Nasogastric (gastric, nutritional) tube: indications for placement, introduction, operation. Tube feeding: procedure technique Feeding a patient through a nasogastric tube

Such an irreplaceable medical device as a nasogastric tube has helped save more than one life. It can often be seen in bedridden and seriously ill people. To understand how it benefits a person in critical condition, it is worth finding out why and how the product is used.

What it is

A nasogastric tube is similar to a flexible tube. Its length and diameter may vary, so the device is selected individually and only after consultation with a doctor.

The probes are made of silicone and polyvinyl chloride. Both materials are non-toxic and resistant to hydrochloric acid contained in gastric juice. Thanks to these properties, one product can be used for up to three weeks without being removed from the body.

Indications for use

A nasogastric tube can be used for various purposes. It is used:

• for feeding;
• when administering medications;
• in case of aspiration of stomach contents.

Artificial nutrition with its help is prescribed exclusively by a doctor. Indications for this are:

• swallowing reflex disorder;
• complete refusal to eat (often observed in people with mental disorders);
• swelling, fistulas, injuries associated with the esophagus and larynx;
• rehabilitation after organ surgery gastrointestinal tract, chest and abdominal cavity;
• acute pancreatitis;
• lack of consciousness or coma.

However, even in the presence of one of the pathologies, there are cases when using this method of feeding is impossible.

Contraindications

A nasogastric tube cannot be inserted if the patient has a number of abnormalities. These include:

• exacerbation of gastric ulcer;
• blood clotting pathology (thrombocytopenic purpura, hemophilia, von Willebrand disease);
• varicose veins in the esophagus;
• fractures of the bone tissue of the skull;
• facial injuries.

When such anomalies are not observed, and the installation of a tube is vital, the procedure for introducing the device into the stomach can be carried out.

Installation

If the patient is conscious, then the introduction of a nasogastric tube should begin with an explanation of the essence of the manipulations and the sequence of actions. The manipulations themselves should be performed clearly and consistently.

1. To add rigidity, place the probe in the freezer for an hour. This will help reduce the patient’s gag reflex and make the process of inserting the tube easier.
2. Place the person in a comfortable position.
3. To check air permeability, ask to breathe alternately through both nostrils.
4. Wear gloves.
5. Remove the probe from the sterile packaging.
6. Make two marks on the tube. The first - equal to the distance from earlobe to the tip of the nose. The second - from the xiphoid process of the sternum to the teeth.
7. Lubricate the tip with glycerin or gel mixed with lidocaine (to reduce pain).
8. Insert the probe through the nostril. Slowly advance to the first mark.
9. Give the patient water and ask him to take small sips.
10. Insert the tube to the second mark. Swallowing movements should accompany the process.

After nasogastric tube will be advanced to the required length, its position should be checked. To do this, up to thirty milliliters of air is injected into the tube using a syringe. If gurgling sounds are heard over the stomach area, it means the process was successful.

After successful insertion of the tube (as after each feeding), its end protruding from the nose is fastened to clothing with a pin. For better fixation, it should also be attached to the patient’s skin using an adhesive plaster. A cap is put on the end.

Nutritional features and diet

Before you start feeding through a nasogastric tube, you should study what and in what quantity can be given to the patient. The basic rule is that only liquid foods are suitable for nutrition.

You can buy ready-made mixtures. They are sold in special PVC bags that are attached to the tube. It is much cheaper to prepare such food yourself. For feeding a patient through a tube, the following are perfect:

• decoction or liquid puree of vegetables, meat, fish;
• compote;
• kefir, milk;
• thin semolina porridge.

For the first few days, the frequency of an adult’s meals can reach up to five times a day. Portions should not exceed two hundred milliliters. Gradually, the number of feedings begins to decrease. The daily food intake (including water) should be within two liters.

Feeding a child through a nasogastric tube has its own nuances. Differences in the functioning of children digestive system and the small volume of the gastrointestinal tract determines the characteristics of artificial nutrition. Its organization is characterized by:

• the use of probes having a length of forty to sixty centimeters and a hole diameter of up to two and a half millimeters;
• administration of solutions at a rate not exceeding sixty milliliters per hour;
• the use of mixtures adapted to the baby’s age in content and volume.

