Feeding patients

The caregiver from the very beginning should specify from the attending physician the nature of the nutritional food necessary for his ward. Should be obtained the most detailed information on the diet, a list of recommended and contraindicated products, cooking features, recommendations for feeding the patient. As a rule( with most diseases), 4 meals a day is used. However, in some diseases of the stomach, cardiovascular system, it is recommended to take food 5 or 6 times a day in small portions( fractional meals).The most appropriate distribution of the daily ration( with 4 meals a day): breakfast - 30%, lunch - 10, lunch - 40, dinner - 20%.Detailed description of therapeutic nutrition for various diseases and pathological conditions is presented in the section "Diets of therapeutic nutrition".

Before feeding the patients, the caregiver should wash his hands thoroughly with soap and put on a special gown or apron for these purposes. The room in which the patient is located should be appropriately prepared for meals. It is necessary to remove everything that can suppress the appetite: cans with phlegm, vessels, urinals, drugs with a sharp and unpleasant odor, etc.

Using a basin with warm water, it is necessary to wash the patient's hands with soap, if necessary, wet the face wipe. Walking sick

should be fed at the table. Half-bed and bed regimens presuppose the feeding of patients sitting on the bed with the use of a bedside table or special holders( trays) of trays. Patients on a strictly bed rest should be fed in bed with the immediate care of the caregiver.

Aesthetics of eating patients is of great importance in improving their appetite. To do this, you should think over the table setting, ensure the cleanliness of the table cloth, napkins and, of course, cutlery. The temperature of the food should not be too high not to burn the mucous membrane of the mouth, but not too low, which can cause unpleasant sensations. We must not forget that any disease has a significant adverse effect on the human nervous system. Patients become irritable, picky, their character during the disease largely varies. Therefore, a sharp smell of food, increased or lowered temperature of it, an unusual kind of dishes can cause negative emotions in patients, up to refusal to eat. In order to avoid the noted adverse events, it is necessary to ensure that the temperature of the first dishes does not exceed 60-65 "C, the second dishes - 55-60 ° C, and the temperature of cold snacks is in the range from 7 to 14 ° C.

Do not force patients "through strength" to eat up the entire amount of breakfast, lunch or dinner. To avoid undesirable consequences of overeating( vomiting, a feeling of heaviness in the abdomene., eructation, etc.) should be fed in small portions, but more often, coordinating the fractionality of the diet with the attending physician.

It is necessary to achieve high taste qualities of dishes. Satisfaction of the taste of the patient is an indispensable condition for successful treatment, as the appetite in most patients is reduced. This is especially true for salt-free( diets) diets, when spices, herbs, white roots, sour vegetable and fruit juices should be widely used to increase taste and soften the unpleasant sensation of fresh food.

If the doctor does not allow the patient to eat at the table, the caregiver must take care to create a comfortable position for him to eat in the bed. The patient should be slightly raised, put under the back of the pillow, make a convenient device for feeding him in bed or put a bedside table( bedside table).Feeding seriously ill, often devoid of appetite and categorically refusing to eat, requires a caring great skill and patience. Sometimes there is a conviction, sometimes weasel, and sometimes you can do without persuasion, simply by offering the patient a possible choice of dishes according to the prescribed diet.

Before feeding a seriously ill patient, it is necessary to cover his breast with a napkin. If you can not give it a semi-sitting position, then at least slightly raise the head end of the bed. In this case, liquid dishes - grated soup, recommended drinks( tea, juices, compote, kissels, etc.) are best given from the drinker. In the absence of the latter, you should use a dining room or a dessert spoon. When feeding seriously ill patients, you should not use forks or other sharp objects, and to avoid choking patients should not drink from cups or glasses.

To severely weakened patients, patients with severe swallowing disorders and in a number of other cases can be assigned artificial feeding. The most commonly used feeding through the probe is a thin rubber tube( diameter 5-8 mm) 100 cm long, one end of which is rounded and has 2 oval holes in the walls. Before feeding, the probe should be boiled, cooled in cold boiled water and greased rounded end with glycerin or paraffin oil, put on it a funnel with a capacity of 200 ml and preheat the liquid food prescribed by the doctor for administration( milk, cream, raw eggs, broth, mucous soups, kissel,fruit juices, vegetable or dissolved butter, tea, special nutritional mixtures, etc.) in the amount of 3-4 glasses.

The rounded end of the probe is inserted into one of the outer nasal apertures and is advanced along the bottom wall of the nasal passage. Having reached the nasopharynx, the probe is advanced into the esophagus. The absence of a cough reflex makes it possible to make sure that the probe was in the esophagus, and not in the airways. After this, continue the introduction of the probe to a mark of 70 cm and pour food in small portions through the outer end of the probe, connected to the funnel.

