Order of food distribution. Nutrition for patients in medical institutions Distributing food to patients
Food is distributed from the catering unit strictly according to the time established for each department. It begins only after the hospital doctor on duty takes a food sample. The barmaid places bins of food on special mobile tables and delivers them to the pantry, where tableware is stored and an electric stove for heating food (if necessary), titans for hot water (large-capacity water boilers) and a washing machine are installed. Then, after the food is delivered to the department in accordance with portion requirements, its distribution by the barmaid, junior nurse and ward nurse begins. If, before distributing food, the junior nurse carried out activities to care for the sick (helped with the morning toilet, cleaned the wards, etc.), she must change into special clothes and thoroughly sanitize her hands. Medical personnel should be provided with separate dressing gowns with special markings “For food distribution.”
Patients with a general (free) regime have lunch in the dining room, where they are seated according to the principle of dietary tables. After meals, tables are cleared, and after dinner they are washed with hot water and soap. Dishes are washed twice hot water with mustard or soda, be sure to disinfect with a 0.2% clarified solution of bleach, rinse with hot water and place in drying cabinets. Food waste is placed in marked, closed buckets or bins.
For patients who are in the ward mode, the letter is delivered to the ward. Food is delivered to the wards on special gurneys.
Distribution of food by technical personnel cleaning hospital premises (nurses and cleaners) is not allowed.
Feeding the sick
Depending on the method of eating, the following forms of nutrition for patients are distinguished.
Active nutrition - the patient eats independently.
Passive nutrition - the patient eats with the help of a nurse. (Feeds the seriously ill nurse with the help of junior medical staff.)
Artificial nutrition - feeding the patient with special nutritional mixtures through the mouth or tube (gastric or intestinal) or by intravenous drip administration of drugs.
Passive nutrition
During strict bed rest, the weakened and seriously ill, and, if necessary, elderly and senile patients, are assisted in feeding by a nurse. When feeding passively, you should lift the patient’s head with the pillow with one hand, and with the other, bring a sippy cup with liquid food or a spoon with food to his mouth. The patient should be fed in small portions, always leaving the patient time to chew and swallow; You should drink it using a sippy cup or from a glass using a special straw.
How to perform the procedure
1.Ventilate the room.
2. Treat the patient’s hands (wash or wipe with a damp, warm towel).
3. Place a clean napkin on the patient’s neck and chest.
4. Place dishes with warm food on the bedside table (table).
5. Give the patient a comfortable position (sitting or half-sitting)
During strict bed rest, you should lift the patient's head with the pillow with one hand, and with the other, bring a sippy cup with liquid food or a spoon with food to his mouth.
6. Choose a position that is comfortable for both the patient and the nurse (for example, if the patient has a fracture or acute cerebrovascular accident).
7. Feed small portions of food, be sure to leave the patient time to chew and swallow.
8. Give the patient something to drink using a sippy cup or from a glass using a special straw.
9. Remove the dishes, napkin (apron), help the patient rinse his mouth, wash (wipe) his hands.
10. Place the patient in the starting position.
Artificial nutrition
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 bypassing the gastrointestinal tract.
Main indications for artificial nutrition.
Damage to the tongue, pharynx, larynx, esophagus: swelling, traumatic injury, wound, tumor, burns, scar changes etc.
Swallowing disorder: after appropriate surgery, in case of brain damage - cerebrovascular accident, botulism, traumatic brain injury, etc.
Diseases of the stomach with its obstruction.
Coma.
Mental illness (food refusal).
Enteral nutrition is a type of nutritional therapy used when it is impossible to adequately provide the body’s energy and plastic needs in a natural way. In this case, nutrients are administered orally either through a gastric tube or through an intraintestinal tube. Previously, the rectal route of introducing nutrients was also used - rectal nutrition (administration of food through the rectum), but in modern medicine it is not used, since it has been proven that fats and amino acids are not absorbed in the colon. However, in some cases (for example, with severe dehydration due to uncontrollable vomiting), rectal administration of the so-called saline solution (0.9% sodium chloride solution), glucose solution, etc. is possible. This method is called a nutrient enema.
The organization of enteral nutrition in medical institutions is carried out by a nutritional support team, including anesthesiologists and resuscitators, gastroenterologists, therapists and surgeons who have undergone special training in enteral nutrition.
Main indications:
Neoplasms, especially in the head, neck and stomach;
CNS disorders – comatose states, cerebrovascular accidents;
Radiation and chemotherapy;
Gastrointestinal diseases – chronic pancreatitis, nonspecific ulcerative colitis and etc.;
Diseases of the liver and biliary tract;
Nutrition in the pre- and postoperative periods;
Trauma, burns, acute poisoning;
Infectious diseases – botulism, tetanus, etc.;
Mental disorders - anorexia nervosa (persistent refusal to eat due to mental illness), severe depression.
Main contraindications: intestinal obstruction, acute pancreatitis, shock; anuria, the presence of food allergies to the components of the prescribed nutritional mixture; uncontrollable vomiting.
Depending on the duration of the course of enteral nutrition and the preservation of the functional state of various parts of the gastrointestinal tract, the following routes of administration of nutritional mixtures are distinguished.
1. Drinking nutritional mixtures in the form of drinks through a tube in small sips.
2. Tube feeding using nasogastric, nasoduodenal, nasojejunal and dual-channel tubes (the latter for aspiration of gastrointestinal contents and intraintestinal administration of nutritional mixtures, mainly for surgical patients).
3. By applying a stoma (Greek stoma - hole: an external fistula of a hollow organ created surgically): gastrostomy (opening in the stomach), duodenostomy (opening in the duodenum), jejunostomy (opening in the jejunum). Ostomies can be created using surgical laparotomy or surgical endoscopic methods.
There are several ways to administer nutrients enterally:
In separate portions (fractionations) according to the prescribed diet (for example, 8 times a day, 50 ml; 4 times a day, 300 ml);
Drip, slow, long;
Automatically regulating food supply using a special dispenser.
For enteral feeding, liquid food is used (broth, fruit drink, formula), mineral water; Homogeneous dietary canned foods (meat, vegetables) and mixtures balanced in the content of proteins, fats, carbohydrates, mineral salts and vitamins can also be used.
Parenteral nutrition (feeding) is carried out by intravenous drip administration of drugs. The injection technique is similar intravenous administration medicines.
Main indications.
Mechanical obstacle to the passage of food in various parts of the gastrointestinal tract: tumor formations, burns or postoperative narrowing of the esophagus, inlet or outlet
section of the stomach.
Preoperative preparation of patients with extensive abdominal operations, exhausted patients.
Postoperative management of patients after gastrointestinal surgery.
Burn disease, sepsis.
Major blood loss.
Violation of the processes of digestion and absorption in the gastrointestinal tract (cholera, dysentery, enterocolitis, disease of the operated stomach, etc.), uncontrollable vomiting.
Anorexia and food refusal.
The following types of nutrient solutions are used for parenteral feeding. “Proteins – protein hydrolysates, solutions of amino acids: “Vamin”, “Aminosol”, polyamine, etc.
Fats are fat emulsions.
Carbohydrates – 10% glucose solution, usually with the addition of trace elements and vitamins.
Blood products, plasma, plasma substitutes.
There are three main types of parenteral nutrition.
1. Complete - all nutrients are introduced into the vascular bed, the patient does not even drink water.
2. Partial (incomplete) - only essential nutrients (for example, proteins and carbohydrates) are used.
3. Auxiliary – oral nutrition is not enough and additional administration of a number of nutrients is necessary.
In medical inpatient institutions, a 4-time meal plan is established, and for some groups of patients 5–6 and even 8 times a day. The daily diet should be distributed as follows (as a percentage of the total energy value of the day): breakfast - 15–25%, lunch - 35%, dinner - (and kefir at night) - no more than 25%. The patient's feeding time depends on the number of meals, but the break between them should be no more than 4 hours a day. daytime, with 5 meals a day, a second breakfast is introduced, and with 6 meals a day, an afternoon snack is also introduced. In some cases, the patient is first given liquid food, which leaves the stomach faster, and after 1–1.5, solid food.
The optimal system is a centralized food preparation system, when food is prepared for all departments in one room of the medical institution and then delivered to each department in labeled heat-insulating containers. In the pantry (dispensing room) of each hospital department there are special stoves (bain-marie) that provide heating of food with steam if necessary, since the temperature of hot dishes should be 57–62 C, and cold ones - not lower than 15 C.
Food distribution
1) Food is distributed by the barmaid (distributor) and the ward nurse in accordance with the portion requirements.
2) Feeding seriously ill patients is carried out by the ward nurse at the patient’s bedside.
3) Patients on general treatment eat in the dining room.
4) For patients on a ward basis, food is delivered to the ward on special tables.
5) Before distributing food, the nurse and barmaid must put on gowns marked “for distributing food” and wash their hands.
6) Nurses involved in cleaning premises are not allowed to distribute food.
Artificial nutrition - the introduction 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 nutrition through 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 back wall pharynx into the esophagus. 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 placed on its free end, into which 2-3 glasses of liquid food are poured (strong broth with egg yolk, milk, sweet fruit juices, 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 with an adhesive patch 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 of the lip 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 peptic ulcer stomach (for non-operative exclusion of the stomach from the digestive process).
Considering the great difficulties for the patient (the probe is left in small intestine for 2-3 weeks) and the lack of advantages compared to other methods of treating peptic ulcer, 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 inserted directly into the stomach or 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 in the mouth to chew so that it is mixed 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. When a larger amount is introduced, a spasm of the circular muscles of the intestine may occur and food is released back through the fistula.