Feeding through a nasogastric tube: algorithm

Artificial feeding of adults and children must be carried out in compliance with all hygienic and medical requirements. Before the procedure, the patient must be seated in a comfortable position, his hands washed and explained what he will do.

Feeding itself through a nasogastric tube (algorithm) consists of sequential actions.

1. The correct position of the tube is checked.
2. The patient's skin and mucous membranes are examined for damage.
3. The end of the probe is clamped.
4. A special syringe filled with a nutritional mixture is attached to the tube. It rises half a meter above the stomach.
5. The clamp is removed.
6. Feeding is carried out (recommended speed is three hundred milliliters per ten minutes).
7. The tube is washed with boiled water from another syringe and clamped again.
8. The end is closed with a plug.

The edge of the probe is reattached with an adhesive tape to the patient's skin.

Possible complications

If all rules are followed, feeding through a nasogastric tube is successful. It does not cause discomfort to the patient and is positively perceived by the body. When various violations Complications arise when inserting a tube, feeding and care, and choosing a diet and diet.

• If installed incorrectly or if a PVC product with a large diameter is selected, the probe may become twisted or clogged. This is fraught with bleeding, bedsores, perforations of the intestinal walls or nasopharynx.
• Using formulas containing lactose or contaminated with bacteria, as well as introducing them too quickly, causes a negative reaction in the body. It manifests itself in the occurrence of diarrhea, vomiting, flatulence, aspiration, and reflux.
• Water and electrolyte imbalance in the diet, as well as prolonged feeding with hyperosmolar formulas can lead to metabolic disorders in the patient. As a result, tube feeding syndrome, hyperglycemia, and abnormally high or low concentrations of potassium in the blood may occur.

To avoid such deviations, you must consult a specialist before inserting a nasogastric tube and feeding through it. It is good if the first manipulations are supervised by a doctor or a person with experience in such care.

All materials on the site were prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative in nature and are not applicable without consulting a doctor.

Author: Averina Olesya Valerievna, candidate of medical sciences, pathologist, teacher of the department of pathological anatomy and pathological physiology

Nasogastric tube- this is a tube inserted into the patient through the nasal passage into the esophagus and further into the stomach for various purposes.

The main purposes of inserting a nasogastric tube:

• Nutrition for a patient who various reasons cannot eat by himself.
• Decompression of the stomach in case of difficulty in the natural passage of its contents into the intestines.
• Aspiration of gastric contents.
• Introduction medicines.

Indications for insertion of a gastric tube

The most common situations when inserting a nasogastric tube is necessary are:

1. Intestinal obstruction (as an element of complex conservative therapy, and also how preoperative preparation or postoperative stage).
2. Acute pancreatitis.
3. Injuries to the tongue and pharynx.
4. Postoperative period after resection of the stomach, intestines, suturing of a perforated ulcer, resection of the pancreas, and other operations on the abdominal and thoracic cavities.
5. Unconscious state of the patient (coma).
6. Mental illnesses in which a person refuses to eat.
7. Difficulty swallowing as a result of the lesion nervous regulation(diseases of the central nervous system, condition after a stroke).
8. Abdominal injuries.
9. Fistulas of the esophagus.
10. Strictures (narrowing) of the esophagus, passable for the probe.

Preparing for probe insertion

Placement of a gastric tube is usually a life-saving intervention. It does not require any special preparation. If the patient is conscious, it is necessary to explain the essence of the procedure and obtain his consent.

Contraindications to probe insertion

Contraindications to the installation of a nasogastric tube are:

• Facial injuries and skull fractures.
• Varicose veins of the esophagus.
• Hemophilia and other bleeding disorders.
• Stomach ulcer in the acute phase.

What is a nasogastric tube?

A nasogastric tube is a tube made of implantable, non-toxic polyvinyl chloride (PVC) or silicone. The medical industry produces modern probes of various lengths and diameters, for adults and children.

AND PVC and silicone are resistant to hydrochloric acid, with correct use do not lose their properties for 3 weeks.

Nasogastric tube

Main types of probes:

1. Standard.
2. Enteral feeding tubes. They are significantly smaller in diameter and have a rigid conductor for easy installation.
3. Dual-channel probes.
4. Orogastric tubes. They have a larger diameter and are designed for gastric lavage.

