Artificial feeding of patients. Feeding the sick. Types of nutrition, their characteristics. Feeding procedure. Methodological recommendations for self-training of cadets and students in the discipline “Physical Training” Krasnodar

Patient's nutrition. Artificial nutrition of the patient

Lecture

The student must know:

basic principles of rational nutrition;

basic principles of therapeutic nutrition;

characteristics of treatment tables;

organizing meals for patients in the hospital;

types of artificial nutrition, indications for its use;

contraindications to the insertion of a gastric tube;

problems that may arise when feeding the patient.

The student must be able to:

make a portion requirement;

conduct a conversation with the patient and his relatives about the diet prescribed by the doctor;

feed a seriously ill patient from a spoon and using a sippy cup;

insert a nasogastric tube;

provide artificial nutrition to the patient (on a phantom);

carry out the nursing process in case of failure to meet the patient’s needs for adequate nutrition and fluid intake using the example of a clinical situation.

Questions for self-study:

concept of diet,

energy value of food,

main components of the diet: proteins, fats, vitamins, carbohydrates, etc., concept, meaning,

diet of a healthy person,

concept of diet therapy,

basic principles of therapeutic nutrition,

organization of therapeutic nutrition in a hospital, the concept of therapeutic tables or diets,

characteristics of treatment tables - diets,

organization and feeding of seriously ill patients,

artificial nutrition, its types, features.

Glossary

terms

wording

Anorexia

Lack of appetite

Diet

Lifestyle, diet

Diet therapy

Medical nutrition

Diarrhea

Pancreatitis

Inflammation of the pancreas

Stoma

An opening connecting the cavity of internal organs with the external environment

Theoretical part

Food consists of organic and inorganic substances.

Organic are proteins, fats and carbohydrates, inorganic are mineral salts, micro and macroelements, vitamins and water.

Organic compounds

Substances

Structure

Functions

Squirrels(albumin, proteins)

consist of amino acids

1construction; 2enzymatic; 3 motor (contractile muscle proteins); 4 transport (hemoglobin); 5 protective (antibodies); 6 regulatory (hormones).

Fats

(lipids)

composed of glycerol and fatty acids

1 energy; 2 construction;

3 thermoregulatory 4 protective 5 hormonal (corticosteroids, sex hormones) 6 are part of vitamins D, E 7 source of water in the body 8 supply of nutrients.

CarbohydratesMonosaccharides : glucose fructose,

ribose,

deoxyribose

Highly soluble in water

Energy

Disaccharides : sucrose , maltose ,

Soluble in water

1Energy 2 Components DNA, RNA, ATP.

Polysaccharides : starch, glycogen, cellulose

Poorly soluble or insoluble in water

1energy

2 supply of nutrients

Inorganic compounds

Substances

Functions

Products

Macronutrients

O2, C, H, N

Contains all organic matter in cells, water

Phosphorus (P)

Part of nucleic acids, ATP, enzymes, bone tissue and tooth enamel.

Milk, cottage cheese, cheese, meat, fish, nuts, herbs, legumes.

Calcium (Ca)

Part of bones and teeth, it activates blood clotting.

Dairy products, vegetables, fish, meat, eggs.

Microelements

Sulfur (S)

Included in vitamins, proteins, enzymes.

Legumes, cottage cheese, cheese, lean meat, oatmeal

Causes the conduction of nerve impulses, activator of protein synthesis enzymes.

Vegetables, mostly potatoes, fruits, mostly dry - apricots, dried apricots, raisins, prunes.

Chlorine (Cl)

It is a component of gastric juice (HCl) and activates enzymes.

Sodium (Na)

Ensures the conduction of nerve impulses, maintains osmotic pressure in cells, stimulates the synthesis of hormones.

The main source is table salt, (NaCl)

Magnesium (Mg)

Contained in bones and teeth, it activates DNA synthesis and participates in energy metabolism.

Bran, rye bread, vegetables (potatoes, cabbage, tomatoes), millet, beans, cheese, almonds.

Iodine (I)

It is part of the thyroid hormone, thyroxine, and affects metabolism.

Seaweed, shrimp, mussels, sea fish.

Iron (Fe)

Part of hemoglobin, myoglobin, lens and cornea of the eye, enzyme activator. Provides oxygen transport to tissues and organs.

Liver, meat, egg yolk, tomatoes, herbs, green (by color) apples.

Water (H2 O)

60 – 98% is found in the human body. It makes up the internal environment of the body, participates in hydrolysis processes, and structures the cell. Universal solvent, catalyst for all chemical processes. Loss of 20% - 25% of water leads to death.

Principles of rational nutrition

1 Principle – nutritional balance, food variety - the ratio of proteins, fats and carbohydrates in food should be respectively 1.0: 1.2: 4.6 by weight of these substances.

2 Principle - calorie content of food - food products must have sufficient energy value, approximately 2800 - 3000 kcal of the daily diet.

3 Principle –diet – 4 times a day, breakfast – 25%, lunch – 30%,

afternoon snack – 20%, dinner – 25% . The method of cooking is of great importance; for example, boiling for too long destroys vitamins. It is also necessary to store food correctly, since improper storage (repeated defrosting and freezing, long-term storage, etc.) changes the chemical composition of food and destroys vitamins.

Principles of therapeutic nutrition

Diet(therapeutic table) - therapeutic nutrition, this is a food ration (daily amount of food), which is prepared for the patient for the period of illness or its prevention. Diet therapy– treatment with diet and nutrition.

from one diet to another:

1 gradual – for example, table 1a, 1b, 1 for gastric ulcer.

2 stepped – “zigzag” method recommended by the Institute of Nutrition

Russian Academy of Medical Sciences for most patients with chronic diseases, when previously prohibited products are allowed once every 7–10 days, i.e. Contrasting days are recommended. The strict diet remains in the form of 1 – 2 fasting days per week.

In hospitals, the diet is controlled by ward nurses, senior

nurses, heads of departments, nutritionists, nutritionists.

Drawing up a ward portion plan and

issuing portion requirements

Every day, after the doctor’s rounds, the guard (ward) nurse draws up a ward portion sheet, where she indicates the ward number, the number of patients in the ward and the number of dietary tables, sums it up, indicating the number of patients at her post and the number of people receiving a particular diet. Then the portion holder is handed over to the head nurse.

The portion requirement is issued today for tomorrow, and on Friday for Saturday and Sunday and Monday.

If the patient is admitted after drawing up and submitting a portion request to the kitchen, then an additional portion portion is served.

Having received information from the guard nurses, the head nurse writes out a portion requirement for the entire department, which indicates the number of patients in the department and the number of patients receiving a particular diet. This portion requirement is signed by the head nurse and the head of the department. Additional food may be prescribed in the form of cottage cheese, kefir, milk, etc.

The portion requirement is submitted to the kitchen nutritionist no later than 12 o'clock.

The head nurse returns the ward portion requirements to the ward nurses so that they can monitor the patients’ nutrition.

The dietitian prepares a hospital-wide portion requirement that specifies the number of patients in the entire hospital and the number of patients receiving a particular diet. This portion requirement is signed by the hospital's chief physician, chief accountant and nutritionist.

Based on this portion requirement, the nutritionist draws up a daily menu for each diet.

According to this menu, the nutritionist prepares menu-requirement(menu layout) in which the number of products required for preparing dishes is calculated.

Based menu-requirements(menu layouts) receive products in stock today for tomorrow (or for Saturday, Sunday and Monday).

In addition, the nurse on duty is required to submit information (name list) to the barmaid (dispenser) at the buffet.

Room number

Full Name

Diet No.

Mode

Ivanov Pyotr Alekseevich

Petrov Igor Vladimirovich

Sidorov Oleg Ivanovich

Sokolova Anna Alekseevna

Petrova Victoria Alexandrovna

Portion requirement

Branch: Ophthalmic____ Post No._ 1 __discharge date_ 24.11_2008

On _ 25. 11. 2008 G.

chambers

Qty

patients

D E T TABLES

Additional

nutrition

Fasting days

And that:

Charge nurse _____________

Portion requirement

Branch: _ Eye______ date of: 24.11. 2008g.

On 25.11. 2008 G. Time: 12 hour 00 min.

post

Qty

patients

Additional

nutrition

Fasting days

And that:

Head department _________________

Art. nurse ___________________

Portion requirement

MUGB No. 1 __________________________ date 24.11. 2008 G.

name of health care facility

On 25. 11. 200 8 g. Time: 12 hour 30 min.

Branch

Qty

patients

Additional

noe

nutrition

Fasting days

Ophthalmic

Surgical

Traumatological

And that:

269

Ch. doctor _________________

Ch. buhg. _________________

Dietitian_________________

Checking patients' bedside tables

Goals: 1.checking the sanitary condition of the bedside tables; 2.checking for the presence of prohibited products.

Bedside tables are checked daily; for patients who do not inspire confidence in the nurse, bedside tables are checked twice a day

Typically, bedside tables consist of 3 sections:

V first - personal hygiene items are stored (comb, toothbrush, toothpaste, etc.);

in second – food products that can be stored for a longer period of time (cookies, candies, apples, etc.). All products must be in packaging;

Remember !You cannot store food without packaging in the nightstand!

IN third – linen and other care items.

Bedside tables are treated with disinfectant solutions after each patient is discharged.

Checking refrigerators

Refrigerators, depending on the volume, are located either in a room for one room, or in a separate room for several rooms.

Refrigerators are checked once every three days.

Goals checks: 1- presence of expired and spoiled products; 2- sanitary condition of refrigerators.

When storing products in the refrigerator, the nurse should warn the patient that he must write a label in which he notes his full name, room number and the date the product was stored.

If products are found that have expired or are spoiled, the nurse must notify the patient about this and remove the product from the refrigerator (if the patient is in general care).

When checking, products that have expired are laid out on a special table next to the refrigerator so that patients can sort them out.