Rectal nutrition is the administration of nutrients through the rectum using enemas. Replenishes the body's need for liquid, table salt 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. They use mixtures of amino acids, solutions of glucose, vitamins, minerals. The administration of these solutions is carried out as directed and under the supervision of a physician.
Diet therapy is a therapeutic diet prescribed to a patient for the period of treatment and carried out under the supervision of a physician.
To properly build a therapeutic diet, you need to:
know the physiology of digestion and nutrition;
know the influence of food components on disease processes;
take into account changes in food due to the nature of culinary processing.
The food of a healthy and sick person consists of proteins, fats, carbohydrates, vitamins, mineral salts and water.
The main components of food - proteins, fats and carbohydrates - are a source of nutrition and energy for the body. When burned or oxidized in the body, they release heat, which is usually measured in calories. A large calorie (kcal) denotes the amount of heat required to heat 1 kg of water per g. When oxidized in the body, 1 g of protein releases 4.1 kcal, 1 g of carbohydrates also produces 4.1 kcal, and 1 g of fat produces 9.3 kcal. .
Knowing the amount of proteins, fats and carbohydrates that make up a given product, you can calculate its calorie content. To make it easier to calculate the calorie content of diets, there are special tables indicating the amount of pure proteins, fats, carbohydrates and calories per 100 g of product.
The required calorie content of the daily diet is determined depending on: normal body weight, age, work performed and the nature of the disease.
Immediately before serving food, tables must be prepared, covered with clean tablecloths, and oilcloth tablecloths must be thoroughly washed. It should be emphasized that it is very important for patients to prepare the place for eating food and the staff to distribute it. There should be a noticeable transition from the implementation of medical prescriptions and patient care to the feeding procedure. The neat appearance and clean hands of the employee distributing food are important not only to prevent the introduction of various pathogenic bacteria into the food, but also instill in patients confidence in the staff and a desire to eat the food served. It gains more higher value when feeding patients suffering from decreased appetite and disgust.
The environment in which you eat also affects your appetite. Cleanliness, order, appetizing smells, beautifully decorated dishes stimulate the appetite. If the distribution room - the pantry - is located close to the dining room, then food is distributed in the pantry, and the dishes are immediately served on the tables. If the distribution room is located far from the dining room, then it is convenient to use special gurneys on which food tanks and tableware are placed. Food is served directly at the tables.
The ward nurse ensures that the patient receives food that corresponds to the prescribed diet. If for some reason the patient was unable to receive food on time (urgent dressing, delayed X-ray examination), the nurse should leave food for him, make sure that it is warmed up, and the patient is not left without breakfast or lunch.
1. Food is distributed by the barmaid (distributor) and the ward nurse, in accordance with the portion requirements.
2. Feeding seriously ill patients is carried out by a nurse at the patient’s bedside.
3. In the pantry (dispensing room) a menu for each diet should be posted indicating the weight of the portions.
4. Patients who are allowed to walk eat in the dining room.
5. For patients on bed rest, the barmaid and the ward nurse deliver food to the ward on special tables. to the ward.
6. Before distributing food, the nurse and barmaid must put on “food distribution” gowns and wash their hands.
7. Nurses involved in cleaning premises are not allowed to distribute food.
Feeding seriously ill patients is carried out by the ward nurse. After feeding patients, the dining room and serving area are cleaned, dishes are disinfected and washed.
3. Feeding seriously ill patient in bed: setting the table, feeding from a spoon and sippy cup.
Caring for seriously ill patients requires great patience, skill and compassion from the nurse. Such patients are very vulnerable, often capricious in their desires, and impatient. All these changes do not depend on the patient himself, but are associated with the influence of the disease on the patient’s psyche and behavior. These should be regarded as symptoms serious illness. For a seriously ill patient, food and drink become especially important, often determining either recovery or progression of the disease. Poor nutrition several times increases the risk of developing bedsores, slows down recovery, and contributes to the progression of the underlying disease.
Seriously ill patients receive food in the ward. To do this, food is served on an individual tray, covered with lids so that it does not cool down during transfer (transportation on a cart). Feeding seriously ill patients is the responsibility of the ward nurse. These patients often have reduced appetite and require a special approach, patience and attention. Everything before meals healing procedures should be completed and, as far as possible, all natural functions completed. The nurse makes sure that the ward is clean and ventilated, and the patients are prepared for meals. The degree of nurse participation in feeding depends on the patient’s condition: some patients actively eat, and the nurse only helps move the table or seat them, change dishes, put away dishes; Other, very weak patients require constant assistance when eating.
Before you start feeding, it is necessary to carry out all medical procedures and carry out the patient’s physiological functions. After this, it is necessary to ventilate the room and help the patient wash his hands. A nurse can help the nurse with this. It is best, if the condition allows, to give the patient a semi-sitting position or raise the head of the head. If this cannot be done, then it is necessary to turn the patient's head to the side. A great help in feeding a seriously ill patient is a functional bed equipped with a special over-bed table. If there is none, then instead of a table you can use a bedside table. Cover the patient's chest with a napkin, and if necessary. put some oilcloth on it. Food should be semi-liquid and warm.
If a seriously ill patient has an appetite at hours not established by the regime, and all previous days he has refused food, the ward nurse should make an exception, “disturb” the daily routine and, if necessary, warm up food and feed the patient at night.
End of work -
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Assistant nurse for patient care
Average vocational education Republic of Tatarstan.. Kazan Medical College.. specialties..
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Filling out an emergency notice
An emergency notification is drawn up by doctors and paramedical staff of the healthcare unit in the event that a patient is diagnosed with head lice, an infectious disease (suspected), a foodborne illness, or an acute occupational disease.
Filling out documentation upon discharge from hospital
Target. Document the outcome of the disease.
Indications. End of the patient's hospital stay.
Material resources: 1. Medical card
Determining the patient's body weight
Regularly weighing patients is a reliable method of controlling edema. Body weight is of great importance for clinical practice, in particular for the diagnosis of certain diseases: obesity,
Algorithm for measuring patient body weight
Preparation for the procedure: 1. Check the serviceability and accuracy of the medical scales in accordance with the instructions for their use.
2. Place a napkin on the scale platform.
3. B
Determining the patient's height
Upon admission, if the patient’s condition allows, it is customary to determine height using a special wooden stadiometer in a standing or sitting position.
Determining the patient's height
If the patient has hearing impairment, use
Determining the patient's height
Preparation for the procedure 1. Explain the upcoming procedure and obtain consent (if possible).
2. Lower the head of the bed to a horizontal level (or to the maximum
Patient transport
The method of transporting the patient from the emergency room to the specialized department is determined by the doctor depending on the severity of the patient’s condition: on a stretcher or on a gurney, on a wheelchair, in arms, on foot.
Devices for determining blood pressure
The auscultatory method of measuring blood pressure was proposed in 1905 by N.S. Korotkov.
There are manual (tonometer), semi-automatic and automatic types of devices that measure blood pressure.
Tonometer
Blood pressure measurement (order of the Ministry of Health of Russia dated January 24, 2003 No. 4), registration of indicators. Patient information
To measure blood pressure correctly, a number of conditions must be met.
1. Conditions for measuring blood pressure. The measurement should be carried out in a calm, comfortable environment
Determining the patient's height
Algorithm for studying blood pressure on the brachial artery
Preparation for the procedure: 1. Introduce yourself to the patient, explain the purpose and course of the procedure.
2. Wash and dry your hands (using soap or antiseptic).
3. Give the patient
Errors in blood pressure measurement. Teaching the patient self-monitoring of blood pressure
In order to avoid mistakes when changing blood pressure, you must strictly adhere to certain rules. These universal rules should be followed regardless of the type of device: - 30 minutes before
Preparation for the procedure 1. Tell the patient that you will teach him how to measure blood pressure. 2. Determine the patient's motivation and ability to learn. 3. Check with the patient whether he agrees
Determination of NPV, registration
The combination of inhalation and subsequent exhalation is considered one breathing movement. The number of breaths in 1 minute is called the respiratory rate (RR) or simply the respiratory rate. Normal breathing
Glossary
Preparation for the procedure: 1. Wash and dry your hands (using soap or antiseptic).
2. Prepare a thermometer (glass mercury): check its integrity, if necessary
Preparation for the procedure: 1. Wash and dry your hands (using soap or antiseptic).
2. Prepare the thermometer: check its integrity and, if necessary, wipe it dry
Algorithm for measuring temperature in the rectum
Preparation for the procedure: 1. Wash and dry your hands (using soap or antiseptic), put on gloves.
2. Prepare a thermometer: check its integrity, if necessary -
Recording temperature on a temperature sheet
To graphically display daily temperature fluctuations, temperature sheets are drawn up, in which the patient’s name is indicated, and the results of measuring body temperature are recorded. They take him to the reception
Nursing care for the patient during each period of fever
An increase in body temperature above 37 °C is called fever.
Body temperature rises during infectious diseases and some conditions accompanied by disruption of thermoregulatory activity
The second period is stabilization of high body temperature
May last from several hours to several days. Skin vessels dilate, heat transfer increases in accordance with heat production, so further increase in body temperature stops
The third period of fever is a decrease in temperature
The temperature can drop critically, that is, very quickly - from high numbers to low ones, for example from 40 to 36 ° C within an hour. This is accompanied by a sharp drop in vascular tone, a decrease in blood pressure, and the appearance of
Drawing up portion requirements
Medical nutrition - diet therapy - is the most important element of complex therapy. Prescribed in combination with other types of therapy (pharmacological drugs, physiotherapeutic procedures). Medical pit
Characteristics of diets
Diet No. 0. Prescribed: after surgery on the digestive organs, with traumatic brain injury, cerebrovascular accident.