The main features that a modern probe should have for ease of use:

• The end of the probe inserted inside must be sealed and have a rounded, atraumatic shape.
• At the end of the probe there are several lateral holes.
• The probe must be marked along its length.
• At the outer end of the probe there should be a cannula for connecting the feeding system (preferably with an adapter).
• The cannula should be closed with a convenient cap.
• The probe should have a radiopaque mark at the distal end or a radiopaque line along its entire length.

Technique for placing a nasogastric tube

If the patient is conscious, the placement of the probe is as follows:

1. Before inserting the probe, it must be kept in the freezer for about an hour. This gives it the rigidity necessary for insertion, as well as low temperature reduces the gag reflex.
2. Position – sitting or reclining.
3. The patient is asked to close first one nostril, then the other, and breathe. This determines the more passable half of the nose.
4. The distance from the tip of the nose to the earlobe is measured and a mark is made on the probe. Then the distance from the incisors to xiphoid process sternum, a second mark is made.
5. Held local anesthesia nasal cavity and pharynx with a spray of 10% lidocaine.
6. The end of the probe is lubricated with lidocaine or glycerin gel.
7. The probe is inserted through the lower nasal passage to the level of the larynx (to the first mark).
8. Next, the patient should help further advance the probe by making swallowing movements. To make swallowing easier, you usually give water in small sips or through a straw.
9. The probe is gradually advanced into the stomach (up to the second mark).
10. Check the position of the probe. To do this, you can try to aspirate the gastric contents with a syringe. You can inject 20-30 ml of air with a syringe and listen to noises over the stomach area. A characteristic “gurgling” indicates that the tube is in the stomach.
11. The outer end of the probe is fastened with a pin to clothing or glued to the skin with an adhesive plaster. The cap is closed.

If the patient is unconscious:

Inserting a probe into a patient in a coma poses certain difficulties, since there is a high risk of the probe getting into the Airways. Features of gastric tube insertion in such patients:

• When inserting the probe, the doctor inserts two fingers of his left hand deep into the pharynx, pulls the larynx up (along with the endotracheal tube, if available) and back side fingers inserts a probe.
• It is advisable to confirm the correct position of the probe in the stomach with radiography.

Video: insertion of a nasogastric tube

Possible complications when inserting a nasogastric tube

1. The probe gets into the respiratory tract.
2. Nosebleeds. Bleeding can occur both during the installation of the probe and in the delayed period as a result of pressure sores of the nasal mucosa.
3. Perforation of the esophagus.
4. Pneumothorax.
5. Sinusitis.
6. Reflux esophagitis, ulceration and stricture of the esophagus.
7. Aspiration pneumonia.
8. Mumps, pharyngitis due to constant breathing through the mouth.
9. Water-electrolyte disturbances with constant long-term aspiration without replenishment of losses.
10. Infectious complications (retropharyngeal abscess, laryngeal abscess).

Caring for the decompression tube

A gastric decompression tube is installed for a short period of time (a few days at most). The goal is to aspirate gastric contents to relieve the underlying parts of the digestive tract a (with obstructive and paralytic intestinal obstruction, pyloric stenosis, after operations on the abdominal organs).

Aspiration is carried out several times a day with a syringe or suction. To prevent the probe from becoming clogged, it is periodically purged with air and changed position (twisted, pulled).

A two-channel probe is often used for continuous aspiration (air flows through one of the channels).

It must be remembered that in this case the patient loses fluid and electrolytes, so the corresponding losses must be replenished intravenous administration under laboratory control of blood electrolytes.

After aspiration, the probe is washed with saline.

The amount of aspirate is measured and recorded (subtracting the volume of lavage fluid).

You should think about removing the probe if:

• Aspirate per day does not exceed 250 ml.
• Gases are released.
• Normal bowel sounds are heard.

Feeding the patient through a tube

Placement of a gastric tube to feed the patient is carried out for a longer period. This occurs in situations where the patient himself cannot swallow, but the esophagus for the probe is passable. Quite often, patients with a tube installed are discharged home, having previously trained relatives in how to care for it and organize nutrition (usually these are patients with damage to the central nervous system, with consequences of a stroke, inoperable patients with tumors of the pharynx, larynx, oral cavity, esophagus).

The feeding tube is installed for a maximum of 3 weeks, after which it needs to be changed.

Organization of nutrition through a tube

The patient is fed through a tube using a Janet syringe or a drip enteral nutrition system. You can also use a funnel, but this method is less convenient.