Refrigerators are defrosted and washed once every 7 days.

Refrigerators (inner surface)

Hydrogen peroxide with 0.5% detergent

3% solution

2 times wiping followed by washing with water

Checking gears

Purpose: checking for prohibited products

Deliveries are delivered to patients by a special person - a peddler; most often she does not have a medical education, so her functions include not accepting perishable products; the rest of the products must be checked by the ward nurse.

The ward nurse checks the transfers of patients who do not inspire confidence in her and violate the regime, for this she compiles a list of such patients, in which she indicates the department, full name. patients and room number.

This list is given to the peddler so that she can show these patients to the nurse for verification before giving them to them.

If prohibited products are found, they are returned to the person who brought them.

Characteristics of diets

Diet No. 1a

Indications: peptic ulcer of the stomach and duodenum, the first 8–10 days of exacerbation; acute gastritis and exacerbation of chronic gastritis, the first 1 - 2 days.

Characteristic: mechanical, chemical and thermal sparing of the mucous membrane of the stomach and duodenum; all food is in liquid and semi-liquid form. Meals 6-7 times a day, diet weight about 2.5 kg, table salt up to 8g.

milk and mucous soups from cereals and wheat bran with butter, pureed vegetables (carrots, beets) and

puree from boiled lean meat and fish, semolina milk soup. Soufflé made from boiled lean meat and fish. Liquid, pureed, milk porridges. Soft-boiled eggs, steam omelet. Whole milk. Soufflé made from freshly prepared cottage cheese. Rose hip decoction, not strong tea. Butter and olive oil are added to dishes.

Excluded: vegetable fiber, broths, mushrooms, bread and bakery products, lactic acid products, spices, snacks, coffee, cocoa.

Diet No. 1b

Indications: exacerbation of gastric and duodenal ulcers, 10–20 days of illness, acute gastritis, 2–3 days.

Characteristic: more moderate mechanical, chemical and thermal sparing of the mucous membrane of the stomach and duodenum compared to diet No. 1a; All food is in semi-liquid and puree form. Meals 6 - 7 times a day, diet weight up to 2.5 - 3 kg, table salt up to 8 - 10g.

Range of products and dishes: dishes and products of diet No. 1a, as well as white, thinly sliced, unbrown crackers - 75 - 100g, 1 - 2 times a day - meat or fish dumplings or meatballs; pureed milk porridges and milk soups from rice, barley and pearl barley, pureed vegetable purees. Kissels, jelly from sweet varieties of berries and fruits, juices diluted in half with water and sugar, sugar, honey.

Excluded: the same as in diet No. 1a.

Diet No. 1

Indications: exacerbation of peptic ulcer, subsiding stage; chronic gastritis with preserved and increased secretion in the acute stage.

Characteristic: moderate mechanical, chemical and thermal sparing of the mucous membrane of the stomach and duodenum; food is boiled and mainly pureed. Meals 5 - 6 times a day, diet weight 3 kg, table salt 8 - 10g.

Range of products and dishes: yesterday's white and gray bread, white crackers, biscuit. Milk, pureed, cereal and vegetable soups (except cabbage). Steam cutlets (meat and fish), chicken and fish, boiled or steamed; Vegetable puree, porridges and puddings, pureed, boiled or steamed; soft-boiled eggs or steam omelet. Sweet varieties of berries, fruits, juices from them, sugar, honey, jam, baked apples, jelly, mousse, jelly. Whole milk, cream, fresh sour cream, fresh low-fat cottage cheese. Tea and cocoa are weak, with milk. Unsalted and vegetable butter.

Limit: coarse vegetable fiber, broths.

Excluded: spices, coffee, mushrooms.

Diet No. 2

Indications : chronic gastritis with secretory insufficiency; acute gastritis, enteritis, colitis during the period of convalescence as a transition to a balanced diet.

Characteristic : Mechanically gentle, but promoting increased gastric secretion. Food is boiled, baked, fried without breading. Table salt up to 15g per day.

Range of products and dishes: yesterday's white bread, plain crackers, plain cookies and pies 1 – 2 times a week. Cereal and vegetable soups with meat and fish broth. Lean beef, boiled, stewed, steamed, baked, fried without breading and jelly. Non-fat fish in pieces or chopped, boiled, steamed aspic. Vegetables:

potatoes (limited), beets, grated carrots, boiled, stewed, baked; raw tomatoes. Compotes, jelly, jelly, mousse from ripe fresh and dry fruits and berries (except melons and apricots), fruit and vegetable juices, baked apples, marmalade, sugar. Whole milk with good tolerance. Acidophilus, kefir, fresh non-sour cottage cheese, raw and baked; mild grated cheese; sour cream - in dishes. Meat, fish, sour cream and vegetable sauces. Bay leaf, cinnamon, vanillin. Tea, coffee, cocoa with water and milk. Butter and sunflower. Soft-boiled eggs, fried omelet.

Excluded: legumes and mushrooms.

Diet No. 3

Indications : chronic intestinal diseases with a predominance of constipation, a period of mild exacerbation and a period of remission.

Characteristic : Increase in diet foods rich in plant fiber, and foods that enhance intestinal motor function. Table salt 12 - 15g per day.

Range of products and dishes: wheat bread from wholemeal flour, black bread with good tolerance. Soups with low-fat broth or vegetable broth with vegetables. Meat and fish are boiled, baked, sometimes chopped. Vegetables (especially leafy ones) and raw fruits, in large quantities (prunes, figs), sweet dishes, compotes, juices. Crumbly porridges (buckwheat, pearl barley). Cottage cheese and cheesecakes, one-day kefir. Hard boiled egg. Butter and olive oil - in dishes

Excluded: turnips, radishes, garlic, mushrooms.

Diet No. 4

Indications : acute enterocolitis, exacerbation of chronic colitis, a period of profuse diarrhea and pronounced dyspeptic symptoms.

Characteristic: chemical, mechanical and thermal sparing of the intestines. Eating 5 – 6 times a day. All dishes are steamed and pureed. Table salt 8 – 10g. The duration of the diet is 5 – 7 days.

Range of products and dishes: white bread crackers. Soups made with low-fat meat broth, cereal decoctions with egg flakes, semolina, and pureed rice. Meat is not fatty, minced, boiled

or steam. Poultry and fish in their natural form or chopped, boiled or steamed. Porridges and puddings made from pureed cereals in water or low-fat broth. Juices from fruits and berries, decoction of rose hips, blueberries. Tea, cocoa with water, jelly, jelly. Eggs (if well tolerated) – no more than 2 eggs per day (soft-boiled or steam omelet). Butter 40 – 50g.

Limitations: sugar up to 40g, cream.

Excluded: milk, vegetable fiber, spices, snacks, pickles, smoked meats, legumes.

Diet No. 5

Indications : acute hepatitis and cholecystitis, recovery period; chronic hepatitis and cholecystitis; cirrhosis of the liver.

Characteristic: mechanical and chemical sparing, maximum liver sparing. Limitation of animal fats and extractives High carbohydrate content Food is not crushed. Roasting is not allowed. Meals 5 - 6 times a day, diet weight 3.3 - 3.5 kg, table salt 8 - 10g.

Range of products and dishes: yesterday's wheat and rye bread. Soups from vegetables, cereals, pasta with vegetable broth, dairy or fruit. Lean varieties of meat and fish, boiled, baked after boiling; soaked herring. Raw vegetables and greens (salads, vinaigrettes), non-acidic sauerkraut. Fruits and berries, except very sour ones. Sugar up to 100g, jam, honey. Milk, curdled milk, acidophilus, kefir, cheese. An egg - in a dish, and if well tolerated - an omelet 2 - 3 times a week.

Excluded: mushrooms, spinach, sorrel, lemon, spices, cocoa.

Diet No. 5a

Indications : acute diseases of the liver and biliary tract with concomitant diseases of the stomach and intestines; acute and chronic pancreatitis, exacerbation stage.

Characteristic : the same as with diet No. 5, but with mechanical and chemical sparing of the stomach and intestines (food is given to the patient mainly in pureed form).

Range of products and dishes: dried wheat bread. Slimy soups made from vegetables, cereals, noodles, with vegetable broth or milk, pureed, puree soup. Steamed meat cutlets, meat soufflé. Low-fat boiled fish, steam soufflé made from it. Boiled, steamed vegetables,

mashed. Porridge, especially buckwheat, mashed with water or with the addition of milk. Egg - only in the dish. Sugar, honey, jelly, jelly, compotes of sweet fruits and berries. Milk - only in the dish, lactic acid products and cottage cheese are fresh (soufflé). The tea is not strong. Sweet fruit and berry juices. Butter and vegetable oil - only for dishes.

Excluded: snacks, spices, turnips, radishes, sorrel, cabbage, spinach, cocoa.

Diet No. 7

Indications : acute nephritis, convalescence period; chronic nephritis with minor changes in urine sediment.

Characteristic : chemical sparing of the kidneys. Limitation of table salt (3 – 5 g per patient’s hands), liquids (800 – 1000 ml), extractives, hot seasonings.

Range of products and dishes: white and bran bread without salt (3 - 5 g per patient's hands), liquids (800 - 1000 ml), fatty meats and poultry, boiled, in pieces, chopped and mashed, baked after boiling. Lean fish in pieces, chopped, grated, boiled and lightly fried after boiling. Natural, boiled and baked vegetables, vinaigrettes, salads (without salt). Cereals and pasta in the form of porridges, puddings, cereals. Egg – one per day. Fruits, berries in any form, especially dried apricots, apricots, sugar, honey, jam. Milk and dairy products, cottage cheese. White sauce, vegetable and fruit sauces. Butter and vegetable oil.

Limit: cream and sour cream.

Excluded: soups.

Diet No. 7a

Indications : acute nephritis, exacerbation of chronic nephritis with pronounced changes in urine sediment.

