diet. all restrictions (diets) must be reasonable and justified.
artificial nutrition
Artificial nutrition is understood as the introduction of food (nutrients) into the patient's body enterally (Greek entera - intestines), i.e. through the gastrointestinal tract, and parenterally (Greek para - near, entera - intestines) - bypassing the gastrointestinal tract. main indications for artificial nutrition.
Damage to the tongue, pharynx, larynx, esophagus: edema, traumatic injury, injury, swelling, burns, scarring, etc.
Swallowing disorder: after an appropriate operation, with brain damage - cerebrovascular accident, botulism, with traumatic brain injury, etc.
Diseases of the stomach with its obstruction.
Coma. mental illness (refusal of food).
Terminal stage of cachexia.
The order of the procedure:
1. Check the room
2. Treat the patient's hands (wash or wipe with a damp warm towel)
3. Put a cleansing napkin on the neck and chest of the patient
4. Place a dish with warm food on the bedside table (table)
5. Give the patient a comfortable position (sitting or half-sitting).
6. Choose a position that is convenient for both the patient and the nurse (for example, if the patient has a fracture or acute cerebrovascular accident).
7. Feed small portions of food, always leaving the patient time to chew and swallow.
8. Water the patient with a drinker or from a glass using a special tube.
9. Remove the dishes, napkin (apron), help the patient rinse his mouth, wash (wipe) his hands.
10. Place the patient in the starting position. Probe feeding of patients
Enteral nutrition is a type of nutritional therapy used when it is impossible to adequately meet the energy and plastic needs of the body in a natural way. while the nutrients are administered through the mouth, either through a gastric tube or through an intra-intestinal tube.
Main indications:
Neoplasms, especially in the head, neck and stomach;
CNS disorders
Radiation and chemotherapy;
Diseases of the gastrointestinal tract;
Diseases of the liver and biliary tract;
Nutrition in pre- and postoperative periods
Trauma, burns, acute poisoning;
Infectious diseases - botulism, tetanus, etc.;
Psychiatric disorders - anorexia nervosa, severe depression
artificial nutrition is made when normal nutrition through the mouth is difficult or impossible (some diseases of the oral cavity, esophagus, stomach). Artificial nutrition is carried out using a probe inserted into the stomach through the nose or mouth. (Fig No. 18, B) It can be administered parenterally, bypassing the digestive tract (intravenous drip). Through the probe, you can enter sweet tea, fruit drink, mineral water without gas, broths, etc. in the amount of 600-800 ml / day. procedure artificial feeding the nurse performs as follows: prepare a sterile thin gastric tube, a syringe (with a capacity of 20 ml or Janet's syringe) or a funnel, 3-4 glasses of food. If there are no contraindications, the procedure is carried out with the patient in a sitting position. If the patient cannot be seated or is unconscious, the probe is inserted in the supine position. The probe lubricated with glycerin or vaseline is inserted 15-17 cm through the lower nasal passage into the nasopharynx, the patient's head is slightly tilted forward, the index finger is inserted into the mouth and, squeezing it, the probe is inserted to the posterior pharyngeal wall, advanced into the stomach. After making sure that the probe is in the stomach, put a funnel or syringe on the free end of the probe and pour in small portions of liquid food heated to body temperature (20-30 ml each). For artificial nutrition through a probe, milk, cream, raw eggs, dissolved butter, slimy and mashed vegetable soup, broths, juices, cocoa and coffee with cream, jelly, glucose solutions are used. The total one-time amount of food is 0.5-1 l. After feeding, the funnel or syringe is removed, and the probe is left, fixing it on the patient's head.