1. The patient is placed in an elevated head position.
2. The outer end of the probe is lowered to the level of the stomach.
3. A clamp is applied towards the end of the probe.
4. A Janet syringe with a nutrient mixture (preheated to 38-40 degrees) or a funnel is connected to the connecting port.
5. The end of the probe with a syringe rises to a level of 40-50 cm above the level of the stomach.
6. The clamp is removed.
7. Gradually the nutritional mixture is introduced into the stomach. It is advisable that the mixture be administered without pressure. 300 ml of the mixture is administered over 10 minutes.
8. The probe is washed from another syringe with boiled water or saline solution (30-50 ml).
9. The clamp is reapplied.
10. The probe is lowered to the level of the stomach, the clamp above the tray is removed.
11. The plug closes.

Nutrient formulas that can be administered through a tube:

• Milk, kefir.
• Meat and fish broths.
• Vegetable decoctions.
• Compotes.
• Vegetables, meat purees, diluted to a liquid consistency.
• Liquid semolina porridge.
• Special balanced mixtures for enteral nutrition (enpits, inpitan, ovolakt, unipits, etc.)

The first portions of food do not exceed 100 ml, gradually the portions increase to 300-400 ml, the frequency of meals is 4-5 times a day, the daily volume of food along with liquid is up to 2000 ml.

Special systems for enteral nutrition are produced. This system consists of a wide mouth PVC formula bag and a tube attached to it, with an adjustable clamp on the tube. The tube is connected to the cannula of the probe and food is delivered to the stomach by drip.

Video: feeding through a nasogastric tube

Caring for a Patient with a Gastric Tube

Basic principles:

1. Rinse the probe after each meal with saline solution or still water.
2. Limit as much as possible the entry of air into the stomach and the flow of gastric contents through the tube (follow all feeding rules and position the tube at the required level; during the period between feedings, the end of the tube must be closed with a plug).
3. Before each feeding, check to see if the tube has moved. To do this, you can make a mark on the probe after installing it or measure the length of the outer part of the probe and check it each time. If you are in doubt about the correct position, you can try to aspirate the contents with a syringe. Normally, the fluid should be dark yellow or greenish in color.
4. The probe must be periodically twisted or pulled to avoid bedsores of the mucous membrane.
5. If the nasal mucosa is irritated, it should be treated with antiseptics or indifferent ointments.
6. Thorough oral hygiene is necessary (brushing teeth, tongue, rinsing or irrigating the mouth with liquid).
7. After 3 weeks the probe must be replaced.

Video: caring for a nasogastric tube

conclusions

Main conclusions:

• The insertion of a nasogastric tube is a necessary measure, which essentially has no alternative in some situations.
• This manipulation in itself is simple, it is carried out by any resuscitator or in emergency situations- a doctor of any specialty.
• At proper care a feeding tube may be in the stomach long time, allows you to maintain the energy balance of the body, prolongs the life of the patient.
• An alternative to tube feeding is installation. But the disadvantages of installing a gastrostomy tube are that it surgery, which has its contraindications and is not available to everyone.

A thin probe is rarely used for a procedure such as gastric lavage, but it is more often used for other purposes. For example, when receiving gastric contents for research or for enteral nutrition ().

rice. 3

Before the procedure, the patency of the nasal passages is checked, for which the patient is asked to close his nostrils one by one, blowing air through a free nasal passage. Do not attempt to enter Fig.3. Enteral nutrition of the patient through a nasogastric tube.

nasogastric tube for a victim with a facial injury. Cooling the probe in the refrigerator for 30 minutes before the procedure makes it more rigid, which greatly facilitates its insertion. The appearance of signs of respiratory failure during insertion may indicate that the probe has entered one of the bronchi. In this case, the probe should be removed immediately.

Target. Indications. Contraindications. Equipment. Measuring the length of the probe. Patient position All these parameters are similar to working with thick gastric tube

(see above).

It is more convenient for the person performing the procedure to stand to the right of the patient. Before insertion, the probe is moistened with water or glycerin (or petroleum jelly). Take the probe with your right hand at a distance of 10-15 cm from the blind end, and with your left hand you need to support its free end. The probe is inserted through the lower nasal passage, approximately 15-20 cm, and then the patient can be asked to swallow it to the desired depth (mark). To swallow the probe, the patient drinks water in small sips. This helps the process of swallowing the probe (the glottis closes and the cough reflex is suppressed).