Characteristic : chemical sparing, strict restriction of fluid (600 - 800 ml) and salt (1 - 2 g on the patient’s hands); All dishes are mashed, boiled or steamed.

Product range: the same as with diet No. 7, meat and fish are limited to 50g per day. Vegetables only boiled or pureed. Fruits are raw and boiled only in pureed form.

Excluded: soups.

Diet No. 8

Indications : obesity.

Characteristic : chemical sparing, limiting the energy value of the diet mainly due to carbohydrates and fats. Increasing the amount of protein. Limit table salt to 3–5 g, liquid to 1 liter, extractives, spices and seasonings. Increase in plant fiber. Eating 5 – 6 times a day.

Range of products and dishes: black bread (100 – 150g). Meat, fish, vegetarian soups - half a plate. Lean meat and fish, boiled in pieces. Buckwheat porridge is crumbly. Vegetables of all types (especially cabbage) with vegetable oil. Potatoes are limited. Fruits and

raw berries and juices from them, excluding sweet ones: grapes, figs, dates. Butter and sour cream are limited; low-fat milk and dairy products, low-fat cottage cheese. Compote, tea, coffee with xylitol.

Excluded: flavoring seasonings.

Diet No. 9

Indications : diabetes.

Characteristic : chemical sparing, limitation or complete exclusion of refined carbohydrates, limitation of cholesterol-containing foods. Individual selection of daily energy value. Boiled or baked food Fried foods are limited.

Range of products and dishes: black rye bread, protein-bran bread, coarse wheat bread (no more than 300g per day). Soups with vegetable broth. Lean meats and fish. Porridge: buckwheat, oatmeal, pearl barley, millet; legumes; eggs - no more than 1.5 pieces per day (yolks are limited).

Dairy products, cottage cheese. Fruits and vegetables in large quantities.

Limit: carrots, beets, green peas, potatoes, rice.

Excluded: salted and pickled dishes; semolina and pasta; figs, raisins, bananas, dates.

Diet No. 10

Indications : diseases of the cardiovascular system without symptoms of circulatory failure.

Characteristic : chemical sparing, limitation of animal fats, cholesterol-containing foods, table salt (5g per patient’s hands). Eating 5 – 6 times a day. Food boiled or baked.

Range of products and dishes: coarse gray bread, crackers, soft biscuits, crispbread. Soups (half a plate) vegetarian, cereal, dairy, fruit; borscht, beetroot soup; low-fat meat broth - once a week. Lean meat and poultry, boiled and baked; frying after boiling is allowed. Lean fish, soaked herring – once a week. Protein omelet. Vegetable vinaigrettes and salads (except for leaf and head lettuce, sorrel and mushrooms) with vegetable oil. Oatmeal and buckwheat porridge, crumbly, puddings, casseroles. Lactic acid products, milk, cottage cheese, low-fat cheese. Fruits, berries,

any fruit juices. Fats for cooking and eating – 50g, half of which are vegetable. Weak tea and coffee. Sugar – up to 40g per day.

Excluded: fatty dishes from meat, fish, pastry, brains, liver, kidneys, caviar, refractory fats, ice cream, salty snacks and canned food, alcohol, cocoa, chocolate, beans.

Diet No. 10a

Indications : diseases of the cardiovascular system with severe symptoms of circulatory failure.

Characteristic : chemical sparing, sharp limitation of table salt and free liquid. Exclusion of food substances and drinks that stimulate the central nervous system,

activity of the heart and irritating the kidneys. Food is prepared without salt. Food is given pureed.

Range of products and dishes: the same as with diet No. 10, but meat and fish are limited to 50g per day, given only boiled, vegetables -

only in boiled and mashed form. Fruits are raw and boiled only in pureed form.

Excluded: soups, spicy and salty dishes, strong tea and coffee, fatty and flour dishes.

Diet No. 11

Indications : tuberculosis without intestinal disturbances and without complications; general exhaustion.

Characteristic : a complete, varied diet for enhanced nutrition (increased energy value), with a large amount of complete proteins, fats, carbohydrates, vitamins and salts, especially calcium.

Range of products and dishes: a variety of products and dishes. Products rich in calcium salts: milk, cheese, buttermilk, figs. At least half of the protein comes from meat, fish, cottage cheese, milk and eggs.

Excluded: ducks and geese.

Diet No. 13

Indications : Acute infectious diseases (febrile conditions).

Characteristic : thermal sparing (for high fever), varied, mostly liquid, food with the advantage of coarse plant fiber, milk, snacks, spices. Eating 8 times a day, in small portions.

Range of products and dishes: white bread and crackers, meat broth, pureed meat soup in a slimy broth. Meat soufflé. Soft-boiled eggs and omelet.

Porridge pureed. Fruit, berry, vegetable juices, fruit drinks, jelly. Butter.

Diet No. 15

Indications: all diseases in the absence of indications for a special diet.

Characteristic : a physiological complete diet with double the amount of vitamins and the exclusion of fatty meat dishes. Eating

4 – 5 times a day.

Range of products and dishes: white and rye bread. Various soups.

Various pieces of meat (except fatty varieties). All kinds of fish. Dishes from cereals, pasta, legumes. Eggs and dishes made from them. Vegetables and fruits are different. Milk and dairy products. Various sauces and spices (pepper and mustard - for special indications). Canned snacks in moderation. Tea, coffee, cocoa, fruit and berry juices, kvass. Butter and vegetable oil in its natural form, in salads and vinaigrettes.

Diet No. 0

Indications : the first days after operations on the stomach and intestines (prescribed for no more than 3 days). Characteristic : chemical, mechanical sparing. Eating every 2 hours (from 8.00 to 22.00). Food is given in liquid and jelly form.

Range of products and dishes: tea with sugar (10g), fruit and berry jelly, jelly, apple compote (without apples), rosehip decoction with sugar; 10 g of butter is added to rice water and weak meat broth.

Fasting days

Name of the diet and its composition

Indications

Milk day No. 1

Every 2 hours, 6 times a day, 100 ml of milk or kefir, yogurt, acidophilus; At night, 200 ml of fruit juice with 20 g of glucose or sugar; You can also take 25g of dried white bread 2 times a day.

Diseases of the cardiovascular system with symptoms of circulatory failure

Milk day No. 2

1.5 liters of milk or curdled milk for 6 servings

250ml every 2 – 3 hours

Gout, obesity.

Curd day

400 – 600g of low-fat cottage cheese, 60g of sour cream and 100ml of milk for 4 servings in its natural form or in the form of cheesecakes, puddings. You can also have coffee with milk twice.

Obesity, heart disease, atherosclerosis

Cucumber day

2 kg of fresh cucumbers for 5 – 6 doses

Obesity, atherosclerosis, gout, arthrosis

Salad day

1.2 - 1.5 kg of fresh vegetables and fruits in 4 - 5 doses per day - 200 - 250 g each in the form of salads without salt. Add a little sour cream or vegetable oil to vegetables, and sugar to fruits.

syrup

Hypertension, atherosclerosis,

kidney disease, oxaluria, arthrosis.

Potato day

1.5 kg of baked potatoes with a small amount of vegetable oil or sour cream (without salt) for 5 servings - 300 g each.

Heart failure, kidney disease

Watermelon day

1.5 kg of ripe watermelon without peel for 5 servings – 300g.

Liver diseases, hypertension, nephritis, atherosclerosis.

Apple Day No. 1

1.2 – 1.5 kg of ripe raw peeled and mashed apples for 5 doses – 300g each.

Acute and chronic colitis with diarrhea.

Apple Day No. 2

1.5 kg of raw apples for 5 – 6 servings. For kidney disease, add 150-200g of sugar or syrup. You can also have 2 servings of rice porridge with 25g rice each

Obesity, nephritis, hypertension, diabetes.

Fasting day from dried apricots

Pour 500g of dried apricots with boiling water or lightly steam and divide into 5 portions

Hypertension, heart failure

Composite day
1.5 kg of apples, 150 g of sugar and 800 ml of water are boiled and distributed into 5 doses during the day.

Kidney and liver diseases.

Rice and compote day

Prepare 1.5 liters of compote from 1.2 kg of fresh or 250 g of dried fruits and berries; Cook porridge in water from 50g rice and 100g sugar. Give a glass 6 times a day

compote, 2 times - with sweet rice porridge.

Liver diseases, gout, oxaluria.

sugar day

5 times a glass of hot tea from 30 -

40g sugar each.

Liver diseases, nephritis, chronic colitis with diarrhea

Meat

a) 270g of boiled meat, 100ml of milk, 120g of green peas, 280g of fresh cabbage for the whole day.

b) 360g of boiled meat for the whole day.

Obesity

Artificial nutrition

theoretical part

Artificial nutrition refers to 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.

Types of artificial nutrition:

I. Enteral (via the gastrointestinal tract):

a) through a nasogastric tube (NGT);

b) using a gastric tube inserted through the mouth;

c) through a gastrostomy tube;

d) rectal (using nutritional enemas).

II. Parenteral (bypassing the gastrointestinal tract):

a) by injection; b) using infusions

using a probe and funnel

When it is impossible to feed the patient naturally, food is introduced into the stomach or intestines through probe or stoma, or with an enema. When such administration is not possible, then nutrients and water (saline solutions) are administered parenterally. Indications for artificial nutrition and its methods are chosen by the doctor. The nurse must be proficient in feeding the patient through probe. A funnel or system for drip administration of nutrient solutions, or a Janet syringe is connected to the inserted probe, and the patient is fed with the help of these devices.

For algorithms for inserting a tube and artificial nutrition through a tube, see the algorithms.

Feeding the patient using a thick gastric tube and funnel

Equipment: nutritional mixture “Nutrizon” or “Nutricomp” 50-500 ml, heated to a temperature of 38º-40º, boiled fresh water 100-150 ml, oilcloth, napkin, gloves, gauze napkins, container for used material, waterproof bag, sterile glycerin or petroleum jelly , cotton swabs, sterile funnel with a capacity of 0.5 l, sterile thick gastric tube, plug.