3. Give the patient
Purpose: to provide food intake when
Feeding a seriously ill patient with a spoon
4.Wash and dry your hands. Wear gloves.
5. Liberally treat the blind end of the probe with glycerin (or other water-soluble lubricant).
6.Ask the patient to tilt his back slightly
Algorithm for feeding a seriously ill patient through a 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. Wash and dry
Drinking regime; Helping the patient get enough fluids
Drinking regimen is the most rational order for drinking water during the day. At the same time, the drinking regime is directly tied to proper nutrition, since in addition to eating food for human health Determination of water balance Purpose: diagnosis of hidden edema.
Equipment: medical scales, graduated glass container for collecting urine, water balance sheet.
Preparing and changing bed linen for a seriously ill patient
Functional purpose simple
medical services :prevention of bedsores, ensuring personal hygiene of the patient. Material resources: a set of pure white
Preparation and change of underwear and clothing for a seriously ill patient
Functional purpose of a simple medical service: prevention of bedsores, ensuring personal hygiene of the patient.
Material resources: non-sterile gloves
Preparation for the procedure
1. Introduce yourself to the patient, explain the purpose and course of the procedure (if the patient is conscious). Make sure the patient has
informed consent
for the upcoming procedure. 2.Process ru
Caring for the oral cavity of a seriously ill patient
The functional purpose of a simple medical service is to ensure the patient’s personal hygiene.
Diaper rash manifests itself in the form of erythema (redness) of the skin folds. Subsequently, if treatment is not started, superficial cracks appear deep in the fold, and in advanced cases bleeding occurs
Providing a vessel to a seriously ill patient
The functional purpose of a simple medical service is to ensure personal hygiene.
Material resources: bedpan, oilcloth, toilet paper, linen
Giving a urine bag to a seriously ill patient
The functional purpose of a simple medical service is to ensure personal hygiene.
Material resources: bedpan (for women) or urine bag (for
Changing a diaper
The functional purpose of a simple medical service: prevention of bedsores, ensuring the patient’s personal hygiene.
Material resources:non-sterile pepper
Algorithm for performing the manipulation
I. Preparation for the procedure. 1. Introduce yourself to the patient, explain the process and purpose of the procedure. 2. Separate the patient with a screen (if necessary). 3. Treat your hands hygienically
Caring for hair, nails, shaving a seriously ill patient The functional purpose of a simple medical service is to ensure the patient’s personal hygiene. Material resources: water thermometer, liquid soap, shampoo. cr
Feeding a seriously ill patient with a spoon
Application of mustard plasters
Indications: 1.
Inflammatory diseases
Feeding a seriously ill patient with a spoon
respiratory tract. 2. Angina.
3. Hypertensive crisis.
4. Myositis.
5. Neuralgia.
6. Osteochondrosis.
6. Immerse the mustard plaster in water, temperature – 40-45°C.
7. Apply the mustard plaster firmly to the skin with the side covered with mustard.
8. Repeat paragraphs. 6-7, placing the required amount of mustard plaster
12.Remove the compress after the prescribed time.
6. Immerse the mustard plaster in water, temperature – 40-45°C.
13.Wipe the skin and apply a dry bandage.
6. Immerse the mustard plaster in water, temperature – 40-45°C.
14.Wash your hands.
15.Make a record of the procedure performed and the patient’s reaction in medicine
13. Remove the compress after the prescribed time.
14. Dry the skin and apply a dry bandage.
15. Wash your hands.
16. Make a record of the procedure performed and the reaction.
18. At the end of the procedure, remove the catheter and place it in a disinfectant solution.
19. Remove gloves, wash hands.
20. Make a record of the medical service performed.
Glossary.
Spasm vasoconstriction Necrosis necrosis Infiltrate tissue compaction inflammatory
16. Make a record of the procedure performed and the reaction.
16. Make a record of the procedure performed and the reaction.
Installation of the gas outlet pipe. Observation and care of the patient after the procedure
16. Make a record of the procedure performed and the reaction.
16. Make a record of the procedure performed and the reaction.
Increased gas formation in the intestines when its motor function is impaired is called flatulence.
If the release of gases from the intestines using a cleansing enema is undesirable, but
Algorithm of actions
16. Make a record of the procedure performed and the reaction.
Increased gas formation in the intestines when its motor function is impaired is called flatulence.
Preparation for the procedure: 1. Introduce yourself to the patient, explain the purpose and course of the upcoming procedure.
2. Separate the patient with a screen (if the procedure is performed in many ways) Enemas An enema is a therapeutic and diagnostic medical service that involves the introduction of various liquids into the lower segment of the colon. Therapeutic enemas are used for the following purposes: Preparing the patient and administering a cleansing enema
Goal: to empty the intestines.
Equipment: sterile catheter, 1 pair of sterile gloves, sterile wipes, sterile glycerin, antiseptic solution, urine collection container, sterile trays.
Wear sterile gloves
6. Wrap the penis with sterile wipes. 7. Pull back foreskin
Wear sterile gloves
(if available), grab the penis from the side with your left hand and pull it to its maximum length perpendicularly
8. Cover the vaginal opening with sterile napkins.
9. Spread the labia minora to the sides with your left hand. With your right hand, take a sterile napkin moistened with an antiseptic solution and apply
Caring for the perineum of a patient with a urinary catheter
Equipment: terry cloth mittens, towel, gloves, absorbent diaper (oilcloth and regular diaper), water container, cotton balls. Preparation in Types and use of removable urinals. Care of catheters and urine bags
Urine collection systems are removable urinals, made of rubber,
polymer material
16. Make a record of the procedure performed and the reaction.
(nylon, nylon). The urinal consists of a catheter and a drainage bag. Applicable for violations of the EU
Types of gastric tubes
Type of probe Characteristics Purpose Thin gastric Diameter 5-9 mm Fractional studied
16. Make a record of the procedure performed and the reaction.
Flushing using a gastric tube (patient conscious) Preparation for the procedure: 1. Introduce yourself to the patient, explain the process and purpose of the procedure.
16. Make a record of the procedure performed and the reaction.
2. Usa
16. Make a record of the procedure performed and the reaction.
16. Make a record of the procedure performed and the reaction.
Material resources
1. Thick sterile gastric tube with a diameter of 10-15 mm, length - 100-120 cm with marks at a distance of 45, 55, 65 cm from the blind end - 1 pc.
2. Rubber tube 70cm long (to extend
Preparation for the procedure: 1. Measure blood pressure and count pulse.
2. Remove the patient’s dentures (if any).
Filling out requirements for medicines and the procedure for obtaining them from a pharmacy
In accordance with the needs of the department, the head nurse prescribes and receives medications from the pharmacy. There are special instructions for prescribing medications from a pharmacy.
With senior nurses, at the post, in treatment rooms
Name of the medicinal product________________________________________________________________________________ Concentration, dosage, unit of measurement _______________________
Distribution of medicines to patients of the medical department
Goal: Ensure that patients take medications on time.
Equipment: medications, prescription sheets, sterile pipettes, spoons, beakers, container with boiled water
Sublingual route of administration (sublinqua)
With sublingual and subbucal administration (a form of oral administration), the drug is not exposed to digestive and microbial enzymes and is quickly absorbed
Rectal route of administration (per rectum) Introduction medicines through the rectum (rectally) refers to the enteral route of administration. Liquids are administered through the rectum dosage forms
: decoctions, solutions, mucus in the form of microenemas and
Possible patient problems and nursing interventions for them When conducting drug therapy
problems may arise that are associated with the patient’s refusal to take prescribed medications. Typically, patients can motivate their
External route of administration
The external route of administration is the use of medicinal substances on the skin and mucous membranes of the eyes, nose, vagina, and ears.
This route of administration is designed primarily for local action.
Application of powder
Powders or dusting with powdered medicinal substances (talc) are used to dry the skin during diaper rash and sweating. The surface on which the powder is applied must be clean
Inhalation route
The introduction of drugs into the body by inhalation is called inhalation. The drug is in the bottle in the form of an aerosol. Using inhalation medicinal products
Inhalation route
Education
Types of syringes and needles, their structure. Preparing a single-use syringe for use
Injection (translated from Latin as “injection”) is the parenteral administration of drugs (the entry of drugs into the body, bypassing the digestive tract). To perform
The choice of needle depends on the type of injection
Type of injection Needle length, mm Needle diameter, mm Intradermal 0.4 Subcutaneous
Set of medicine from an ampoule and a bottle
Material resources: manipulation table, syringe (of the required volume for a certain type of injection), tray, tweezers, antiseptic or ethyl alcohol 70°, medicines
Calculation and dilution of antibiotics
Antibiotics are administered intramuscularly or intravenously. There are 2 ways to dilute antibiotics: 1:1 and 1:2.
When diluted 1:1, 1 ml of solution should contain 100,000 units of antibiotic.
Technique of intradermal, subcutaneous and intramuscular injections
Plan: 1. Anatomical areas and intradermal injection technique.