Securing the probe

The uncut end of the adhesive plaster is fixed to the nose, and the cut edges are tucked around the probe. Additionally, the probe is fixed to the patient’s cheek. When the probe is not in use, its outer end is placed behind the ear and fixed there. The probe is closed with a plug.

Monitoring the location of the probe

There are several control options.

To clarify the location of the probe, pump out 5-10 ml of the contents and apply it to litmus paper. The litmus paper changing color to pink confirms that the tube is in the stomach.

10 ml of air is injected into the probe, then auscultation of the chest is carried out with a stethoscope and upper sections abdominal cavity. Gurgling sounds in the area of ​​the xiphoid process confirm the presence of the probe in the stomach.

Gastric lavage technique through a nasogastric tube is similar to that described above using a thick gastric tube .

Urethral catheterization

Indications

1. For therapeutic purposes:

Acute urinary retention;

Monitoring urine output;

Intravesical chemotherapy;

Postoperative period after adenomectomy, operations on the bladder, urethra.

2. For diagnostic purposes:

Urine collection for research;

Retrograde injection of contrast agents (cystourethrography);

Urodynamic study.

Contraindications

Traumatic urethral rupture.

Urethral stricture.

Acute prostatitis.

Acute urethritis.

Blood in the urethra.

Hemoscrotum (scrotum filled with blood).

Bruising of the perineum.

Prostate gland inaccessible to palpation.

Anesthesia

Not required.

Position

Patients lie on their backs.

Women - with half-bent and spread legs.

Equipment

Antiseptic.

Sterile balls, napkins.

Sterile Vaseline ointment or lidocaine jelly lubricant.

Foley catheter No. 16 - for men and No. 18 - for women. (photo)

Syringe 10 ml.

Sterile solution of furatsilin or dioxidin.

Container for collecting urine.

Sterile gloves.

Target: Feeding a seriously ill patient when natural feeding is impossible.
Indications: Unconscious state. Refusal to eat Surgeries on the esophagus of the stomach. Swelling of the larynx and esophagus. Contraindications: No.

Equipment:
1. Phonendoscope
2. System for continuous tube feeding
3. Syringe with a volume of 20-50 ml.
4. Clamp
5. Isotonic sodium chloride solution - 60 ml.
6. Napkin
7. Band-Aid
8. Non-sterile gloves
9. Funnel.
10. Clock.
11. Soap
12. A set of tableware, in accordance with the selected feeding regimen

Algorithm for feeding a seriously ill patient through the mouth and nasogastric tube
I. Preparation for the procedure:
1. Introduce yourself to the patient (if the patient is conscious), inform about the upcoming feeding, the composition and volume of food, and the method of feeding.
2. Treat your hands in a hygienic manner, dry them, put on gloves (if feeding will be done through a nasogastric tube).
3. Prepare nutrient solution; heat it to a temperature of 30-35° C.
4. When feeding the patient orally:
II. Performing the procedure:
8. When feeding the patient through a nasogastric tube
9. Determine the feeding regimen prescribed for the patient - continuous or intermittent (fractional)
10. Wash and dry your hands (using soap or antiseptic)
11. Raise the head end of the bed 30-45 degrees.
12. Check that the probe is positioned correctly.
13. Attach a 20 cm 3 syringe to the distal portion of the probe and aspirate the stomach contents.
14. Assess the nature of the contents - if signs of bleeding appear, stop the procedure.
15. If signs of impaired evacuation of gastric contents are detected, stop feeding.
16. Attach a syringe filled with 20 cm 3 of air to the distal part of the probe and introduce air inside while auscultating the epigastric area.
17. Examine the skin and mucous membranes of the nasal passages, exclude signs of infection and trophic disorders associated with the insertion of a nasogastric tube.
18. Check the quality of probe fixation and, if necessary, replace the adhesive bandage. With continuous tube feeding
19.Rinse the nutritional mixture container and connecting cannula.
20. Fill the container with the prescribed nutritional mixture.
21. Attach the cannula to the distal part of the nasogastric tube or the receiving fitting of the infusion pump.
22. Set the required solution injection rate using a cannula or pump control unit.