Note:

Check the packaging with the probe for leaks and expiration date.

Open the package with a thick gastric tube and funnel.

Determine the depth of probe insertion:

Treat the inner end of the probe with glycerin or vaseline oil

During administration, ask the patient to breathe deeply and swallow.

Place a funnel or a Janet syringe barrel on the outer end of the probe.

Windpipe Esophagus Posterior wall of the pharynx

Place a funnel or cylinder of a Janet syringe at the level of the stomach and pour in a nutrient mixture of 50 - 500 ml (as prescribed by a doctor), temperature - 38° - 40°.

Then slowly lift the funnel or barrel of the Janet syringe up (keep the funnel in an inclined position), making sure that no air gets into the stomach.

After feeding, pour 50-100 ml of boiled water into the funnel or barrel of the Janet syringe and rinse the probe.

Disconnect the funnel or barrel of the Janet syringe from the probe, place it in a waterproof bag, and close the end of the probe with a plug.

Attach the probe to the pillow.

Remove gloves, wash hands.

Problems patient: nausea, vomiting.

Insertion of a nasogastric tube (NGT) through the nose

Indications : need for artificial feeding.

Contraindications : varicose veins of the esophagus, ulcers of the stomach and esophagus, neoplasms, burns and scar formations of the esophagus, gastric bleeding.

Equipment: sterile nasogastric tube in a package; stub; putty knife; glycerin or petroleum jelly; sterile wipes; syringe – 10ml; retainer (piece of bandage); gloves are clean; sterile gloves; sterile tray; napkins; waterproof bag for used material, napkin for chest

Wash your hands to a hygienic level, put on gloves and treat them with a glove antiseptic.

Explain to the patient (if he is conscious) the purpose and course of the procedure, obtain consent.

Place the patient in the Fowler's position (if allowed), cover the chest with a napkin.

Check the nasal passages for patency (the probe must be inserted into a free nasal passage).

Open the package with the probe and place it on a sterile tray.

Remove gloves, put on sterile gloves.

Determine the depth of insertion of the probe, this is 1) the distance from the earlobe to the tip of the nose and to the navel; 2) height – 100cm; 3) up to 2-3 marks on the probe.

Treat the inner end of the probe with glycerin or vaseline oil at a distance of 10-15 cm.

Irrigation of the probe with glycerin Pressing the probe to the back Fixing the probe with

the wall of the pharynx with a spatula using a bandage

Slightly tilt the patient's head forward.

Collect the probe in one hand, with the other hand, lift the tip of the nose with your thumb and insert the probe 15-18 cm. Release the tip of your nose.

Press the probe against the back wall of the pharynx with a spatula or two fingers of your free hand (so as not to get into the trachea), while simultaneously advancing the probe, this must be done quickly so as not to cause a gag reflex, continue to insert the probe to the desired mark.

Note :if the patient is conscious and can swallow, give him half a glass of water and, when swallowing small sips of water, slightly help insert the probe to the desired mark.

Attach a syringe to the outer (distal) end of the probe and suck out 5 ml of stomach contents, make sure that the contents do not contain blood (if blood is detected, show the contents to the doctor), insert the contents back into the probe.

Secure the probe with a safety pin to the patient's pillow or clothing.

Secure the probe with a bandage, tying it across the neck and face without grabbing the ears. Make a knot on the side of the neck; you can secure the probe with an adhesive plaster, attaching it to the back of the nose.

Remove the napkin, place it in a bag,

Help the patient find a comfortable position, adjust the bed, cover the patient with a blanket.

Remove gloves, wash hands. Make an entry in your medical record.

Note: the probe is left in place for 2 weeks. After 2 weeks, the probe must be removed, decontaminated, and then, if necessary, reinserted.

Patient problems when inserting a probe: psychological, penetration of the probe into the respiratory tract, injury to the mucous membrane, bleeding, gag reflex, nausea, vomiting.

Feeding the patient through a nasogastric tube (NGT) drip

Equipment: filled system with nutritional mixture “Nutrizon” or “Nutricomp” 200-500ml (as prescribed by a doctor) 38º-40º, tripod, gloves, warm boiled water 50-100ml, Janet syringe, napkins, napkin (on the chest), heating pad 40º, sterile glycerin or petroleum jelly, cotton pads,

Ventilate the room, clean the bedpan.

Warn the patient about the upcoming feeding.

Place the patient in the Fowler's position (if allowed).

Place a napkin on the patient's chest.

Remove the plug.

Connect the system to the probe, adjust the drop frequency (the speed is determined by the doctor).

Place a heating pad on top of the system tube on the bed (temperature - +40°).

Add the prepared amount of mixture (temperature 38°-40°) at a rate of 100 drops per minute.

Close the clamp on the system and disconnect the system.

Attach a Janet syringe with warm boiled water to the probe, rinse the probe under low pressure.

Disconnect the syringe.

Close the distal end of the probe with a plug.

Change the position of the probe, treat the nasal passage with Vaseline or glycerin, dry the skin near the nose with blotting movements, and change the retainer.

Attach the probe to the patient's pillow or clothing with a safety pin. Remove the napkin.

Help the patient find a comfortable position. Make the bed, cover it with a blanket.

Remove gloves, wash hands.

Make a record of feeding in the medical record.

Feeding a patient through the NGZ using a Janet syringe

Equipment: Janet syringe, nutritional mixture “Nutrizon” or “Nutricomp” 50-500 ml, heated to a temperature of 38º-40º, boiled fresh water 100-150 ml, napkin, gloves, gauze napkins, container for used material, waterproof bag, sterile glycerin or Vaseline oil, cotton pads,

Tell the patient what he will be fed.

Ventilate the room, remove the vessels.

Wash your hands, put on gloves.

Raise the head end of the bed (if the patient is allowed), place a napkin on the chest.

Check the temperature of the nutritional mixture.

Draw the required amount of nutritional mixture into Zhane’s syringe.

Remove the plug, connect the syringe to the probe and slowly (20 - 30 ml per minute) pour in 50 - 500 ml of nutritional mixture (as prescribed by the doctor), temperature - 38°–40°.

Rinse the syringe with boiled water, fill it with 50-100 ml of boiled water and rinse the probe under low pressure.

Disconnect the syringe from the probe, place the syringe in a waterproof bag, and close the end of the probe with a plug.

Remove the napkin and place them in a bag.

Help the patient find a comfortable position, adjust the bed, and cover him.

Remove gloves, wash hands.

Feeding the patient through Rinsing the tube after

NGZ using a Janet syringe feeding

Make a note in the medical record about the procedure.

Patient problems

Feeding the patient through the NGZ using a funnel

Equipment: funnel, nutrient mixture “Nutrizon” or “Nutricomp” 50-500 ml, heated to a temperature of 38º-40º, sterile glycerin or vaseline oil, cotton wool, boiled fresh water 100-150 ml, oilcloth, napkin, gloves, gauze napkins, container for used material, waterproof bag,

Note:Instead of a funnel, the barrel of a Janet syringe is often used

Tell the patient what he will be fed.

Ventilate the room, remove the vessels.

Wash your hands at a hygienic level, put on gloves, treat your gloves with a glove antiseptic.

Raise the head end of the bed (if the patient is allowed), lay an oilcloth and napkin on the chest.

Check the temperature of the nutritional mixture.

Remove the plug, connect the funnel or barrel of the Janet syringe to the probe.

Place the funnel or barrel of the Janet syringe at the level of the stomach, pour 50 ml of the nutrient mixture into it, and slowly lifting it, add the mixture to the required volume (as prescribed by the doctor), while making sure that no air gets into the stomach.

Then lower the funnel or barrel of the Janet syringe again and pour 50-100 ml of boiled water into it and rinse the probe with the same movements.

Disconnect the funnel or barrel of the Janet syringe from the probe and place it in a waterproof bag, close the end of the probe with a plug.

Change the position of the probe by securing it to the patient’s pillow or clothing.

Treat the nasal cavity with the probe inserted, change the retainer.

Remove the oilcloth and napkin and place them in a bag.

Help the patient find a comfortable position, adjust the bed, and cover him.

Remove gloves, wash hands.

Make a note in the medical record about the procedure.

Problems patient: necrosis of the nasal mucosa, nausea, vomiting.

Remember!

After feeding the patient through a tube inserted through the nose or gastrostomy tube, the patient should be left in a reclining position for at least 30 minutes.

When washing a patient who has had a probe inserted through the nose, you should use only a towel or mitten soaked in warm water, and do not use cotton wool or gauze pads.

Feeding a patient through a gastrostomy tube

Equipment: Janet funnel or syringe, container with nutrient mixture (38º-40º) 50-500 ml., boiled water 100-150 ml., absorbent diaper, sterile probe in packaging, gloves, container for used material, waterproof bag, glycerin (if required) .

Tell the patient what he will be fed.

Ventilate the room, remove the vessels.

Wash your hands to a hygienic level, put on gloves.

Place an absorbent diaper on the patient's stomach

Check the temperature of the formula(38º- 40º)

Feeding the patient through a gastrostomy tube. Flushing the tube after feeding.

using a Janet syringe

Draw 50-500 ml of the mixture into the Janet syringe (as prescribed by the doctor).

Remove the plug on the probe

Attach the Janet syringe to the probe.

Introduce the nutrient mixture at a rate of 20-30 ml per minute.

Disconnect the syringe from the probe and close the distal end of the probe with a plug.

Rinse the syringe and take 50 - 100 ml of boiled water,

Remove the plug and rinse the probe with warm boiled water under low pressure.

Disconnect the Janet syringe and place it in a waterproof bag.

Place the plug on the distal end of the probe.

If it is necessary to treat the skin around the stoma, apply an aseptic bandage.

Remove the diaper, help the patient into a comfortable position, straighten the bed, cover with a blanket.