2. Anatomical areas and subcutaneous injection technique.
3. Anatomical areas and technique Algorithm for intradermal administration of drugs Anatomical areas and subcutaneous injection technique
Due to the fact that the subcutaneous fat layer is well supplied with blood vessels, for faster action
medicinal substance Subcutaneous injections are used. Anatomical areas:
Algorithm for subcutaneous administration of drugs
I. Preparation for the procedure.
1. Make sure the patient has informed consent for the upcoming insertion procedure
medicinal product
. If there is none, specify yes
Anatomical areas and intramuscular injection technique
Muscle tissue has an extensive network of blood and lymphatic vessels, which creates conditions for rapid and complete absorption of drugs. To perform an intramuscular injection, choose
Vials with heparin solution are available in 5 ml, 1 ml can contain 5000 IU, 10000 IU, 20000 IU.
Equipment: bottle with heparin, syringe and 2 needles, tweezers, alcohol, sterile cotton ball
Intravenous injection technique. Filling the IV fluid system
Plan: 1. Anatomical areas and intravenous injection technique.
2. Filling the system for intravenous drip administration of liquids.
3. Technique inside
Anatomical areas and intravenous injection technique
Anatomical areas: intravenous administration of drugs is performed in peripheral veins (veins of the elbow, dorsum of the hand, wrists, feet), as well as in central veins. Int.
Algorithm for intravenous administration of drugs (boost)
I. Preparation for the procedure.
1. Make sure that the patient has informed consent for the upcoming procedure of administering the drug. In the absence of such
Filling the IV fluid system
Material resources: couch, manipulation table, sterile kidney-shaped tray, non-sterile tray, venous tourniquet, sterile anatomical tweezers, nested anatomical tweezers
Algorithm for intravenous drug administration
(drip using a system for infusion of infusion solutions) I. Preparation for the procedure.
1. Make sure that the patient has informed consent for the upcoming
Algorithm for taking blood from a peripheral vein
I. Preparation for the procedure.
1. Make sure that the patient has informed consent for the upcoming procedure. If this is not the case, check with your doctor for further steps.
Collection of material from the nose
STEPS NOTE PREPARATION FOR THE PROCEDURE 1. Explain to the patient the meaning and necessity of the upcoming study
Collection of urine for general analysis
Purpose - diagnosis of diseases and monitoring of the course of the disease process Indications - kidney diseases, urinary tract, cardiovascular system, metabolic diseases, pregnancy
Urine collection according to Zimnitsky
Purpose - research functional state kidneys (determine daytime, nighttime, daily diuresis, as well as the amount and relative density of urine in each of 8 servings). Normal daily diuresis is
Collecting urine for sugar
The goal is to detect glucose in urine (in normal urine, glucose is present in traces and does not exceed 0.02%). The appearance of sugar in the urine - glucosuria can be physiologically caused by eating with
Collection of urine for bacteriological examination
Bacteriological and bacterioscopic examination of urine makes it possible to determine the pathogen in an infectious disease urinary system, produce quantitative and qualitative composition of microflora
Rules for storing received material. Preparation of the accompanying document
Urine should be delivered to the laboratory no later than 1 hour after it is collected, otherwise contamination from the environment can lead to alkaline fermentation.
For research
Collection of stool for scatological examination, for occult blood, for the presence of helminths, protozoa, for research for enterobiasis
Collect feces in a clean, dry glass container. It should not contain any impurities of urine or other substances. It is known that feces contain a huge number of microorganisms (billions!). And although big
Collection of stool for occult blood The goal is to identify hidden bleeding from organs digestive tract . Indications: gastric ulcer and
duodenum
, stomach cancer, gastritis, etc. Result Taking stool for examination for helminth eggs and enterobiasis
In the feces there are eggs of helminths: trematodes, or flukes (liver fluke, lancet fluke), cestodes, or tapeworms, nematodes, or
roundworms
(roundworm, pinworm, whipworm,
Functional purpose of a simple medical service: study of the secretory and motor functions of the stomach. Gastric contents are obtained on an empty stomach and after a “trial
Duodenal sounding
The functional purpose of a simple medical service: taking bile for diagnosing diseases of the gallbladder, biliary tract and therapeutic purpose- to stimulate outflow
X-ray examination of the colon (irrigoscopy) is usually carried out after the introduction of a barium suspension into the colon using an enema. To do this, the patient must fulfill certain requirements
Preparing for an X-ray examination
At X-ray methods studies determine the shape, size and mobility of the stomach, detect ulcers, tumors and other pathological changes. The nurse should prepare the patient
Preparation for endoscopic examination
Endoscopic examination esophagus, stomach and duodenum is currently one of the most important diagnostic methods that allows visually determining the localization with great accuracy
Preparation for x-ray examination of the liver and biliary tract
This study is based on the ability of the liver to secrete iodine-containing drugs with bile, which makes it possible to obtain an image of the biliary tract (intravenous and infusion cholangiocholecystography
Preparation for x-ray examination of the kidneys and urinary tract
When performing an X-ray examination of the kidneys, survey radiography of the kidneys and urinary tract and intravenous (excretory) urography, in which a contrast agent is used, are most often used.
Preparation for examination of the kidneys, bladder, pelvic organs and prostate gland
Ultrasound examination of the kidneys does not require special preparation. However, ultrasound examination of the uterus, ovaries (if transvaginal examination is not possible), bladder, prostate gland, in
Algorithm of actions.
1. Call an ambulance through a third party.
Algorithm of actions.
Algorithm of actions.
2. Stand behind the victim and place your arms around the chest.
Algorithm of actions.
3. Squeeze the fingers of one hand
1. Call an ambulance through a third party.
2. Place the patient on a hard base, unbutton tight clothing, and place a cushion under the victim’s shoulders at the level of the shoulder blades.
Option 1 1. Make one hand into a fist and place it in the epigastric region under the sternum.
One rescuer performs artificial ventilation of the lungs, the other performs indirect cardiac massage, their movements are coordinated, clear, and energetic.
Required condition -
Action algorithm
1. Remove clothes from the body and lay on your back without a pillow.
2. Remove existing valuables from the deceased in the department in the presence of the attending or duty doctor, about which a report must be drawn up together with the doctor and
In healthcare facilities, there are two systems for in-hospital organization of food preparation and supply of food to departments:
A) centralized;
B) decentralized; B) mixed. At
B) decentralized; centralized system All raw material processing and food preparation processes are concentrated in the central catering unit.
decentralized system
these processes are carried out separately. The departments are supplied with food by special personnel using intrahospital transport provided with insulated containers, or tanks and special carts are used to carry food.
ATTENTION! The temperature of hot dishes should be 57 - 62 0 C, and cold dishes - not lower than 15 0 C. To control nutrition in large hospitals available nutritionists – , and in.
departments
^ dietitians
The patient's feeding time depends on the number of meals, but the break between meals should be no more than 4 hours during the day; with 5 meals a day, a second breakfast is introduced, and with 6 meals a day, an afternoon snack is also included.
Meal hours:
9 00 – 10 00 – breakfast;
13 00 – 14 00 – lunch;
these processes are carried out separately. 18:00 – 19:00 dinner; 21 30 – kefir. In some cases, patients should be selected
^ individual diets
(tables), coordinating their composition with the nutritionist. For some patients, in order to normalize certain metabolic disorders, fasting days are recommended 1-2 times a week.
Food distribution rules:
Food is distributed in accordance with the data of the ward portion control.
For example
Patients who are allowed to walk eat in the cafeteria.
The dining room should have good lighting (natural). It contains small tables for 4 people and chairs without soft upholstery so that they can be easily wiped down.
For patients on bed rest, the barmaid or ward nurse delivers food to the ward.
these processes are carried out separately. Nurses cleaning premises are not allowed to distribute food!
The dining room, pantry and distribution room should be kept in strict cleanliness, which is monitored by the barmaids and controlled by the head nurse.
Before distributing food, all medical procedures and physiological functions of patients should be completed.
Junior medical staff should ventilate the rooms, help patients wash their hands, and find a comfortable position.
If there are no contraindications, you can slightly raise the head of the patient's bed, or use a bedside table.
The nurse should determine what assistance the patient needs while eating and encourage the patient if he or she attempts to feed on his or her own.
When serving hot drinks, you need to make sure they are not overly hot by placing a few drops on your wrist.
Food should be served quickly to ensure hot items stay hot and cold items stay warm.
The patient's neck and chest should be covered with a napkin, and space should be cleared on the bedside table or bedside table.
For liquid food, you should use a special sippy cup, and semi-liquid food can be given with a spoon.
The patient should not be allowed to talk while eating, because in this case, food can enter the respiratory tract.
There is no need to insist that the patient eats the entire amount of food at once: after a short break, after heating the food, you can continue feeding.
^ Additional Information.
Labeled cleaning equipment is provided for the pantry and dining room.
After every meal in the dining room and pantry wet cleaning of tables and floors using disinfectants.
Sponges and rags used for wiping tables and washing dishes must be soaked in a disinfectant solution, then boiled for 15 minutes, dried and stored in a special place.
^ Disinfection and washing of tableware.
Indications: compliance with sanitary and hygienic requirements.
Material support:
waste container (closed tanks);
three containers for processing dishes;
brush;
0.5% solution of Progress detergent (other products);
0.5% chloramine solution;
water;
Dryer.
Remove remaining food with a wooden spatula into a waste container.
Wash dishes in first containers with a brush, water t – 50 0 C with the addition of degreasers (soda ash or 0.5% Progress detergent solution, or mustard powder).
Disinfect dishes by immersing them in second container with a 0.5% chloramine solution for 30 minutes (or another disinfectant).
Rinse dishes in third containers with hot running water (temperature not lower than 50 0 C).
Dry the dishes on special racks without wiping.
^ Registration of portion requirements.
The doctor examining and treating the patient determines, depending on the disease and condition, the necessary diet and the duration of its use.