1. Monitor the rate of administration of the solution and the volume of the injected mixture every hour.
2. 24. Auscultate peristaltic sounds in all quadrants of the abdomen every hour.
   Check the residual volume of gastric contents every 3 hours. If the volume of the indicator specified in the prescription is exceeded, interrupt feeding.
   26. At the end of the procedure, rinse the probe with 20-30 ml. saline solution or other solution in accordance with the prescribed regimen. With intermittent (fractional) tube feeding regimen
   27. Prepare the prescribed volume of nutritional mixture; pour it into a clean container. Fill a 20-50 ml syringe or funnel with a nutrient solution.
   28. Introduce actively slowly (using a syringe) or passively (using a funnel) the prescribed volume of nutritional mixture into the patient’s stomach, administering fractionally, in portions of 20-30 ml, at intervals of 2-3 minutes.
   29. After introducing each portion, clamp the distal portion of the probe, preventing it from emptying.
   30. At the end of feeding, introduce the prescribed volume of water. If fluid administration is not provided, rinse the probe with 30 ml of saline solution.
   31. Auscultate peristaltic sounds in all quadrants of the abdomen.
   III. End of the procedure:
   32. Process oral cavity, wipe the patient's face from dirt.
   33. Disinfect used material.
   34. Remove gloves, treat hands hygienically, and dry.
   35. Make an appropriate entry about the results of execution in medical documentation

I. Preparation for the procedure.

1. Introduce yourself to the patient (if the patient is conscious), inform about the upcoming feeding, the composition and volume of food, and the method of feeding.

2. Wash and dry your hands (using soap or antiseptic) or wear gloves.

3. Prepare a nutrient solution; heat it to a temperature of 30–35 0 C.

II. Execution of the procedure.

4. When feeding the patient through a nasogastric tube

4.1. Determine the feeding regimen prescribed for the patient - continuous or intermittent (fractional)

4.2. Wash and dry your hands (using soap or hand sanitizer)

4.3. Raise the head end of the bed 30-45 degrees.

4.4. Check that the probe is positioned correctly.

4.4.1. Attach a 20 cm 3 syringe to the distal portion of the probe and aspirate the gastric contents.

4.4.1.1.assess the nature of the contents - if signs of bleeding appear, stop the procedure.

4.4.1.2. if signs of impaired evacuation of gastric contents are detected, stop feeding.

4.4.2. Attach a syringe filled with 20 cm 3 of air to the distal portion of the probe and introduce air inside while auscultating the epigastric area.

4.5. Examine the skin and mucous membranes of the nasal passages, exclude signs of infection and trophic disorders associated with the placement of a nasogastric tube.

4.6. Check the quality of probe fixation and, if necessary, replace the adhesive bandage.

4.7. With continuous tube feeding

4.7.1. Rinse the nutritional mixture container and connecting cannula.

4.7.2. Fill the container with the prescribed nutritional mixture.

4.7.3. attach the cannula to the distal part of the nasogastric tube or the receiving fitting of the infusion pump.

4.7.4. set the required solution injection rate using a cannula dispenser or pump control unit.

4.7.5. control the rate of introduction of the solution and the volume of the injected mixture every hour.

4.7.6. Every hour, auscultate peristaltic sounds in all quadrants of the abdomen.

4.7.7. check the residual volume of gastric contents every 3 hours. If the volume specified in the prescription is exceeded, interrupt feeding.

4.7.8. at the end of the procedure, rinse the probe with 20-30 ml. saline or other solution according to the prescribed regimen.

4.8. With intermittent (fractional) tube feeding regimen

4.8.1. Prepare the prescribed volume of nutritional mixture; pour it into a clean container

4.8.2. fill a 20-50 ml syringe or funnel with a nutrient solution

4.8.3. introduce actively slowly (using a syringe) or passively (using a funnel) the prescribed volume of nutritional mixture into the patient’s stomach. The administration should be carried out fractionally, in portions of 20-30 ml, with intervals between portions of 1-3 minutes.

4.8.4. After introducing each portion, clamp the distal portion of the probe, preventing it from emptying.

4.8.5. At the end of feeding, introduce the prescribed volume of water. If fluid administration is not provided, rinse the probe with 30 ml of saline.