Remove gloves, wash hands.

Make a note in the medical record about the procedure.

Patient problems: tube prolapse, peritonitis, irritation and infection of the skin around the stoma, nausea, vomiting, psychological problems.

REMEMBER ! If a tube falls out of your stoma, do not try to insert it yourself; you should inform your doctor immediately!

Parenteral nutrition

Injection– introduction of nutrients into soft and liquid tissues.

Infusion– infusion of large quantities of fluids intravenously.

When artificially feeding a patient, the daily calorie content of food is about 2000 kcal, the ratio of proteins - fats - carbohydrates:

1: 1: 4. The patient receives water in the form of water-salt solutions on average 2 liters per day.

Vitamins are added to nutritional formulas or administered parenterally. Only liquid foods can be administered through a tube or gastrostomy tube: broths, milk, cream, raw eggs, melted butter, slimy or pureed soup, liquid jelly, fruit and vegetable juices, tea, coffee, or specially prepared mixtures.

Parenteral nutrition is a special type of replacement therapy in which nutrients are administered bypassing the digestive tract to replenish energy and plastic costs and maintain a normal level of metabolic processes.

Types of parenteral nutrition:

1. Complete parenteral nutrition - nutrients are administered only parenterally (bypassing the gastrointestinal tract).

2. Partial parenteral nutrition – nutrients are administered

parenterally and enterally.

Total parenteral nutrition is performed when the delivery of nutrients through the digestive tract is impossible or ineffective. At

some operations on the abdominal organs, severe damage to the mucous membrane of the digestive tract.

Partial parenteral nutrition is used when the introduction of nutrients through the digestive tract is possible, but not very effective. For extensive burns, pleural empyema and other purulent diseases associated with large losses of pus (and therefore fluid).

The adequacy of parenteral nutrition is determined by nitrogen balance

To satisfy plastic processes they use protein drugs : casein hydrolysate; hydrolysine; fibrinosol; balanced synthetic amino acid mixtures: aminozol, polyamine, new alvesin, levamine.

Highly concentrated substances are used as energy sources carbohydrate solutions : (5% - 50% solutions of glucose, fructose) , alcohol (ethyl ) ,fatty emulsions : intralipid, lipofundin, infusolinol .

The introduction of protein drugs without meeting energy needs is ineffective, since most of them will be consumed

to cover energy costs, and only less for plastic ones.

Therefore, protein preparations are administered simultaneously with carbohydrates.

The use of donor blood and plasma as nutrition is not effective because plasma proteins are utilized by the patient’s body in 16–26 days, and hemoglobin in 30–120 days.

But they are not replaceable as replacement therapy for anemia, hypoproteinemia and hypoalbuminemia (erythrocyte mass, all types of plasma, albumin).

Parenteral nutrition will be more effective if it is supplemented with the introduction of anabolic hormones ( nerobol, retabolil).

Parenteral nutrition agents are administered intravenously by drip. Before administration, they are heated in a water bath to a temperature of 37°-38°. It is necessary to strictly observe the speed of drug administration: hydrolysine, casein hydrolysate, fibrinosol - in the first 30

min is administered at a rate of 10 - 20 drops per minute, and then, if well tolerated, the rate of administration is increased to 40 - 60 (prevention of allergic reactions and anaphylactic shock).

Polyamine in the first 30 minutes, inject at a rate of 10-20 drops per minute, and then - 25 - 35 drops per minute. A faster administration of the drug is not advisable, since the excess amino acids do not have time to be absorbed and are excreted in the urine. With faster administration of protein preparations, the patient may experience sensations of heat, facial flushing, and difficulty breathing.

Lipofundin S(10% solution) and other fat emulsions are administered in the first 10 - 15 minutes at a rate of 15 - 20 drops per minute, and then gradually (over 30 minutes) increase the rate of administration to 60 drops per minute. Administration of 500 ml of the drug should last approximately 3 to 5 hours.

Before administration, carbohydrates are also heated and administered at a rate of 50 drops per minute. When administering carbohydrates, it is very important to simultaneously administer insulin. for every 4g of glucose – 1 E.D. insulin for the prevention of hyperglycemic coma.

Vitamins are administered intravenously (intravenously), subcutaneously (subcutaneously), and intramuscularly (intramuscularly).

Remember! All components for parenteral nutrition should be administered at the same time!

Patient problems with parenteral nutrition: hyperglycemic coma, hypoglycemic coma, allergic reactions, anaphylactic shock, pyrogenic reactions.

Homework

S.A. Mukhina, I.I. Tarnovskaya. Practical Guide to the Subject "Fundamentals of Nursing", pp. 290 - 300.
Educational and methodological manual on the basics of nursing, pp. 498 - 525.
http://video.yandex.ru/users/nina-shelyakina/collections/?p=1 in the collection PM 04 on 7 - 8, pages films 64 to 78 and repeat all manipulations

Numerous studies have established that nutritional disorders can be accompanied by various structural and functional changes in the body, as well as disturbances in metabolism, homeostasis and its adaptive reserves. There is a direct correlation between the trophic provision of seriously ill (injured) patients and their mortality - the higher the energy and protein deficiency, the more often they experience severe multiple organ failure and death. It is known that trophic homeostasis, together with oxygen supply, forms the basis of the vital activity of the human body and a fundamental condition for overcoming many pathological conditions. The maintenance of trophic homeostasis, along with its internal factors, is determined primarily by the possibility and reality of the body obtaining the nutrient substrates necessary for life support. At the same time, in clinical practice situations often arise in which patients (victims) for various reasons do not want, should not, or cannot eat food. This category of persons should also include patients with sharply increased substrate needs (peritonitis, sepsis, polytrauma, burns, etc.), when ordinary natural nutrition does not properly provide the body’s needs for nutrients.

Back in 1936, H. O. Studley noted that when patients lost more than 20% of their body weight before surgery, their postoperative mortality rate reached 33%, whereas with adequate nutrition it was only 3.5%.

According to G. P. Buzby, J. L. Mullen (1980), malnutrition in surgical patients leads to a 6-fold increase in postoperative complications and an 11-fold increase in mortality. At the same time, timely administration of optimal nutritional support to malnourished patients reduced the number of postoperative complications by 2-3, and mortality by 7 times.

It should be noted that trophic insufficiency in one form or another is quite often observed in clinical practice among patients with both surgical and therapeutic profiles, amounting, according to various authors, from 18 to 86%. Moreover, its severity significantly depends on the type and characteristics of the clinical course of the existing pathology, as well as the duration of the disease.

The ideological basis for the vital need for early administration of differentiated nutritional support to seriously ill and injured patients deprived of the possibility of optimal natural oral nutrition is due, on the one hand, to the need for adequate substrate provision of the body in the interests of optimizing intracellular metabolism, which requires 75 nutrients, 45-50 of which are irreplaceable, and on the other hand, the need to quickly stop the syndrome of hypermetabolic hypercatabolism and associated autocannibalism that often develops in pathological conditions.

It has been established that it is stress, which is based on glucocorticoid and cytokine crises, sympathetic hypertonicity with subsequent catecholamine depletion, deenergization and cell dystrophy, circulatory disorders with the development of hypoxic hypoergosis, that leads to pronounced metabolic changes. This is manifested by increased protein breakdown, active gluconeogenesis, depletion of somatic and visceral protein pools, decreased glucose tolerance with often a transition to diabetogenic metabolism, active lipolysis and excessive formation of free fatty acids, as well as ketone bodies.

The presented list of metabolic disorganization that occurs in the body due to post-aggressive effects (disease, injury, surgery) is far from complete, can significantly reduce the effectiveness of therapeutic measures, and often, in the absence of appropriate correction of emerging metabolic disorders, generally lead to their complete neutralization with all the ensuing consequences. consequences.

Consequences of metabolic disorders

Under normal conditions, in the absence of any significant metabolic disorders, patients' energy and protein needs usually average 25-30 kcal/kg and 1 g/kg per day. During radical operations for cancer, severe combined injuries, extensive burns, destructive pancreatitis and sepsis, they can reach 40-50 kcal/kg, and sometimes more per day. At the same time, daily nitrogen losses increase significantly, reaching, for example, with traumatic brain injury and sepsis 20-30 g/day, and with severe burns 35-40 g/day, which is equivalent to a loss of 125-250 g of protein. This is 2-4 times higher than the average daily nitrogen loss in a healthy person. At the same time, it should be noted that for a deficiency of 1 g of nitrogen (6.25 g of protein), the patient’s body pays with 25 g of its own muscle mass.

In fact, under such conditions an active process of autocannibalism develops. In this regard, rapid exhaustion of the patient may occur, accompanied by a decrease in the body's resistance to infection, delayed healing of wounds and postoperative scars, poor consolidation of fractures, anemia, hypoproteinemia and hypoalbuminemia, disturbances in the transport function of the blood and digestive processes, as well as multiple organ failure.

Today we can state that malnutrition in patients means a slower recovery, the threat of developing various complications, a longer hospital stay, higher costs for their treatment and rehabilitation, as well as a higher mortality rate for patients.

Nutritional support in a broad sense is a set of measures aimed at proper substrate provision of patients, elimination of metabolic disorders and correction of dysfunction of the trophic chain in order to optimize trophic homeostasis, structural, functional and metabolic processes of the body, as well as its adaptive reserves.

In a narrower sense, nutritional support includes the process of providing patients with all the necessary nutrients using special methods and modern artificially created nutritional mixtures of various types.

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These methods include:

siping - oral consumption of special artificially created nutritional mixtures in liquid form (partial as an addition to the main diet or complete - consumption of only nutritional mixtures);
enrichment of ready-made dishes with powdered specialized mixtures, which increases their biological value;
tube feeding, carried out through a nasogastric or nasointestinal tube, and if long-term artificial nutrition of patients is necessary (more than 4-6 weeks) - through a gastro- or enterostomy;
parenteral nutrition, which can be administered through a peripheral or central vein.