^ Diet number(treatment table) the doctor writes in “ Medical card inpatient » in the appointment sheet.
The ward (or guard) nurse, checking the appointment sheet, daily amounts to portion holder for feeding the sick.
In it, she indicates the total number of patients receiving one or another table of therapeutic nutrition, types of fasting and individual diets.
Information from ward (guard) nurses about the number of diets summarizes the head nurse of the department, signed by the head of the department, then this data is transferred to catering unit.
Based on the summarized data from all portioners in the catering unit, the required number of required dishes is prepared.
these processes are carried out separately.
The portion requirement in the department is drawn up according to the principle "today" to "tomorrow".
Information about patients discharged from the department, to the portion requirement don't turn on.
For patients admitted to various medical departments of the hospital in the evening or at night, a portion plan (an additional requirement) is drawn up by the nurse on duty of the medical department and handed over to the kitchen early in the morning.
^ For Saturday, Sunday and Monday - the portion man is being discharged on Friday.
1
0th city hospital
Form No. 1 - 84
(name of institution)
PORTION MAN
I. Information about the presence of patients
(
as of ^
8
hours January 19 19 88
G.)
| Name of wards (departments) and food standards | Number of patients | Including diets |
||||||||||||
| 1 | 5 | 7 | ||||||||||||
| Ward 201 | 4 | 1 | 3 | |||||||||||
| Ward 202 | 2 | 1 | 1 | |||||||||||
II. Individual supplementary nutrition
| Name of chambers (departments) | Surnames of patients | Food |
|||||
| Ward 203 | Zverev I.I. | ||||||
Head of department ________________ Diet sister _________________
Senior nurse ___________________ Verified
Reception senior nurse
Branches __________________
Medical statistician _______________
(for consolidated portion maker)
^ Types of artificial nutrition.
When is the patient's normal feeding naturally(through the mouth) is impossible or difficult (some diseases of the oral cavity, esophagus, stomach) - food is introduced into the stomach or intestines (rarely) artificially.
Artificial nutrition can be done:
Using a tube inserted through the mouth or nose, or through a gastrostomy tube.
Administer nutrient solutions using an enema (after a cleansing enema).
Administer nutrient solutions parenterally(intravenous drip).
REMEMBER!
With artificial nutrition, the daily calorie content of food is about 2000 calories, the ratio of proteins - fats - carbohydrates is 1: 1: 4.
The patient receives water in the form of water-salt solutions on average 2 liters per day.
Vitamins are added to food mixtures or administered parenterally.
Indications for the use of artificial nutrition:
Difficulty swallowing.
Narrowing or obstruction of the esophagus.
Pyloric stenosis.
Postoperative period (after surgery on the esophagus and gastrointestinal tract).
Uncontrollable vomiting.
Large fluid losses.
Unconscious state.
Psychosis with refusal to eat.
Basic nutrient mixtures and solutions.
Nutritional formula recipes:
Liquid nutritional mixture: 200 – 250 ml water + 250 g milk powder + 200 g crackers + 4 – 6 g salt.
Spasokukotsky's mixture: 400 ml of warm milk + 2 raw eggs + 50 g of sugar + 40 ml of alcohol + a little salt.
Water-salt solutions:
The concentration of salts in them is the same as in human blood plasma.
The simplest water-salt solution of 0.85% isotonic sodium chloride.
Ringer-Locke solution: NaCl – 9 g + KC – 0.2 g + CaCl – 0.2 g + HCO 3 – 0.2 g + glucose – 1 g + water – 1000 ml.
Planning necessary assistance to the patient if problems arise with feeding.
Conduct an initial assessment of the patient's response to feeding (including artificial feeding).
Provide psychological support to the patient by methods of explanation, persuasion, conversation, so that the patient can maintain his dignity.
Help the patient cope with his feelings, give him the opportunity to express his feelings and emotions about feeding.
Ensure that there is informed consent for feeding the patient.
Organize feeding, prepare everything necessary.
Provide assistance during meals.
Strive to maintain a comfortable and safe feeding environment.
Organize training for the patient and his relatives, if necessary, provide information about the rules of nutrition and feeding.
Assess the patient's response to feeding.
Monitor the patient after feeding.
^ Feeding the patient through a gastric tube inserted into the mouth or nose (nasogastric).
Lungs are used as artificial feeding tubes thin tubes:
A) plastic
B) rubber
B) silicone
Their diameter is 3 – 5 – 8 mm, length 100 – 115 cm, at the blind end there are two lateral oval holes, and at a distance of 45, 55, 65 cm from the blind end there are marks that serve as a guide for determining the length of probe insertion.
Feeding the patient through a nasogastric tube using a funnel.
Equipment:
thin rubber probe with a diameter of 0.5 - 0.8 cm
clamp
tray
towel
napkins
clean gloves
funnel
boiled water 100 ml
petrolatum
Tell the patient what he will be fed (after agreement with the doctor).
Warn him 15 minutes in advance. about the upcoming meal.
Ventilate the room.
Help the patient assume a high Fowler's position.
Wash your hands, put on gloves.
Treat the probe with Vaseline.
Insert a nasogastric tube through the lower nasal passage to a depth of 15–18 cm.
Using a gloved finger of your left hand, determine the position of the probe in the nasopharynx and press it against the back wall of the pharynx so that it does not fall into the trachea.
Tilt the patient's head slightly forward and right hand move the probe to the middle third of the esophagus.
these processes are carried out separately. If air does not come out of the probe during exhalation and the patient’s voice is preserved, then the probe is in the esophagus.
Connect the free end of the probe to the funnel.
Slowly fill the funnel, located obliquely at the level of the patient’s stomach, with a nutrient mixture (tea, fruit drink, raw eggs, still mineral water, broth, cream, etc.).
Slowly raise the funnel 1 m above the level of the patient's stomach, keeping it straight.
As soon as the nutrient mixture reaches the mouth of the funnel, lower the funnel to the level of the patient’s stomach and clamp the probe.
Repeat the procedure using the entire prepared amount of the nutrient mixture.
Pour 50 - 100 ml of boiled water into the funnel to rinse the probe.
Disconnect the funnel from the probe and close its distal end with a plug.
Wash the hands.
Feeding the patient through a nasogastric tube using a Janet syringe.
Equipment:
Janet syringe with a capacity of 300 ml
syringe 50 ml
clamp
tray
phonendoscope
nutrient mixture (t 38 0 – 40 0 C)
warm boiled water 100 ml
Place the patient in the Fowler's position.
Ventilate the room.
Heat the nutrient mixture in a water bath to 38 0 – 40 0 C.
Wash your hands (you can wear gloves).
Insert a nasogastric tube (if it is not already inserted).
Draw the nutrient mixture (prescribed amount) into the Janet syringe.
Place a clamp on the distal end of the probe.
Connect the syringe to the probe, lifting it 50 cm above the patient’s body so that the piston handle is directed upward.
Remove the clamp from the distal end of the probe and provide a gradual flow of the nutritional mixture. If it is difficult to pass the mixture, use the syringe plunger, moving it down.
After emptying the syringe, clamp the probe with a clamp (to prevent food from leaking out).
Above the tray, disconnect the syringe from the probe.
Attach a 50 ml Janet syringe with boiled water to the probe.
Remove the clamp and wash the probe under pressure.
Disconnect the syringe and close the distal end of the probe with a plug.
Attach the probe to the patient's clothing with a safety pin.
Help the patient find a comfortable position.
Wash your hands (remove gloves).
Make a record of the feeding.
Feeding the patient using a tube inserted into the stomach through a gastrostomy tube.
Prescribed for obstruction of the esophagus and stenosis (narrowing) of the pylorus. In these cases, a funnel is attached to the free end of the probe, through which initially small portions (50 ml) 6 times a day heated liquid food is introduced into the stomach. Gradually the volume of food introduced is increased up to 250 – 500 ml, and the number of feedings reduced to 4 times.
Sometimes the patient is allowed to chew the food on his own, then it is diluted in a glass with liquid, and the diluted form is poured into a funnel. With this feeding option, reflex stimulation of gastric secretion is maintained. Feeding through a gastrostomy tube is used both in hospital and at home. IN the latter case Relatives need to be taught feeding and tube rinsing techniques.
Feeding through a gastrostomy tube.
Equipment:
funnel (Zhanet syringe)
food container
boiled water 100 ml
Wipe down the bedside table.
Tell the patient what he will be fed.
Ventilate the room.
Wash your hands (it is better if the patient sees this), you can put on gloves.
Place the cooked food on the bedside table.
Assist the patient into the Fowler's position.
Unfasten the probe from clothing. Remove the clamp (plug) from the probe. Attach the funnel to the probe.
these processes are carried out separately. It is advisable to start feeding with tea (water) to free the tube from mucus and food accumulated between feedings.
Pour the prepared food into the funnel in small portions.
Rinse the probe with warm boiled water through a Janet syringe (50 ml) or directly through a funnel.
Disconnect the funnel, close the probe with a plug (clamp it with a clamp).
Make sure the patient feels comfortable.
Wash the hands.
Useful practical advice.
After use, rinse the probe in a washing container with one of the disinfectant solutions, then soak in another container with a disinfectant solution for at least 60 minutes, then rinse the probe with running water and boil in distilled water for 30 minutes from the moment of boiling. To sterile probes did not dry out or crack, they are stored in a 1% solution boric acid, but before use, rinse again with water.
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 a probe inserted through the nose, use only a towel (mitten) moistened warm water. Do not use cotton wool or gauze pads for this purpose.