The need for special dietary restrictions and/or supplements depends on the diagnosis. Apply in the form oral administration, tube or parenteral nutrition. When fed orally, the consistency of food varies from liquid to puree or from soft to hard; with tube feeding and the introduction of parenteral formulations, their concentration and osmolality must be determined. Enteral nutrition is indicated when the oral route of food intake is not possible or the gastrointestinal tract cannot absorb food components. Similar situations occur with anorexia, neurological disorders (dysphagia, cerebrovascular disorders), malignant neoplasms. With the enteral method, nasogastric, nasoduodenal, jejunostomal and gastrostomal probes are used, which are installed using endoscopic techniques. The use of small-diameter plastic or polyurethane probes is justified due to the low incidence of complications such as nasopharyngitis, rhinitis, otitis media, and strictures. There are various tube feeding formulas used in clinics, but in principle they can be divided into two categories.
Rice. 18. A - Feeding a seriously ill person.
B - Feeding a seriously ill patient through a gastrostomal tube.
Lightweight formulas. They consist of di- and tripeptides and (or) amino acids, glucose oligosaccharides and vegetable fats or medium chain triglycerides. The residue is minimal and requires a slight load on the digestive processes for assimilation. Such mixtures are used in patients with short bowel syndrome, partial intestinal obstruction, pancreatic insufficiency, NUC (ulcerative colitis), radiation enteritis and intestinal fistulas.
Completely liquid nutritional formulas - contain a complex set of nutrients and are used in most patients with a functioning gastrointestinal tract. Bolus feeding begins with the introduction into the tube every 3 hours of 50-100 ml of an isotonic or slightly hypotonic solution of the nutrient mixture. This volume can be increased by gradual addition of 50 ml per feeding, if tolerated by the patients, until the established daily feeding volume is reached. The balance in the stomach should not exceed 100 ml 2 hours after feeding. If the volume is increased, the next feeding should be delayed and the stomach residue measured after 1 hour. Continuous gastric infusion begins with the introduction of a nutrient mixture diluted by half at a rate of 25-50 ml / h. As tolerated by the patient, the infusion rate and the concentration of the nutrient mixture are increased to meet the necessary energy needs. The head of the patient's bed should be raised during feeding.
Complications with enteral nutrition.
1. Diarrhea.
2. Distension of the stomach or retention in the stomach.
3. Aspiration.
4. Electrolyte imbalance (hyponatremia, hyperosmolarity).
5. Overload.
6. Warfarin resistance.
7. Sinusitis.
8. Esophagitis.
One-component nutrient solutions of proteins, carbohydrates and fats can be combined to create formulas designed to solve specific problems, for example, high energy with low protein and sodium for malnourished patients with cirrhosis, ascites and encephalopathy.
parenteral nutrition. In cases where the patient cannot eat normally or his condition worsens, it is necessary to use partial or total parenteral nutrition. Indications for total parenteral nutrition (TPN): 1) malnourished patients who are unable to take or assimilate food normally; 2) patients with regional enteritis, when it is necessary to unload the intestines; 3) patients with a satisfactory state of nutrition, who need 10-14 days of abstinence from oral food intake; 4) patients with prolonged coma when it is impossible to feed through a tube; 5) for the implementation of nutritional support for patients with increased catabolism caused by sepsis; 6) patients receiving chemotherapy that interferes with the natural way of eating; 7) for prophylactic purposes in patients with severe malnutrition before the upcoming surgical operation.
In principle, PPP should provide 140-170 kJ (30-40 kcal) per 1 kg of body weight, while the amount of fluid administered should be 0.3 ml / kJ (1.2 ml / kcal) per day. To this amount should be added volumes equivalent to losses due to diarrhea, through the stoma, during suction through the nasogastric tube and drainage of the fistula.