With some diseases of the esophagus, which are manifested by a sharp violation of its patency as a result of constriction, the operative way is to make a gastric fistula, through which it is possible to inject the probe and pour food directly into the stomach. At home, you should pay special attention to the cleanliness of the edges of the fistula and the surrounding abdominal skin. Do not allow food contamination in these areas. After each feeding of the patient through the gastric fistula, it is necessary to produce the skin toilet around the fistula: it is washed with warm boiled water, wiped dry and smeared with softening creams or pastes. At the end of this hygienic procedure, a dry sterile dressing is applied to the treated skin and fixed with a band-aid.

In some cases, at home, you have to feed the patient through nutritional enemas. Before you put a nourishing enema, you need to clean the intestines with a regular enema. For feeding with a nutritional enema, intravenous drip infusion systems are usually used, replacing only the intravenous needle with the rectal tip. The use of these devices provides the necessary( dosed) rate of introduction of nutrient mixtures into the rectum, saving patients from unpleasant sensations of desires on the stool.

Before the delivery of the nourishing enema, the system for the drip introduction of the mixtures must be boiled and cooled. At the same time, the bulb should be disconnected from the connecting tubes prior to boiling. The system is collected immediately before the feeding procedure.100-150 ml of the nutrient mixture is poured into the flask, it is filled with the entire system, regulated with a clamping device, and only then the tip is injected into the rectum. The rate of intake of the

nutrient mixture into the intestine must be adjusted by the pressure device in such a way that the number of drops of the solution does not exceed 80-100 per minute. Setting nutrient enemas is quite a complex and responsible procedure, but feasible at home. Therefore, the first 2-3 sessions of nourishing enemas by carers should be conducted under supervision and with the help of medical personnel( nursing nurses).

When taking care of a patient at home, the crucial point is to comply with the regime of fluid intake and take into account the amount of liquids and liquids discharged. With regard to drinking patients should follow the doctor's instructions firmly. With some diseases accompanied by fever, sweating, thirst of patients, consumption of a large amount of liquid is indicated. On the contrary, there are a number of pathological conditions, which are manifested by edema, increased arterial pressure, impaired urination or thermoregulation, in which it is necessary to significantly reduce fluid intake, despite the thirst of patients. Therefore, on the instructions of the doctor for a specific situation, the patient should be determined the regime of fluid intake, the violation of which can lead to very serious consequences.

In these patients, the caregiver must maintain a map of the account of the drunk fluid and the excreted urine, summing up every day. Here it is necessary to note the body temperature of the patient, the increase of which increases sweating and, accordingly, the body's need for liquid. The caregiver should know exactly with the doctor how much fluid can be given to the patient per day, how many times a day and what drinks are preferred.

Each patient, treated at home, should have individual dishes for eating and drinking, individual cutlery.

This applies not only to infectious patients, who present a danger of infection for others, but also patients with any other diseases. The weakened organism of the patient is susceptible to the action of any microbes, even opportunistic ones, which in healthy people can not cause diseases and pathological disorders. Therefore, healthy family members surrounding the patient may be carriers of conditionally pathogenic microorganisms capable of provoking the development of a number of diseases, including infectious diseases. This makes it necessary to use individual cups, plates, spoons, and other dishes for patients.

In the intervals between meals, individual dining utensils of patients should be kept separately from the rest of the dishes of the family in a specially allocated place, closed with a clean towel or napkin. Immediately before meals, the patient's dishes should be scalded with steep boiling water, cooled, and only after that it can be used for feeding.

Observance of the necessary requirements for washing dirty dining utensils of patients is an important condition for the prevention of intestinal diseases in them. The dishwashing mode includes:

a) mechanical removal of food residues( brush, wooden spoon);B) washing the dishes with a brush in water at a temperature of 45-48 ° C with the addition of detergents approved and recommended by the sanitary authorities for the indicated purposes: "Progress"( 5 g of preparation per 1 liter of water), "Don"( 1 g of preparation per1 liter of water), trisodium phosphate( 10 g of the preparation per 1 liter of water), paste "Special-

2"( according to the instructions on the label), sodium bicarbonate, technical calcined soda( up to J20 g per 1 liter of water);

c) washing dishes in water at a temperature of 50 "C with the addition of 1% clarified chloric lime solution in an amount of 10 cm per 1 liter of water;

d) rinsing dishes with hot water at a temperature not lower than 70" C;E) drying of dishes on special stands( separately from dishes of the whole family) in the closet or under a clean dry towel or napkin.

Washing of lunch appliances( spoons, knives and forks of stainless metals) should be carried out in the same way as washing the tableware, but the washed instruments should be boiled, and then dry with a clean towel. Glassware( glasses, cups) are washed in two waters or in running water and rubbed with a clean towel. Trays should be washed with hot water and wiped with a specially allocated towel for this purpose.