For patient convenience, outer end nasogastric tube can be secured (tied) on his head so that it does not interfere with him (the probe can not be removed during the entire period of artificial feeding, about 2 - 3 weeks).
You can check the correct position of the nasogastric tube in the stomach:
Place a clamp on the distal end of the probe above the tray (to prevent the contents of the stomach from leaking out);
remove the plug from the probe;
draw 30 - 40 ml of air into the syringe;
attach the syringe to the distal end of the probe;
remove the clamp;
put on a phonendoscope and place its membrane on the stomach area;
Inject air from a syringe through the probe and listen for sounds in the stomach (if there are no sounds, you need to tighten and move the probe).
Prescribed to patients with obstruction of the digestive tract, when normal nutrition is impossible (tumor), as well as after operations on the esophagus, stomach, intestines, etc., as well as in exhaustion, weakened patients in preparation for surgery. For this purpose, preparations containing products of protein hydrolysis are used - amino acids (hydrolysine, casein protein hydrolyzate, fibronosol), as well as artificial mixtures of amino acids (new Alvezin, levamine, polyamine, etc.); fat emulsions (lipofundin, intralipid); 10% glucose solution. In addition, up to 1 liter of electrolyte solutions, B vitamins, and ascorbic acid are administered.
Parenteral nutrition products administered intravenously by drip. Before administration, they are heated in a water bath to body temperature (37–38 0 C). It is necessary to strictly observe the rate of administration of drugs: hydrolysine, casein protein hydrolysate, fibronosol, polyamine in the first 30 minutes. administered at a rate of 10–20 drops per minute, and then, if well tolerated, the rate of administration is increased to 40–60.
Polyamine in the first 30 min. administered at a rate of 10–20 drops per minute, and then 25–35 drops per minute. Faster administration is not advisable, since excess amino acids are not 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) is administered in the first 10 - 15 minutes at a rate of 15 - 20 drops per minute, and then gradually (over 30 minutes) the rate of administration is increased to 60 drops per minute. Administration of 500 ml of the drug should last approximately 3–5 hours.
REMEMBER! Administer all components for parenteral nutrition at once.
Feeding a seriously ill patient with a spoon.
Indications: inability to eat independently (bed rest, serious condition).
Ask the patient about their favorite dishes and agree on the menu with the attending physician or nutritionist.
Warn the patient 15 minutes in advance that a meal is to be taken and obtain his consent.
Ventilate the room, make room on the bedside table or move the bedside table (wipe the surface of the bedside table with a clean rag).
Assist the patient, if possible, into a high Fowler's position (reduces the risk of asphyxia).
Help the patient wash his hands (wipe with a damp towel) and cover his chest with a napkin (infection safety is ensured).
Wash and dry your hands.
Bring and place on the bedside table food and liquids intended for eating and drinking: hot dishes should be hot (60 0), cold dishes should be cold.
Ask the patient in what order he prefers to eat.
Check the temperature of hot food by dropping a few drops onto the back of your hand (to ensure patient safety).
Offer to drink (preferably through a straw) a few sips of liquid (dry mouth decreases, chewing solid food becomes easier).
these processes are carried out separately. If the patient’s condition does not allow him to be given a sitting position, you need to raise the patient’s head with the pillow with your left hand, and bring the spoon with semi-liquid food to your mouth with your right hand.
11.Feed slowly:
name each dish offered to the patient;
fill the spoon 2/3 full with hard (soft) food;
touch the lower lip with a spoon so that the patient opens his mouth;
touch the spoon to the tongue and remove the empty spoon;
give time to chew and swallow food;
Offer a drink after a few spoons of solid (soft) food.
13. Invite the patient to rinse his mouth with water after eating (the rate of growth of bacteria in the mouth decreases).
14. Remove dishes and leftover food after eating, shake off crumbs from the bed (infection safety is ensured).
15. Place the patient in a comfortable position.
16.Wash and dry your hands.
Nutrition is one of the the most important factors, which have a significant impact on the health, performance and resistance of the body to environmental influences. Hippocrates also said that “...food should be medicine, and medicine should be food.”
Diet (Greek) diaita - lifestyle, diet) - the diet of a healthy and sick person. Dietetics (diet + Greek. logos - teaching) is a branch of medicine that studies human nutrition under normal conditions and in various diseases, and also deals with the organization of therapeutic nutrition.
Medical nutrition (diet therapy) is the use of specially formulated food rations and diets for therapeutic or preventive purposes.
The diet determines the time and number of meals, the intervals between them and the diet. The food ration regulates the requirements for food in terms of energy value, chemical composition, food set, weight, techniques food. Nutrition should be rational - physiologically complete, taking into account a number of factors, including gender, age and character physical activity human, as well as balanced - food must maintain a certain ratio of nutrients.
THE IMPORTANCE OF NUTRITION IN LIFE
HUMAN BODY
According to the doctrine of balanced nutrition, for good absorption of food and adequate maintenance of the body’s vital functions, it is necessary to supply it with all nutrients (nutrients) in certain proportions to each other (Table 4-1 and Appendix 1), which may vary depending on gender, age, nature of work, climate, physiological state of the body (for example, pregnancy, breastfeeding).
Table 4-1. The average daily requirement of an adult for nutrients and energy (according to Pokrovsky A.A., 1976; with corrections)
Formula balanced nutrition - the normal ratio between proteins, fats and carbohydrates for young men and women engaged in mental work is 1:1.1.1:4.1, respectively; for heavy physical labor - 1:1,3:5. When calculating, the number of proteins is taken as a unit. For example, if the diet contains 90 g of protein, 81 g of fat and 450 g of carbohydrates, then the ratio will be 1:0.9:5. In therapeutic diets, if necessary, the content of proteins, fats or carbohydrates is changed. The optimal ratio of calcium, phosphorus and magnesium for absorption is 1:1.5:0.5.
Squirrels participate in all life processes, act as a source of essential amino acids, provide the body with material for the synthesis of hormones, hemoglobin, vitamins, enzymes; proteins are involved in maintaining a constant reaction of the environment in plasma, cerebrospinal fluid, and intestinal secretions. Animal proteins should account for 55-60% total number squirrel. The daily protein requirement is 100-120 g.
Fats participate in metabolic processes, being part of cells and tissues; they serve as a valuable energy material - when 1 g of fat is burned, 9 kcal are released. Of the total amount of fats, vegetable oils as sources of essential fatty acids should account for up to 30% of the diet. The daily requirement for fat is estimated at 60-150 g.
Carbohydrates are not only an energy source (the oxidation of 1 g of carbohydrates provides the release of 4 kcal), but also necessary substance for normal metabolism of proteins and fats (“fats burn in the flame of carbohydrates”) and the synthesis of hormones, enzymes, and the secretion of the salivary glands. Of the total amount of carbohydrates, starch should make up 75-80% of the diet, easily digestible carbohydrates - 15-20%, fiber and pectins - 5%. The daily need for carbohydrates is estimated at 400-500 g.
Alimentary fiber. An important component of proper nutrition is the mandatory inclusion in the diet of so-called ballast substances - dietary fiber (plant fibers, cell membranes); the daily need for them is 25-30 g. Dietary fiber is involved in processes such as reducing energy consumption by creating a feeling of fullness, stimulating intestinal motor function and bile secretion, reducing cholesterol levels in the blood, normalizing intestinal microflora, etc.
Water, making up more than 60% of body weight, it provides vital processes of the body - metabolic, digestive, heat
loregulatory, excretory, etc. The daily need for water is 2-3 liters.
Vitamins must be included in the food consumed (see Appendix 1). The term “vitamin” was proposed by the Polish biochemist Casimir Funk (1912): Greek. vita - life + lat. amin - protein (Casimir Funk believed that all substances necessary for the body are of protein nature and contain amino groups). Currently, vitamins include organic low-molecular compounds of various structures and different chemical natures. Vitamins are mainly synthesized by plants and microorganisms. These substances are involved in all metabolic processes of the body; They play a great role in the prevention of cardiovascular and oncological diseases.
Isolated intake of only one of the 20 known vitamins can cause an imbalance of other organic substances necessary for the normal functioning of the body. Therefore, a number of complex preparations have been developed - the so-called multivitamins (Undevit, Decamevit, Unicap, etc.). Unfortunately, their recipe is made up of synthetic vitamins that do not fully correspond to natural ones. Therefore, preference should be given to natural products (see Appendix 2). The absence of one or more vitamins in food causes significant disturbances in growth, tissue nutrition, metabolism and other disorders, sometimes leading to death. In particular, the shortage ascorbic acid(vitamin C), nicotinic acid(vitamin PP), pyridoxine (vitamin B 6) promotes the development and progression of atherosclerosis and coronary artery disease.
Mineral substances take part in the construction of tissues, regulation of the electrolyte composition of the blood, and influence the most important processes of the body’s vital functions (digestion, immunity, hematopoiesis, hemocoagulation, etc.). For the first time, the chemical elements contained in the body were divided into macroelements, microelements and ultramicroelements by the Russian scientist Vladimir Ivanovich Vernadsky (1863-1945). According to its classification as macroelements (Greek. macros- large) include calcium, phosphorus, magnesium, potassium, sodium, chlorine, sulfur (their content in the body is 0.1% of the chemical composition of the body* and higher), microelements
* Oxygen, carbon, hydrogen and nitrogen account for about 98% of the total chemical composition of the body.
(Greek micros- small) - iron, iodine, fluorine, selenium, zinc, copper, etc. (their content in the body is 0.01-0.0001%), ultramicroelements - chromium, silicon, gold, radium, uranium, etc. ( content in the body is 0.0001% or less).