In patients with oliguria, the basal amount of infused fluid should be 750-1000 ml, to which is added a volume equivalent to excreted urine and other losses. In the presence of edema, the introduction of sodium is limited to 20-40 mmol / day. A positive nitrogen balance is usually achieved by introducing 0.5-1.0 g of amino acids per 1 kg of body weight per day, together with the infusion of non-protein energy components. The maximum protein-saving effect of carbohydrates and fats falls on a diet of 230-250 kJ (55-60 kcal) per 1 kg per day of ideal body weight. To ensure sufficient non-protein calorie nutrition, carbohydrates and fats are administered along with amino acids, using a Y-shaped tee for this. A mixture in which lipids provide half of the energy requirements approaches the composition of a normal diet, does not cause either hyperinsulinism or hyperglycemia, and eliminates the need for additional insulin administration. Complications, associated with the introduction of a catheter include: pneumothorax, thrombophlebitis, catheter embolism, hyperglycemia (with infusion of hypertonic glucose solution). With prolonged parenteral nutrition, disseminated candidiasis may develop. Hypokalemia, hypomagnesemia, and hypophosphatemia can lead to confusion, seizures, and coma. Hyperchloraemic acidosis may develop if the sodium acetate content of the formula is inadequate. Hypoglycemia can occur with a sudden cessation of PPP, its genesis is secondary, and is caused by a relative excess of endogenous insulin. The infusion rate is gradually reduced over 12 hours, or a replacement injection of 10% dextrose solution is carried out for several hours.
Basic principles of clinical nutrition. Feeding the seriously ill.
Basic principles of rational nutrition
Basic principles of clinical nutrition
Characteristics of the main treatment tables
Organization of meals for patients in the hospital
Types of artificial nutrition, indications for its use
Possible patient problem, for example:
Decreased appetite
Lack of knowledge about prescribed diet
Create a portion request
Conduct a conversation with the patient and his relatives about the treatment table prescribed by the doctor
Teach the patient the principles of rational and therapeutic nutrition.
Monitor grocery transfers, the sanitary condition of bedside tables and refrigerators, the shelf life of food products
Feeding a seriously ill patient with a spoon and drinker
Insert a nasogastric tube
Perform artificial feeding of the patient (on a phantom)
Carry out the nursing process in case of violation of the patient's need for adequate nutrition and fluid intake using the example of a clinical situation
Treatment tables/diet(Greek δίαιτα - lifestyle, diet) - a set of rules for eating food by a person or other living organism.
Purpose of nutrition to give the body such food that, after digestion in the gastrointestinal tract, entering the blood and tissues (absorption) and subsequent oxidation (combustion), would lead to the formation of heat and vital energy (muscular, nervous).
Health food - it is, first of all, the nutrition of a sick person, providing his physiological needs for nutrients and at the same time a method of treatment with nutrition from specially selected and prepared products, acting on the mechanisms of the development of the disease - the state of various systems and metabolic processes. In this regard, most diets used for a long time contain the norm of all nutrients.
There are the following types of nutrition for patients:
Oral (conventional) nutrition (natural)
Artificial:
Enteral (tube) nutrition - through a probe inserted into the stomach;
Through the rectum;
Parenteral - intravenous administration of nutrients, which is used when tube feeding is not possible;
Through a gastrostomy
One of the basic principles of therapeutic nutrition of patients in a hospital is the diet and balance diet (the amount of food that provides a person's daily need for nutrients and energy), i.e., compliance with a certain ratio of proteins, fats, carbohydrates, vitamins, minerals and water in the proportions necessary for the human body.
So healthy human diet should 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, microelements, etc. At the same time, the ratio of proteins, fats, carbohydrates and other ingredients in the patient's diet may vary depending on the nature of the disease.
The most optimal for a healthy person is four meals a day, in which breakfast includes 25% of the total diet, second breakfast - 15%, lunch - 35%, dinner - 25%. With some diseases, the diet changes.
Medical nutrition is based on 3 main principles: gentle, corrective and replacement.
Gentle principle - it is a mechanical, chemical and thermal sparing of a diseased organ and system. A chemically sparing diet is prescribed to patients with gastrointestinal diseases, if necessary, to reduce their secretory and motor functions. At the same time, alcohol, cocoa, coffee, strong broths, fried and smoked meat are excluded from the diet. Assign foods that cause weak secretion - butter, cream, milk soups, vegetable purees.
mechanical sparing- all in a grated, puree-like form.