Basic principles of active nutritional support:

Timely administration - any exhaustion is easier to prevent than to treat.
Adequacy of implementation - substrate provision of patients, focused not only on calculated needs, but also on the real possibility of the body absorbing incoming nutrients (too much does not mean good).
The optimal timing is until the main indicators of the trophological status are stabilized and the possibility of optimal nutrition of patients naturally is restored.

It seems quite obvious that nutritional support should be focused on certain standards (protocols), which represent a certain guaranteed (at least minimal) list of necessary diagnostic, therapeutic and preventive measures. In our opinion, it is necessary to highlight standards of action, content and support, each of which includes a sequential list of specific activities.

A. Standard of Action

Includes at least two components:

early diagnosis of nutritional disorders in order to identify patients requiring active nutritional support;
selection of the most optimal method of nutritional support, in accordance with a certain algorithm.

The absolute indications for prescribing active nutritional support to patients are:

1. The presence of a relatively rapidly progressive loss of body weight in patients due to an existing disease, amounting to more than:

2% per week,
5% per month,
10% per quarter,
20% for 6 months.

2. Initial signs of malnutrition present in patients:

body mass index< 19 кг/ м2 роста;
shoulder circumference< 90 % от стандарта (м — < 26 см, ж — < 25 см);
hypoproteinemia< 60 г/л и/ или гипоальбуминемия < 30 г/л;
absolute lymphopenia< 1200.

3. Threat of developing rapidly progressing trophic insufficiency:

lack of opportunity for adequate natural oral nutrition (cannot, do not want, should not take food naturally);
the presence of pronounced phenomena of hypermetabolism and hypercatabolism.

The algorithm for choosing tactics for nutritional support of a patient is presented in Diagram 1.

Priority method

When choosing one or another method of artificial therapeutic nutrition for patients, in all cases preference should be given to more physiological enteral nutrition, since parenteral nutrition, even fully balanced and meeting the body’s needs, cannot prevent certain undesirable consequences from the gastrointestinal tract. It should be taken into account that the regenerative trophism of the mucous membrane of the small intestine is 50%, and 80% of the large intestine is provided by the intraluminal substrate, which is a powerful stimulus for the growth and regeneration of its cellular elements (the intestinal epithelium is completely renewed every three days).

A long-term absence of food chyme in the intestine leads to degeneration and atrophy of the mucous membrane, a decrease in enzymatic activity, disruption of the production of intestinal mucus and secretory immunoglobulin A, as well as active contamination of opportunistic microflora from the distal to the proximal parts of the intestine.

The resulting degeneration of the glycocalyx membrane of the intestinal mucosa leads to a disruption of its barrier function, which is accompanied by active transportal and translymphatic translocation of microbes and their toxins into the blood. This is accompanied, on the one hand, by excessive production of pro-inflammatory cytokines and the induction of a systemic inflammatory response of the body, and on the other, by depletion of the monocyte-macrophage system, which significantly increases the risk of developing septic complications.

It should be remembered that in conditions of a post-aggressive reaction of the body, it is the intestine that becomes the main undrained endogenous focus of infection and the source of uncontrolled translocation of microbes and their toxins into the blood, which is accompanied by the formation of a systemic inflammatory reaction and often developing against this background of multiple organ failure.

In this regard, prescribing early enteral support (therapy) to patients, a mandatory component of which is minimal enteral nutrition (200-300 ml/day of nutritional mixture), can significantly minimize the consequences of the aggressive effects of various factors on the gastrointestinal tract and preserve its structural integrity and multifunctional activity, which is a necessary condition for faster recovery of patients.

Along with this, enteral nutrition does not require strict sterile conditions, does not cause life-threatening complications for the patient, and is significantly (2-3 times) cheaper.

Thus, when choosing a method of nutritional support for any category of seriously ill (injured) patients, one should adhere to the currently generally accepted tactics, the essence of which, in a brief summary, can be presented as follows: if the gastrointestinal tract works, use it, and if not, make it work!

B. Content Standard

Has three components:

determining the patients' needs for the required volume of substrate provision;
selection of nutritional mixtures and formation of a daily diet of artificial therapeutic nutrition;
drawing up a protocol (program) for planned nutritional support.

The energy needs of patients (victims) can be determined by indirect calorimetry, which will undoubtedly more accurately reflect their actual energy expenditure. However, such capabilities are currently practically absent in the vast majority of hospitals due to the lack of appropriate equipment. In this regard, the actual energy consumption of patients can be determined by the calculation method using the formula:

DRE = OO × KMP, where:

DRE - actual energy consumption, kcal/day;
OO - basic (basal) energy metabolism under resting conditions, kcal/day;
IMC is the average metabolic correction coefficient depending on the condition of the patients (unstable - 1; stable state with moderate hypercatabolism - 1.3; stable state with severe hypercatabolism - 1.5).

To determine the basal metabolic rate, the well-known Harris-Benedict formulas can be used:

OO (men) = 66.5 + (13.7 × × MT) + (5 × P) - (6.8 × B),

OO (women) = 655 + (9.5 × MT) + + (1.8 × P) - (4.7 × B), where:

BW—body weight, kg;
P—body length, cm;
B - age, years.

In a more simplified version, you can focus on the average OO indicators, which are 20 kcal/kg for women and 25 kcal/kg per day for men. It should be taken into account that for each subsequent decade of a person’s life after 30 years, OO decreases by 5%. The recommended volume of substrate provision for patients is given in Table. 1.

Scheme 1. Algorithm for choosing nutritional support tactics

B. Security Standard

Nutrient mixtures for enteral nutrition of patients

Contraindications for enteral nutrition are

Subtleties of parenteral nutrition

Table 4. Three-in-one containers

Micronutrients

Basic principles of effective parenteral nutrition

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Artificial nutrition is the administration of nutrients through a tube, fistula or enema, as well as intravenously or subcutaneously.

The following types of artificial nutrition are distinguished.

Feeding through a tube. Indications for feeding through a gastric tube: inability to swallow independently or refusal to eat (with mental illness). A thin gastric tube is inserted through the lower nasal passage and nasopharynx, then along the back wall of the pharynx into. If the probe enters the larynx instead of the esophagus, the patient begins to cough and a stream of air enters and exits through the probe when breathing. When inserting the probe, the patient is in a sitting position with his head slightly thrown back. After the probe enters the esophagus, a funnel is put on its free end, into which 2-3 glasses of liquid food are poured (strong broth with egg yolk, milk, sweets, etc.). Introduce food slowly, under slight pressure, several times a day. If necessary, the tube can be left in the stomach for 3-4 weeks. The outer end of the probe is fixed sticky to the skin of the cheek or auricle.

In restless patients, as well as those in an unconscious state, a rubber tube is fixed to the skin or cheek with a silk suture, tied with the same silk thread. The indication for nutrition through a thin tube inserted into the duodenum or jejunum is the stomach (for non-operative exclusion of the stomach from the digestive process).

Considering the great difficulties for the patient (the tube is left in the small intestine for 2-3 weeks) and the lack of advantages compared to other methods of treating peptic ulcers, this method can be used only in exceptional cases.

Nutrition through surgical fistula of the stomach or small intestine. Indications for nutrition through a gastric fistula: sharp narrowing or obstruction of the esophagus, and through a small intestinal fistula - obstruction of the pylorus. If there is a fistula, the probe is directly inserted into the small intestine. In the first days after the operation, small portions of food (150-200 ml) are introduced into the stomach 5-6 times a day, warm. Subsequently, the number of single doses is reduced to 3-4 per day, and the amount of food administered is increased to 300-500 ml. For better digestion, sometimes such a patient is given food to chew so that it mixes with saliva. Then the patient collects it in a mug, dilutes it with the required amount of liquid and pours it into the funnel. For small intestinal fistula, 100-150 ml of food mass is administered. If a larger amount is introduced, the circular muscles of the intestine may occur and food is released back through the fistula.

Rectal nutrition - the introduction of nutrients through enemas. Replenishes the body's need for fluid, and to a lesser extent, nutrients. For rectal artificial nutrition, an isotonic sodium chloride solution, a 5% glucose solution, an isotonic mixture of 25 g of glucose and 4.5 g of sodium chloride per 1 liter of water and amino acid solutions are most often used. Approximately 1 hour before the nutritional enema, the intestines are cleansed with a regular enema. Small nutritional enemas (up to 200-500 ml of solution heated to a temperature of 37-38°, with the addition of 5-40 drops of opium tincture to suppress intestinal peristalsis) can be administered 3-4 times a day. Larger amounts of solution (1 liter or more) are administered once by drop method.

Parenteral nutrition is the administration of nutrients intravenously or subcutaneously. Mixtures of amino acids, solutions of glucose, vitamins, and minerals are used. The administration of these solutions is carried out as directed and under the supervision of a physician.

Patient's nutrition. Artificial nutrition of the patient

Lecture

The student must know:

basic principles of rational nutrition;
basic principles of therapeutic nutrition;
characteristics of treatment tables;
organizing meals for patients in the hospital;
types of artificial nutrition, indications for its use;
contraindications to the insertion of a gastric tube;
problems that may arise when feeding the patient.

The student must be able to:

make a portion requirement;
conduct a conversation with the patient and his relatives about the diet prescribed by the doctor;
feed a seriously ill patient from a spoon and using a sippy cup;
insert a nasogastric tube;
provide artificial nutrition to the patient (on a phantom);
carry out the nursing process in case of failure to meet the patient’s needs for adequate nutrition and fluid intake using the example of a clinical situation.

Questions for self-study:

concept of diet,
energy value of food,
main components of the diet: proteins, fats, vitamins, carbohydrates, etc., concept, meaning,
diet of a healthy person,
concept of diet therapy,
basic principles of therapeutic nutrition,
organization of therapeutic nutrition in a hospital, the concept of therapeutic tables or diets,
characteristics of treatment tables - diets,
organization and feeding of seriously ill patients,
artificial nutrition, its types, features.