Currently, only macroelements and microelements are isolated. Macroelements are needed by the human body every day, the need for them is measured in grams. The content of microelements in the body is less than 0.01% of the chemical composition of the body; the daily need for them is calculated in milligrams and/or micrograms (gammas).
HEALING NUTRITION
Medical nutrition is an essential component of complex therapy. The founder of Russian dietetics, Manuil Isaakovich Pevzner (1872-1952), wrote: “...The patient’s nutrition is the main background against which other therapeutic factors should be applied - where there is no therapeutic nutrition, there is no rational treatment.” Dietary nutrition and drug treatment complement each other, which increases the effectiveness of treatment.
Nevertheless, there may potentially be a number of negative aspects in the diet-medication relationship. If they are not taken into account, miscalculations may be made in the treatment of patients. A medicine taken simultaneously with food reaches the site of its main absorption later - the intestines (therefore, in the absence of contraindications, the drug is best taken 1 hour before a meal or 2 hours after a meal). The following examples are most illustrative.
If proteins predominate in the diet, the pharmacological effect of some drugs, for example digoxin, quinidine, cimetidine, caffeine, theophylline, tetracycline, and anticoagulants, is reduced.
Carbohydrates slow down the evacuation of gastric contents, as a result of which the absorption of co-trimoxazole (for example, Biseptol), sulfadimethoxine is delayed.
Under the influence of foods rich in fat, the therapeutic effectiveness of anthelmintic (helminthic) drugs, as well as nitrofurantoin, phenyl salicylate, and sulfonamides, is significantly reduced. At the same time, foods rich in fat can
be beneficial in cases where it is necessary to increase the absorption of fat-soluble drugs - anticoagulants, metronidazole, diazepam, vitamins A, D, E, K. In an acidic environment, antibiotics such as benzylpenicillin, amoxicillin, erythromycin, lincomycin, oleandomycin, cycloserine are partially inactivated. Acidic fruit and vegetable juices can neutralize the pharmacological effect of erythromycin, ampicillin, cycloserine and, conversely, enhance the effect of salicylates, barbiturates, nitrofurans; they can also slow down the absorption of ibuprofen and furosemide. Taking sleeping pills at the same time as grapefruit juice can cause poisoning (fatalities have been reported in Canada).
While taking amidopyrine, aminazine, antipyrine, appetite suppressants, tetracyclines, antidiabetic biguanides, you should not eat smoked sausages due to the possibility of the formation of carcinogenic nitrosamines. If the patient eats foods containing large amounts of the amino acids tyramine and phenylethylamine (cheese, cream, coffee, yeast, beer, goose liver, Riesling and Sherry wines), as well as serotonin (pineapples, peanuts, bananas, nettles) , dioxyphenylethylamine (beans, legumes, bananas), then he is strictly prohibited from taking monoamine oxidase inhibitors (for example, nialamide), since patients may experience severe hypertensive crises.
Cardiac glycosides, diuretics, glucocorticoids should be prescribed against the background of a diet rich in potassium salts (potatoes, apricots, raisins, figs, nuts, peaches, dried apricots). When taking anabolic hormones, you need a diet containing large amounts of protein and calcium salts (cottage cheese, milk, eggs, meat). You should know that the hypotensive effect of antihypertensive drugs is enhanced by viburnum, rowan, beets, and strawberries. When prescribing anticoagulants, it is recommended to avoid taking foods containing vitamin K (lettuce, spinach, green tomatoes, white cabbage, fresh liver), since vitamin K is an antidote* of anticoagulants and helps increase blood clotting (hypercoagulation).
* Antidotes (Greek. antidotes- given against something) - substances (usually drugs) intended to neutralize poisons that have entered the body or neutralize an overdose of a drug.
Taking medications can interfere with the absorption of nutrients from the intestines. Thus, a group of laxatives reduces the absorption of all nutrients and at the same time disrupts the water-salt balance in the body. Levomycetin impairs the absorption of proteins; large doses of this antibiotic, taken against the background of a semi-starvation diet, can provoke the development of aplastic anemia. The antibiotic neomycin reduces the absorption of carotene, amino acids, fats, iron, fat-soluble vitamins, and glucose.
Modern diet therapy and dietary prevention are based on the achievements of the theory of balanced nutrition. One of the options for a personal approach to therapeutic nutrition is an individual physiological diet, proposed back in 1962 by Kazan scientist-therapists Professor A.G. Teregulov and associate professor A.I. Golikov. The algorithm for an individual physiological diet takes into account the age, gender and body weight of the patient, the features of his diagnosis, the state of the basal metabolic rate, his profession, tolerance food products. Individually for the patient, they describe the chronodynamics of food intake (usually 4-6 split meals a day), recommend a water regime (on average 1000-1200 ml of liquid per day), indicate the salt balance (the average rate of table salt is 3.5-4.5 g /day). They also calculate the calorie content of the diet and specifically indicate in grams the protein (meat, fish, poultry, cottage cheese, cheese, etc.), fat-containing (animal butter, vegetable oil, margarine, milk, sour cream, etc.) products, carbohydrates and fruit and vegetable products included in the diet products. Be sure to calculate the daily intake of plant dietary fiber (the average norm is 25-30 g/day). The rhythm of protein nutrition is important: on Mondays, Thursdays, and sometimes Saturdays, meat food is allowed, on Tuesdays, Wednesdays and Fridays - fish, and on Sunday a “fasting”, mainly vegetarian, day is recommended. For overweight patients, the calorie content of food is calculated based on the “proper” body weight, but the amount of protein is determined based on the true weight.
Basic principles of therapeutic nutrition
1. Individualization of nutrition based on somatometric data (height, body weight, etc.) and the results of metabolic studies in a particular patient.
2. Ensuring digestion in case of disruption of the formation of digestive enzymes. For example, with a deficiency in the intestines
peptidase enzyme, which breaks down the gluten protein of wheat, rye, barley, oats (celiac disease), or hypersensitivity to gluten (celiac disease), all products containing protein from these cereals should be excluded from the diet.
3. Taking into account the interaction of nutrients in the gastrointestinal tract (GIT) and the body: it is necessary to provide for a balance of nutrients that can affect their digestibility - for example, the absorption of calcium from the intestines worsens with an excess of fats, phosphorus, magnesium, oxalic acid in food .
4. Stimulation of restoration processes in organs and tissues by selecting the necessary nutrients, especially amino acids, vitamins, microelements, essential fatty acids.
5. Compensation for nutrients lost by the patient’s body. For example, in case of anemia, in particular after blood loss, the diet should increase the content of microelements necessary for hematopoiesis (iron, copper, etc.), a number of vitamins and complete proteins of animal origin.
6. Targeted change in diet for the purpose of a kind of training of biochemical and physiological processes in the body (for example, a regimen of frequent meals of low energy value in obesity).
7. The use of sparing methods in nutrition (in case of irritation or functional failure of an organ or system) - restriction in nutrition of chemical, mechanical or temperature stimuli.
8. The use in nutrition of methods of gradual expansion of strict diets at the expense of less sparing dishes and products.
9. The use of fasting methods and “contrast days” in nutrition - the use of “contrast days” against the background of the main therapeutic diet - load days (for example, adding excluded nutrients to the diet) and fasting days. Stress days not only contribute to jerky stimulation of function, but also serve as a test for functional endurance. The purpose of fasting days is to briefly facilitate the functions of organs and systems, to promote the release of products of impaired metabolism from the body. Based on the predominance of nutrients, fasting diets are divided into protein (milk, curd, meat and vegetable), carbohydrate (fruit, sugar and vegetable), fat (cream, mixed
tan), combined (consisting of various products). There are strict indications for prescribing a certain fasting diet. Thus, in case of chronic heart failure, you can prescribe protein, carbohydrate, combined fasting diets or alternate them (Table 4-2).
Table 4-2. Starter and fasting diets for chronic heart failure
Dairy diet(including the Carell diet* and its variants). In addition to use in patients with heart failure, it is also prescribed for hypertension, obesity, liver and biliary tract diseases, pyelitis and pyelocystitis. With this diet, milk, kefir, yogurt are given every 2-2.5 hours, 200-250 ml each
6 times a day (1.2-1.5 l in total) or the Karell diet is prescribed.
Curd diet: it is prescribed for severe heart failure, chronic nephritis with edema, but without azotemia, and for obesity. It includes 500 g of cottage cheese and 150 g of sugar, 1-2 glasses of rosehip decoction. The patient is given food in 5 doses in equal parts every 2-2.5 hours.
Apple diet prescribed for obesity, hypertension, chronic nephritis, chronic pancreatitis. The patient is given 250-300 g of ripe raw apples 5 times a day (1.25-1.5 kg in total). For chronic enterocolitis, the patient is given 250-300 g of raw grated apples without peel and seeds 5 times a day. The calorie content of the diet is 500-600 kcal.
Compote diet prescribed for the same diseases as apple juice. The patient is given 6 times a day 1 glass of compote made from 200 g of dried fruit, 60-70 g of sugar with 1.5 liters of water. Calorie content 750 kcal.
Milk-potato diet: it is prescribed for chronic nephritis with edema and azotemia, heart failure, and diseases with acidosis. The diet is prescribed for 2-6 days, it consists of 1 kg of potatoes and 0.5 liters of milk. Table salt is excluded. Calorie content 1200-1300 kcal.
Raisin diet used for the same diseases as milk-potato. It is prescribed for 1 day and consists of 0.5 kg of seedless raisins. Raisins are given 5-6 times a day in equal portions.