Thermal sparing achieved by culinary processing of products (boiled, steamed, stewed)
Chemical sparing - exclusion of spicy, marinades, canned foods, seasonings, salt restriction.
For example, in case of peptic ulcer, fried foods (meat, potatoes) are poorly tolerated by patients, while steamed and finely chopped meat dishes or vegetable purees are well tolerated.
Corrective principle is based on a decrease or increase in the diet of a particular substance. Thus, in diabetes mellitus, a disease in which carbohydrate metabolism is sharply disturbed, carbohydrate restriction is very important. On the contrary, in some diseases of the liver, the heart, the amount of carbohydrates increases.
They limit the intake of fat in diseases of the liver, pancreas and obesity, and, conversely, an increase in fat is indicated for debilitating infectious diseases, tuberculosis.
With some diseases, there is a need for fasting for 1-2 days. These are the so-called fasting days. During this period, the patient is either completely starving, or he is given only fruits, milk or cottage cheese. Such food unloading has a good effect on obesity, gout, BA. Table salt is limited in diseases of the heart and kidneys, accompanied by edema, with arterial hypertension. In these cases, the liquid is also limited. On the contrary, in case of poisoning, dehydration of the body, the introduction of fluid is increased.
The substitution principle aims to introduce with food substances in which the body lacks, as is done with beriberi, protein deficiency (nephrotic syndrome).
In Russia, the Scientific Research Institute of Clinical Nutrition has developed schemes for dietary tables, which are accepted in all medical institutions in our country.
Therapeutic diets
Diet 1. PUD and PUD, chronic gastritis with increased secretory function. Characteristics - mechanical, chemical, thermal sparing of the gastrointestinal tract, restriction of sodium chloride, substances that linger in the stomach for a long time (meat, fats). Allowed are white crackers, white stale bread, milk, cream, soft-boiled eggs, butter, slimy soups, jelly, vegetable and fruit juices, fresh cottage cheese, sour cream).
diet 2. Chronic gastritis with reduced secretory function. Characteristics - juicy and secretion-stimulating components are allowed, such as broths, mashed borscht, meat, fish, but steamed, not in pieces.
diet 3. Dyskinesia of the colon with constipation. Characteristic - an increased amount of vegetable fiber (black bread, cabbage, apples, beets, pumpkin) and liquids. Foods that cause rotting and fermentation in the intestines (a large amount of meat, simple carbohydrates) are excluded.
diet 4. Enteritis with diarrhea, severe dyspeptic symptoms. "Hungry", "intestinal" diet. Characteristic - restriction of fats and simple carbohydrates (contribute to steatorrhea and fermentation), spicy and spicy substances.
diet 5. Chronic hepatitis, cirrhosis of the liver. 5P - pancreatitis. Characteristics - strong stimulants of the stomach, pancreas, fats, meat are excluded. "The liver loves warm and sweet things." 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), erythremia. Characteristics - exclude foods rich in purine bases (meat, legumes, chocolate, cheese, spinach, coffee), introduce alkalizing foods (vegetables, fruits, berries, milk). Drinking plenty of fluids helps flush out uric acid.
Diet 7. Kidney diseases (glomerulonephritis, pyelonephritis, amyloidosis). Characteristic - a significant restriction of protein and salt, in some cases - liquid.
diet 8. Obesity. Characteristic - a significant reduction in total calories due to simple carbohydrates and fats. The introduction of fasting days (kefir, cottage cheese, apple). Exclude seasonings that increase appetite, somewhat limit the amount of fluid (often increased blood pressure).
diet 9. Diabetes mellitus with normal and underweight (with obesity - diet 8). Characteristics - simple carbohydrates are significantly limited (replaced by sweeteners), to a lesser extent - fats.