Glossary

Theoretical part

Food consists of organic and inorganic substances.

Organic are proteins, fats and carbohydrates, inorganic are mineral salts, micro and macroelements, vitamins and water.

Organic compounds

Substances	Structure	Functions
Proteins (albumin, proteins)	consist of amino acids	1construction; 2enzymatic; 3 motor (contractile muscle proteins); 4 transport (hemoglobin); 5 protective (antibodies); 6 regulatory (hormones).
Fats (lipids)	composed of glycerol and fatty acids	1 energy; 2 construction;
		3 thermoregulatory 4 protective 5 hormonal (corticosteroids, sex hormones) 6 are part of vitamins D, E 7 source of water in the body 8 supply of nutrients.
Carbohydrates Monosaccharides: glucose fructose, ribose, deoxyribose	Highly soluble in water	Energy Energy
Disaccharides: sucrose , maltose ,	Soluble in water	1Energy 2 Components DNA, RNA, ATP.
Polysaccharides: starch, glycogen, cellulose	Poorly soluble or insoluble in water	1 energy 2 supply of nutrients

Inorganic compounds

Substances	Functions	Products
Macroelements O2, C, H, N	Contains all organic matter in cells, water
Phosphorus (P)	Part of nucleic acids, ATP, enzymes, bone tissue and tooth enamel.	Milk, cottage cheese, cheese, meat, fish, nuts, herbs, legumes.
Calcium (Ca)	Part of bones and teeth, it activates blood clotting.	Dairy products, vegetables, fish, meat, eggs.
Trace elements Sulfur (S)	Included in vitamins, proteins, enzymes.	Legumes, cottage cheese, cheese, lean meat, oatmeal
Potassium (K)	Causes the conduction of nerve impulses, activator of protein synthesis enzymes.	Vegetables, mostly potatoes, fruits, mostly dry - apricots, dried apricots, raisins, prunes.
Chlorine (Cl)	It is a component of gastric juice (HCl) and activates enzymes.	The main source is table salt (NaCl)
Sodium (Na)	Ensures the conduction of nerve impulses, maintains osmotic pressure in cells, stimulates the synthesis of hormones.	The main source is table salt (NaCl)
Magnesium (Mg)	Contained in bones and teeth, it activates DNA synthesis and participates in energy metabolism.	Bran, rye bread, vegetables (potatoes, cabbage, tomatoes), millet, beans, cheese, almonds.
Iodine (I)	It is part of the thyroid hormone, thyroxine, and affects metabolism.	Seaweed, shrimp, mussels, sea fish.
Iron (Fe)	Part of hemoglobin, myoglobin, lens and cornea of the eye, enzyme activator. Provides oxygen transport to tissues and organs.	Liver, meat, egg yolk, tomatoes, herbs, green (by color) apples.
Water (H2O)	60 – 98% is found in the human body. It makes up the internal environment of the body, participates in hydrolysis processes, and structures the cell. Universal solvent, catalyst for all chemical processes. Loss of 20% - 25% of water leads to death.

Principles of rational nutrition

1 Principle –nutritional balance, food variety - the ratio of proteins, fats and carbohydrates in food should be respectively 1.0: 1.2: 4.6 by weight of these substances.

2 Principle - calorie content of food - food products must have sufficient energy value, approximately 2800 - 3000 kcal of the daily diet.

3 Principle –diet – 4 times a day, breakfast – 25%, lunch – 30%,

afternoon snack – 20%, dinner – 25%. The method of cooking is of great importance; for example, boiling for too long destroys vitamins. It is also necessary to store food correctly, since improper storage (repeated defrosting and freezing, long-term storage, etc.) changes the chemical composition of food and destroys vitamins.

Principles of therapeutic nutrition

1 principle– organ sparing. Sparing can be: chemical (limitation of salts, or proteins, or fats, or carbohydrates, or water); mechanical (food steamed, ground, grated); thermal- cool food or vice versa – hot (hot tea, coffee).

2 principle– As the patient recovers, his diet changes. There are two ways to go

from one diet to another:

1 gradual – for example, table 1a, 1b, 1 for gastric ulcer.

2 stepped – “zigzag” method recommended by the Institute of Nutrition

In hospitals, the diet is controlled by ward nurses, senior

nurses, heads of departments, nutritionists, nutritionists.

Checking patients' bedside tables

Objectives: 1. checking the sanitary condition of the bedside tables; 2.checking for the presence of prohibited products.

Bedside tables are checked daily; for patients who do not inspire confidence in the nurse, bedside tables are checked twice a day

Typically, bedside tables consist of 3 sections:

V first - personal hygiene items are stored (comb, toothbrush, toothpaste, etc.);

in second – food products that can be stored for a longer period of time (cookies, candies, apples, etc.). All products must be in packaging;

Remember !You cannot store food without packaging in the nightstand!

IN third – linen and other care items.

Bedside tables are treated with disinfectant solutions after each patient is discharged.

Checking refrigerators

Refrigerators, depending on the volume, are located either in a room for one room, or in a separate room for several rooms.

Refrigerators are checked once every three days.

Purposes of the audit: 1- presence of expired and spoiled products; 2- sanitary condition of refrigerators.

When storing food in the refrigerator, the nurse should warn the patient that he must write a label in which

notes full name, chamber number and date of product placement.

If products are found that have expired or are spoiled, the nurse must notify the patient about this and remove the product from the refrigerator (if the patient is in general care).

When checking, products that have expired are laid out on a special table next to the refrigerator so that patients can sort them out.

Refrigerators are defrosted and washed once every 7 days.

Checking gears

Characteristics of diets

Diet No. 1a

Indications: peptic ulcer of the stomach and duodenum, the first 8–10 days of exacerbation; acute gastritis and exacerbation of chronic gastritis, the first 1 - 2 days.

Milk and mucous soups from cereals and wheat bran with butter, pureed vegetables (carrots, beets) and

Excluded: vegetable fiber, broths, mushrooms, bread and bakery products, lactic acid products, spices, snacks, coffee, cocoa.

Diet No. 1b

Indications: exacerbation of gastric and duodenal ulcers, 10–20 days of illness, acute gastritis, 2–3 days.

Range of products and dishes: dishes and products of diet No. 1a, as well as white, thinly sliced, unbrown crackers - 75 - 100g, 1 - 2 times a day - meat or fish dumplings or meatballs; pureed milk porridges and milk soups from rice, barley and pearl barley, pureed vegetable purees. Kissels, jelly from sweet varieties of berries and fruits, juices diluted in half with water and sugar, sugar, honey.

Excluded: the same as in diet No. 1a.

Diet No. 1

Indications: exacerbation of peptic ulcer, subsiding stage; chronic gastritis with preserved and increased secretion in the acute stage.

Characteristic: moderate mechanical, chemical and thermal sparing of the mucous membrane of the stomach and duodenum; food is boiled and mainly pureed. Meals 5 - 6 times a day, diet weight 3 kg, table salt 8 - 10g.

Limit: coarse vegetable fiber, broths.

Excluded: spices, coffee, mushrooms.

Diet No. 2

Indications: chronic gastritis with secretory insufficiency; acute gastritis, enteritis, colitis during the period of convalescence as a transition to a balanced diet.

Characteristic: Mechanically gentle, but promoting increased gastric secretion. Food is boiled, baked, fried without breading. Table salt up to 15g per day.

Excluded: legumes and mushrooms.

Diet No. 3

Indications: chronic intestinal diseases with a predominance of constipation, a period of mild exacerbation and a period of remission.

Characteristic : Increase in diet foods rich in plant fiber, and foods that enhance intestinal motor function. Table salt 12 - 15g per day.

Excluded: turnips, radishes, garlic, mushrooms.

Diet No. 4

Indications : acute enterocolitis, exacerbation of chronic colitis, a period of profuse diarrhea and pronounced dyspeptic symptoms.

Characteristic: chemical, mechanical and thermal sparing of the intestines. Eating 5 – 6 times a day. All dishes are steamed and pureed. Table salt 8 – 10g. The duration of the diet is 5 – 7 days.

Range of products and dishes: white bread crackers. Soups made with low-fat meat broth, cereal decoctions with egg flakes, semolina, and pureed rice. Meat is not fatty, minced, boiled

Limitations: sugar up to 40g, cream.

Excluded: milk, vegetable fiber, spices, snacks, pickles, smoked meats, legumes.

Diet No. 5

Indications: acute hepatitis and cholecystitis, recovery period; chronic hepatitis and cholecystitis; cirrhosis of the liver.

Characteristic: mechanical and chemical sparing, maximum liver sparing. Limitation of animal fats and extractives High carbohydrate content Food is not crushed. Roasting is not allowed. Meals 5 - 6 times a day, diet weight 3.3 - 3.5 kg, table salt 8 - 10g.

Range of products and dishes: yesterday's wheat and rye bread. Soups from vegetables, cereals, pasta with vegetable broth, dairy or fruit. Lean varieties of meat and fish, boiled, baked after boiling; soaked herring. Raw vegetables and greens (salads, vinaigrettes), non-acidic sauerkraut. Fruits and berries, except very sour ones. Sugar up to 100g, jam, honey. Milk, curdled milk, acidophilus, kefir, cheese. An egg - in a dish, and if well tolerated - an omelet 2 - 3 times a week.

Excluded: mushrooms, spinach, sorrel, lemon, spices, cocoa.

Diet No. 5a

Indications : acute diseases of the liver and biliary tract with concomitant diseases of the stomach and intestines; acute and chronic pancreatitis, exacerbation stage.

Characteristic : the same as with diet No. 5, but with mechanical and chemical sparing of the stomach and intestines (food is given to the patient mainly in pureed form).

Excluded: snacks, spices, turnips, radishes, sorrel, cabbage, spinach, cocoa.