III. End of the procedure.

5. Auscultate peristaltic sounds in all quadrants of the abdomen.

6. Treat the oral cavity, wipe the patient’s face from dirt.

7. Recycle and disinfect used material.

8. Remove gloves or wash and dry hands (using soap or antiseptic).

9. Make an appropriate entry about the results of the implementation in the medical documentation

Drinking regime; Helping the patient get enough fluids.

Drinking regimen is the most rational order for drinking water during the day. Wherein drinking regime directly tied to proper nutrition, since in addition to eating for human body Adequate water consumption is also vital. After all, water takes part in the processes of thermoregulation, dissolves mineral salts, “transports” nutrients inside the body, removes metabolic products from the body, etc. Research by scientists has already proven that drinking the optimal amount of water can minimize the manifestations of such chronic diseases such as back pain, migraines, rheumatic pains, and also reduce blood cholesterol levels, normalize blood pressure and promote weight loss.

The patient's menu should be quite nutritious, but during the illness he must completely avoid fatty and heavy foods. It is advisable to give the patient more fruits and vegetables.

Before full recovery the patient needs sufficient fluid. Drinking extra fluids increases mucus production and prevents tissue dehydration, which often develops with high temperature. During a sharp increase in temperature, you should drink at least three liters of fluid per day. The most useful drinks are juices, milk, and alkaline mineral water.

Until complete recovery, the patient should be provided with comfort and peace. It is also necessary to spend most of the day lying down.

Determination of water balance

Target: diagnosis of hidden edema.

Equipment: medical scales, graduated glass container for collecting urine, water balance sheet.

Water balance sheet

Sample Date______________
Name of hospital _____________________
Department ____________
Chamber No.___________
FULL NAME. Ivanov Petr Sergeevich Age 45 years Body mass 70 kg
Diagnosis Examination.

CALCULATION. In our example, daily diuresis should be: 1500x0.8 (80% of the amount of liquid drunk) = 1200 ml, and it is 130 ml less. This means that the water balance is negative, which indicates the ineffectiveness of treatment or an increase in edema.

Change of underwear and bed linen. Placing the patient in bed in the Fowler, Sims, back, side, and stomach positions.

Plan.

1. Requirements for bed linen.
2. Preparation and change of bed linen and underwear.
3. Placing the patient in bed in the following positions: lying on the back, Fowler, lying on the side, on the stomach, Sims.

Questions on the topic.

1. The importance of the patient’s personal hygiene.

2. Hospital linen regime.

3. Features of personal hygiene at different age periods.

1. Requirements for bed linen.

For patients who are completely immobile, it is best to prepare a functional bed. It has a lot of advantages: you can adjust the height of the bed (at least 60 centimeters), with such a bed you will not need to bend over to the patient, you can raise the head or foot part of the bed, the side protective bars will prevent the patient from falling. The head of any bed should be against the wall because all-round accessibility will make it easier to care for, for example, rearrangement of bed linen, turning over the patient. A forced position in bed requires the presence of additional supporting pillows, bolsters or blankets.

Requirements for bedding and beds for a seriously ill patient patient :

1. Regardless of the patient’s level of activity, the mattress should be thick enough, with a smooth, elastic surface.

2. Pillows should be made from natural fillings. Blankets should also be made from natural fibers. The use of synthetics in bedding is undesirable, because only natural fibers “breathe”, which means they do not allow the body to sweat. Good air conductivity of fabrics and fillings of pillows and blankets helps prevent the formation of bedsores in the patient. You should also consider the thickness of blankets and other bedding depending on the temperature in the room. The use of duvets and feather beds in a warm room is undesirable, because... they cause excessive hydration of the skin, which seriously ill patient contraindicated.

3. Bed linen - sheets, duvet covers, pillowcases, as well as underwear - must be clean, made from natural fibers. Sheets should not have scars or seams, and pillowcases should not have knots or fasteners on the front side.

4. The bed of a patient with involuntary urination and fecal discharge should have special devices. Most often, a rubber bed is used, and the mattress and pillow are covered with oilcloth. In addition, for such a patient, special mattresses consisting of three parts are used. The middle part of such a mattress has a recess for the vessel.

5. To give a semi-sitting position to the bed, in addition to the headrest, you also need to have a foot rest so that the patient does not slide.

6. For convenient and safe feeding, it is advisable to have not only a bedside table, but also a table for the bed. It can be placed above the patient near the head.