Diet 10. Cardiovascular diseases. Characteristic - limiting the intake of table salt and liquids, fats, fried meat, other foods containing a lot of cholesterol (butter, lard, sour cream, eggs). Increase the amount of vegetable fiber, bran.
diet 11. Pulmonary tuberculosis. Characteristic - increased calorie content due to additional nutrition (milk, eggs, sour cream, meat). Increased amount of vitamins (vegetables, fruits, herbs).
Diet 12. Diseases of the nervous system and mental illness. Characteristic - restriction of stimulating substances (coffee, tea, alcoholic beverages, hot spices, spices, salinity, marinades). The introduction of medicinal teas (with mint, lemon balm, hop cones).
Diet 13. Acute infectious diseases. Characteristic - an increased amount of protein, fluid and vitamins (taking into account sweating and elevated temperature).
Diet 14. Phosphaturia with alkaline urine and formation of phosphorus-calcium stones. Characteristic - exclude alkalizing products (milk, cottage cheese, cheese), increase fluid intake in order to flush out phosphates.
Diet 15. Lack of indications for the appointment of a therapeutic diet and the normal state of the digestive system. The physiological norm of proteins, fats, carbohydrates, fluids, vitamins, minerals and dietary fiber.
Diet 0, "jawbone". The first days after surgery on the stomach and intestines, impaired consciousness (strokes, traumatic brain injury). Characteristic - liquid or jelly-like food (tea with sugar, rosehip broth, lemon juice and other fruits, jelly, jelly, fruit drinks, weak broth, rice broth).
In order to prevent violations of the diet and regimen, the nurse needs to control the transfer of products by relatives of patients.
Standard diets
Order of the Ministry of Health of the Russian Federation No. 330-2003. "On measures to improve clinical nutrition in medical institutions of the Russian Federation."
It is proposed to switch to a new system of treatment tables / diets - the system of standard diets. The new diet system basically contains M.I. Pevzner and includes 5 options for standard tables / diets.
1. Basic Standard Diet
Purpose of appointment: normalization of the secretory activity of the gastrointestinal tract, intestinal motility, liver and gallbladder function, creation of conditions for the normalization of the body's metabolism and the rapid removal of toxic metabolic products (slags), unloading the cardiovascular system, normalization of cholesterol and interstitial metabolism, increase body resistance and reactivity.
This diet replaces 1, 2, 3, 5, 6, 7, 9, 10, 13, 14, 15 numbered diets.
Characteristic. A diet with a physiological content of proteins, fats and carbohydrates, enriched with vitamins and minerals, vegetable fiber. When prescribing a diet for patients with diabetes, they exclude (refined carbohydrates).
Diet exceptions: spicy seasonings, smoked meats, cream-based confectionery, fatty meats and fish, spinach, sorrel, garlic, legumes, strong broths, okroshka.
Cooking method: boiled, baked and steamed. Diet: 4-6 times a day, fractional.
2. Diet option with mechanical and chemical sparing
Purpose of appointment: moderate mechanical, chemical and thermal sparing contributes to the elimination of the inflammatory process, the normalization of the functional state of the organs of the gastrointestinal tract, and the reduction of reflex excitability.
This diet replaces: 1, 4, 5 numbered diets.
Characteristic. A diet with a 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 gastrointestinal tract receptor apparatus.
Diet exceptions: savory snacks, seasonings, spices, fresh bread, fatty meats and fish, cream, sour cream, legumes, crumbly cereals, strong broths.
Cooking method: boiled, baked, steamed, mashed and not mashed.
Diet: 5-6 times a day, fractional.
3. High protein diet option (high protein)
Purpose of appointment: stimulation of protein synthesis in the body moderate chemical sparing of the digestive tract, kidneys; increase in the immunological activity of the body, activation of hematopoietic processes, stimulation of healing and reduction of inflammation.
This diet replaces 4, 5, 7, 9, 10, 11 numbered diets.