Diet No. 7

Indications : acute nephritis, convalescence period; chronic nephritis with minor changes in urine sediment.

Characteristic : chemical sparing of the kidneys. Limitation of table salt (3 – 5 g per patient’s hands), liquids (800 – 1000 ml), extractives, hot seasonings.

Limit: cream and sour cream.

Excluded: soups.

Diet No. 7a

Indications : acute nephritis, exacerbation of chronic nephritis with pronounced changes in urine sediment.

Characteristic : chemical sparing, strict restriction of fluid (600 - 800 ml) and salt (1 - 2 g on the patient’s hands); All dishes are mashed, boiled or steamed.

Product range: the same as with diet No. 7, meat and fish are limited to 50g per day. Vegetables only boiled or pureed. Fruits are raw and boiled only in pureed form.

Excluded: soups.

Diet No. 8

Indications : obesity.

Characteristic : chemical sparing, limiting the energy value of the diet mainly due to carbohydrates and fats. Increasing the amount of protein. Limit table salt to 3–5 g, liquid to 1 liter, extractives, spices and seasonings. Increase in plant fiber. Eating 5 – 6 times a day.

Excluded: flavoring seasonings.

Diet No. 9

Indications : diabetes.

Characteristic: chemical sparing, limitation or complete exclusion of refined carbohydrates, limitation of cholesterol-containing foods. Individual selection of daily energy value. Boiled or baked food Fried foods are limited.

Dairy products, cottage cheese. Fruits and vegetables in large quantities.

Limit: carrots, beets, green peas, potatoes, rice.

Excluded: salted and pickled dishes; semolina and pasta; figs, raisins, bananas, dates.

Diet No. 10

Indications : diseases of the cardiovascular system without symptoms of circulatory failure.

Characteristic : chemical sparing, limitation of animal fats, cholesterol-containing foods, table salt (5g per patient’s hands). Eating 5 – 6 times a day. Food boiled or baked.

Range of products and dishes: coarse gray bread, crackers, soft biscuits, crispbread. Soups (half a plate) vegetarian, cereal, dairy, fruit; borscht, beetroot soup; low-fat meat broth - once a week. Lean meat and poultry, boiled and baked; frying after boiling is allowed. Lean fish, soaked herring – once a week. Protein omelet. Vegetable vinaigrettes and salads (except for leaf and head lettuce, sorrel and mushrooms) with vegetable oil. Oatmeal and buckwheat porridge, crumbly, puddings, casseroles. Lactic acid products, milk, cottage cheese, low-fat cheese. Fruits, berries,

any fruit juices. Fats for cooking and eating – 50g, half of which are vegetable. Weak tea and coffee. Sugar – up to 40g per day.

Excluded: fatty dishes from meat, fish, pastry, brains, liver, kidneys, caviar, refractory fats, ice cream, salty snacks and canned food, alcohol, cocoa, chocolate, beans.

Diet No. 10a

Indications : diseases of the cardiovascular system with severe symptoms of circulatory failure.

Characteristic : chemical sparing, sharp limitation of table salt and free liquid. Exclusion of food substances and drinks that stimulate the central nervous system,

activity of the heart and irritating the kidneys. Food is prepared without salt. Food is given pureed.

Range of products and dishes: the same as with diet No. 10, but meat and fish are limited to 50g per day, given only boiled, vegetables -

only in boiled and mashed form. Fruits are raw and boiled only in pureed form.

Excluded: soups, spicy and salty dishes, strong tea and coffee, fatty and flour dishes.

Diet No. 11

Indications : tuberculosis without intestinal disturbances and without complications; general exhaustion.

Characteristic : a complete, varied diet for enhanced nutrition (increased energy value), with a large amount of complete proteins, fats, carbohydrates, vitamins and salts, especially calcium.

Range of products and dishes: a variety of products and dishes. Products rich in calcium salts: milk, cheese, buttermilk, figs. At least half of the protein comes from meat, fish, cottage cheese, milk and eggs.

Excluded: ducks and geese.

Diet No. 13

Indications : Acute infectious diseases (febrile conditions).

Characteristic: thermal sparing (for high fever), varied, mostly liquid, food with the advantage of coarse plant fiber, milk, snacks, spices. Eating 8 times a day, in small portions.

Range of products and dishes: white bread and crackers, meat broth, pureed meat soup in a slimy broth. Meat soufflé. Soft-boiled eggs and omelet.

Porridge pureed. Fruit, berry, vegetable juices, fruit drinks, jelly. Butter.

Diet No. 15

Indications: all diseases in the absence of indications for a special diet.

Characteristic : a physiological complete diet with double the amount of vitamins and the exclusion of fatty meat dishes. Eating

4 – 5 times a day.

Range of products and dishes: white and rye bread. Various soups.

Diet No. 0

Indications: the first days after operations on the stomach and intestines (prescribed for no more than 3 days). Characteristic : chemical, mechanical sparing. Eating every 2 hours (from 8.00 to 22.00). Food is given in liquid and jelly form.

Fasting days

Name of the diet and its composition	Indications
Milk day No. 1 Every 2 hours, 6 times a day, 100 ml of milk or kefir, yogurt, acidophilus; At night, 200 ml of fruit juice with 20 g of glucose or sugar; You can also take 25g of dried white bread 2 times a day.	Diseases of the cardiovascular system with symptoms of circulatory failure
Milk day No. 2 1.5 liters of milk or curdled milk for 6 doses of 250 ml every 2 - 3 hours	Gout, obesity.
Curd day 400 - 600g of low-fat cottage cheese, 60g of sour cream and 100ml of milk for 4 servings in its natural form or in the form of cheesecakes, puddings. You can also have coffee with milk twice.	Obesity, heart disease, atherosclerosis
Cucumber day 2 kg of fresh cucumbers for 5 – 6 doses	Obesity, atherosclerosis, gout, arthrosis
Salad day 1.2 - 1.5 kg of fresh vegetables and fruits in 4 - 5 doses per day - 200 - 250 g each in the form of salads without salt. Add a little sour cream or vegetable oil to vegetables, and sugar syrup to fruits.	Hypertension, atherosclerosis, kidney disease, oxaluria, arthrosis.
Potato day 1.5 kg of baked potatoes with a small amount of vegetable oil or sour cream (without salt) for 5 doses - 300 g each.	Heart failure, kidney disease
Watermelon day 1.5 kg of ripe watermelon without peel for 5 doses - 300g.	Liver diseases, hypertension, nephritis, atherosclerosis.
Apple day No. 1 1.2 – 1.5 kg of ripe raw peeled and pureed apples in 5 doses – 300g each.	Acute and chronic colitis with diarrhea.
Apple day No. 2 1.5 kg of raw apples for 5 – 6 doses. For kidney disease, add 150-200g of sugar or syrup. You can also have 2 servings of rice porridge with 25g rice each	Obesity, nephritis, hypertension, diabetes.
Fasting day of dried apricots Pour 500g of dried apricots with boiling water or lightly steam and divide into 5 doses	Hypertension, heart failure
Compote day 1.5 kg of apples, 150 g of sugar and 800 ml of water are boiled and distributed into 5 doses during the day.	Kidney and liver diseases.
Rice-compote day Prepare 1.5 liters of compote from 1.2 kg of fresh or 250 g of dried fruits and berries; Cook porridge in water from 50g rice and 100g sugar. Give a glass of compote 6 times a day, 2 times with sweet rice porridge.	Liver diseases, gout, oxaluria.
Sugar day 5 times a glass of hot tea with 30 - 40g of sugar in each.	Liver diseases, nephritis, chronic colitis with diarrhea
Meat a) 270g boiled meat, 100ml milk, 120g green peas, 280g fresh cabbage for the whole day. b) 360g of boiled meat for the whole day.	Obesity

Artificial nutrition

Theoretical part

Types of artificial nutrition:

I. Enteral (via the gastrointestinal tract):

a) through a nasogastric tube (NGT);

b) using a gastric tube inserted through the mouth;

c) through a gastrostomy tube;

d) rectal (using nutritional enemas).

II. Parenteral (bypassing the gastrointestinal tract):

a) by injection; b) using infusions

Using a probe and funnel

When it is impossible to feed the patient naturally, food is introduced into the stomach or intestines through probe or stoma, or with an enema. When such administration is not possible, then nutrients and water (saline solutions) are administered parenterally. Indications for artificial nutrition and its methods are chosen by the doctor. The nurse must be proficient in feeding the patient through probe. A funnel or system for drip administration of nutrient solutions, or a Janet syringe is connected to the inserted probe, and the patient is fed with the help of these devices.

For algorithms for inserting a tube and artificial nutrition through a tube, see the algorithms.

Parenteral nutrition

Injection– introduction of nutrients into soft and liquid tissues.

Infusion– infusion of large quantities of fluids intravenously.

When artificially feeding a patient, the daily calorie content of food is about 2000 kcal, the ratio of proteins - fats - carbohydrates:

1: 1: 4. The patient receives water in the form of water-salt solutions on average 2 liters per day.

Types of parenteral nutrition:

1. Complete parenteral nutrition - nutrients are administered only parenterally (bypassing the gastrointestinal tract).

2. Partial parenteral nutrition – nutrients are administered

parenterally and enterally.

Total parenteral nutrition is performed when the delivery of nutrients through the digestive tract is impossible or ineffective. At

some operations on the abdominal organs, severe damage to the mucous membrane of the digestive tract.

The adequacy of parenteral nutrition is determined by nitrogen balance

To satisfy plastic processes they use protein preparations:casein hydrolysate; hydrolysine; fibrinosol; balanced synthetic amino acid mixtures: aminozol, polyamine, new alvesin, levamine.

Highly concentrated substances are used as energy sources carbohydrate solutions: (5% - 50% solutions of glucose, fructose) , alcohol (ethyl) ,fat emulsions: intralipid, lipofundin, infusolinol.