Characteristic: a diet with an increased amount of proteins, a normal amount of fats, complex carbohydrates and a restriction of easily digestible carbohydrates. Limitation of chemical and mechanical irritants of the stomach and biliary tract.
Diet exceptions: fatty meat and dairy products, smoked and salted fish, legumes, cream-based confectionery, spices, carbonated drinks.
Cooking method: boiled, baked, stewed, steamed.
Diet: 4-6 times a day, fractional.
4. Reduced protein diet option (low protein)
Purpose of appointment: maximum sparing of kidney function, increased diuresis and improved excretion of nitrogenous slags and incompletely oxidized metabolic products from the body, creating favorable conditions for blood circulation.
This diet replaces 7 number diet.
Characteristic: protein restriction - 20-60 g per day.
Food without salt, enriched with vitamins, minerals, liquids no more than 1 liter. Milk is added only to dishes.
Diet exceptions: offal, fish, sausage, sausages, alcohol, salty snacks, seasonings, legumes, cocoa, chocolate.
Cooking method: boiled, steamed, not pureed, not crushed.
Diet: 4-6 times a day, fractional
5. Reduced calorie diet option (low calorie diet)
Purpose of appointment: prevention and elimination of excessive accumulation of adipose tissue in the body, normalization of protein, water, vitamin, fat and cholesterol metabolism, restoration of metabolism, improvement of blood circulation, weight loss.
This diet replaces: 8, 9, 10 number diets.
Characteristic: moderate restriction of energy value mainly due to fats and carbohydrates, exclusion of simple sugars, restriction of animal fats, table sop (3-5 g per day). In the diet - vegetable fats, dietary fiber, fluid restriction 800-1,500 ml.
Diet exceptions: offal, fish, sausage, smoked meats, mayonnaise, white bread, cream, sour cream, pasta. products, pickled and salted vegetables, raisins, finish figs, grapes.
Cooking method: boiled, steamed.
Diet: 4-6 times a day, fractional.
artificial food.
This is the introduction of nutrients into the human body using probes, fistulas, as well as intravenously.
Indications for the use of artificial nutrition:
Difficulty swallowing (burns of the oral mucosa, esophagus),
Narrowing or obstruction of the esophagus
Pyloric stenosis (with peptic ulcer, tumors),
The period after surgery on the esophagus and gastrointestinal tract,
indomitable vomiting,
Major fluid loss
Psychoses with refusal of food.
Power through gastric tube rarely found in therapeutic departments. The manipulation is performed by a doctor or a well-trained paramedic. There is a danger of food entering the respiratory tract with the development of aspiration pneumonia. Milk, cream, raw eggs, strong broths, glucose solutions, cocoa and coffee with cream, fruit juices are used as nutrients.
powered through postoperative gastric fistula or bowel will have to face in the surgical clinic. The set of products is the same. Additionally, it is allowed to introduce crushed food products diluted with a liquid: finely mashed meat, fish, bread, crackers.
The third way of eating is application of nutrient enemas. It is used for swallowing disorders, obstruction of the esophagus, in the unconscious state of the patient.
A nourishing enema is given half an hour to an hour after a cleansing enema. Water, physiological saline, 5% glucose solution, 3-4% alcohol solution are absorbed from the rectum. Drip administration of these solutions is most often used. At the same time, the intestinal wall does not stretch and intra-abdominal pressure does not increase, peristalsis does not increase. With prolonged use of nutrient enemas, irritation of the rectal mucosa may occur, which is manifested by the urge to defecate or diarrhea.
parenteral nutrition used in cases where the oral route of nutrient administration is either impossible or functionally untenable. Especially widely parenteral nutrition began to be used in connection with the development of gastrointestinal surgery (after surgery, on average, for 5 days, patients are excluded from feeding through the mouth).
The need for parenteral nutrition occurs in cancer patients, with severe injuries, extensive burns, indomitable vomiting (poisoning, acute gastritis), ulcerative or malignant pyloric stenosis, acute pancreatitis.