Tea diet indicated for gastritis with secretory insufficiency, enterocolitis. It is prescribed for 1-2 days. The patient is given per day
7 glasses of sweet tea, 10-15 g of sugar per glass.
* The Karell diet (proposed by Philip Yakovlevich Karell in 1865) is a method of treating diseases of the cardiovascular system and kidneys by feeding only skim milk (0.8-3 l/day) while observing bed rest. In the classic version of this diet, in the first week the patient is given skim milk 200 ml 4 times a day, later eggs and crackers are added with a gradual transition to regular mixed food. Currently used modifications of the Karell diet are presented in table. 4-2.
Meat and vegetable diet prescribed for obesity. It includes 350 g of boiled beef, 0.6 kg of vegetables (cabbage, cucumbers, carrots). Food is taken 6 times a day.
Watermelon diet prescribed for nephritis, gout, kidney stones with uraturia. The patient is given 300 g of watermelon 5 times a day.
Therapeutic diets (diet tables)
IN Russian Federation Until now, a unified number system of diets has been used to ensure the individualization of therapeutic nutrition for a large number of patients with certain diseases and their different courses - therapeutic diets or dietary tables No. 0-15, developed at the Institute of Nutrition of the USSR Academy of Medical Sciences. Each diet has individual characteristics, which reflect the following indicators:
1) indications for use;
2) purpose of destination;
3) general characteristics;
4) chemical composition and calorie content;
5) diet;
6) a list of products and dishes that are allowed and prohibited, compiled in a certain order - products containing proteins, fats, carbohydrates, seasonings and drinks.
Therapeutic diets are differentiated according to the main nosological forms (diseases).
Zero (surgical) diets
Indications: after operations on the digestive organs, as well as in semi-conscious states caused by impaired cerebral circulation, traumatic brain injury, infectious diseases with high body temperature, etc.
Destination goals: providing nutrition in conditions where eating regular food is impossible, difficult or contraindicated; maximum unloading and sparing of the digestive organs, prevention of intestinal bloating (flatulence).
General characteristics: the most mechanically and chemically gentle nutrition (liquid, semi-liquid, jelly-like, pureed food) in the form of three sequentially prescribed diets - No. 0a, No. 0b, No. 0c. Diets contain the most easily digestible sources of proteins, fats and carbohydrates, increased amounts of fluids and vitamins.
The amount of sodium chloride (table salt) is sharply limited. Frequent meals in small portions are indicated. After zero diets, diet No. 1 or No. 1 surgical diet is used. The latter differs from diet No. 1 by the inclusion of weak meat and fish broths and vegetable broths and the limitation of whole milk.
Diet No. 0a. It is prescribed, as a rule, for 2-3 days. The food consists of liquid and jelly-like dishes. The diet contains 5 g of protein, 15-20 g of fat, 150 g of carbohydrates, energy value 3.1-3.3 MJ (750-800 kcal); table salt 1 g, free liquid 1.8-2.2 l. Food temperature should not exceed 45 °C. Up to 200 g of vitamin C is added to the diet; other vitamins are added as prescribed by the doctor. Meals 7-8 times a day, for 1 meal give no more than 200-300 g.
Allowed: weak low-fat meat broth, rice broth with cream or butter, strained compote, liquid berry jelly, rosehip broth with sugar, fruit jelly, tea with lemon and sugar, freshly prepared fruit and berry juices diluted 2-3 times with sweet water (up to 50 ml per appointment). If the condition improves on the 3rd day, add: soft-boiled egg, 10 g butter, 50 ml cream.
Excluded: any dense or pureed foods, whole milk and cream, sour cream, grape and vegetable juices, carbonated drinks.
Diet No. 0b(No. 1a surgical). It is prescribed for 2-4 days after diet No. 0a, from which diet No. 0b differs in the addition of liquid pureed porridge from rice, buckwheat, rolled oats, cooked in meat broth or water. The diet contains 40-50 g of protein, 40-50 g of fat, 250 g of carbohydrates, energy value 6.5-6.9 MJ (1550-1650 kcal); 4-5 g of sodium chloride, up to 2 liters of free liquid. Food is given 6 times a day, no more than 350-400 g per meal.
Diet No. 0b(No. 1b surgical). It serves as a continuation of the expansion of the diet and the transition to physiologically nutritious nutrition. The diet includes puree soups and cream soups, steamed dishes from pureed boiled meat, chicken or fish, fresh cottage cheese, pureed with cream or milk to the consistency of thick sour cream, steamed dishes from cottage cheese, fermented milk drinks, baked apples, well-mashed fruit
and vegetable purees, up to 100 g of white crackers. Milk is added to tea; They give you milk porridge. The diet contains 80-90 g of protein, 65-70 g of fat, 320-350 g of carbohydrates, energy value 9.2-9.6 MJ (2200-2300 kcal); sodium chloride 6-7 g. Food is given 6 times a day. The temperature of hot dishes is not higher than 50 °C, cold - not less than 20 °C.
Therapeutic diets
Diet No. 1a
Indications: a sharp exacerbation of gastric and duodenal ulcers in the first 6-8 days of treatment, a sharp exacerbation of chronic gastritis in the first days of treatment, acute gastritis on the 2-4th day of treatment.
Destination goals: maximum mechanical, chemical and thermal sparing of the gastrointestinal tract, reducing inflammation, improving the healing of ulcers, providing nutrition during bed rest.
General characteristics: a diet of reduced energy value due to carbohydrates and slightly - proteins and fats. The amount of sodium chloride (table salt) is limited. Products and dishes that stimulate the secretion of the stomach and irritate its mucous membrane are excluded. Food is prepared in pureed form, boiled in water or steamed, and served in a liquid and mushy state. Hot and cold dishes are excluded.
proteins 80 g (60-70% animal), fats 80-90 g (20% vegetable), carbohydrates 200 g; energy value 8-8.4 MJ (1900-2000 kcal); sodium chloride 8 g, free liquid 1.5 l.
Diet: 6 times a day in small portions; milk at night.
Excluded products: bread and flour products, vegetables, snacks, fermented milk drinks, cheese, sour cream, regular cottage cheese, raw fruits, confectionery, sauces and spices, coffee, cocoa, carbonated drinks.
Diet No. 1b
Indications: peptic ulcer of the stomach and duodenum or chronic gastritis when a sharp exacerbation subsides after diet No. 1a, acute gastritis after diet No. 1a.
Destination goals: significant mechanical, chemical and thermal sparing of the gastrointestinal tract, reduction of inflammation, improvement of healing
treating ulcers, providing adequate nutrition with semi-bed rest.
General characteristics: The energy value of the diet is slightly reduced due to carbohydrates with a normal content of proteins and fats. Foods and dishes that stimulate the secretion of the stomach and irritate its mucous membrane are sharply limited. Food is boiled in water or steamed, pureed, and served in semi-liquid and puree form. The amount of sodium chloride is limited. Very hot and cold dishes are excluded.
Chemical composition and energy value: proteins 90 g (60-70% animal), fats 90-95 g (25% vegetable), carbohydrates 300-350 g; energy value 10.5-10.9 MJ (2500-2600 kcal); sodium chloride 8-10 g, free liquid 1.5 l.
Diet: 6 times a day; milk at night.
snacks, coffee, cocoa, carbonated drinks, raw fruits, confectionery, fermented milk drinks, cheese.
Diet No. 1
Indications: peptic ulcer of the stomach and duodenum during the recovery period after a sharp exacerbation and with a mild exacerbation, mild exacerbation of chronic gastritis with preserved or increased secretion, acute gastritis during the recovery period. When a peptic ulcer is combined with other organ diseases digestive system They use variants of diet No. 1. Diet No. 1 without mechanical sparing (“unworn”) is used at the last stage of treatment for exacerbation of peptic ulcer disease and in cases of low-symptom, sluggish course. In terms of the chemical composition and food set, this diet corresponds to the “mashed” diet No. 1. Foods and dishes that strongly stimulate gastric secretion are excluded.
Destination goals: moderate chemical, mechanical and thermal sparing of the gastrointestinal tract with adequate nutrition, reducing inflammation, improving the healing of ulcers, normalizing the secretory and motor functions of the stomach.
General characteristics: In terms of energy value, protein, fat and carbohydrate content, it is a physiologically complete diet. Strong stimulants of gastric secretion, irritants of its mucous membrane, lingering in the stomach for a long time and difficult to digest foods and dishes are limited. Food is prepared mainly
grated, boiled in water or steamed. Some dishes are baked without a crust. Fish and lean meats are allowed to be eaten in pieces. Table salt is moderately limited. Very cold and hot dishes are excluded.
Chemical composition and energy value: proteins 90-100 g (60% animal), fats 100 g (30% vegetable), carbohydrates 400-420 g; energy value 11.7-12.6 MJ (2800-3000 kcal); sodium chloride 10-12 g, free liquid 1.5 l.
Diet: 5-6 times a day; Before going to bed, milk and cream.
Excluded foods and dishes: rye and any fresh bread, products made from butter and puff pastry, meat and fish broths, mushroom and strong vegetable broths, cabbage soup, borscht, okroshka; fatty or stringy varieties of meat and poultry, duck, goose, canned food, smoked meats;
fatty, salty fish; high acidity dairy products, sharp, salty cheeses; hard-boiled and fried eggs; millet, pearl barley, barley, corn cereals; legumes; whole pasta; vegetables (white cabbage, turnips, rutabaga, radishes, sorrel, spinach, onions, cucumbers, salted, pickled and pickled vegetables, mushrooms, canned vegetable snacks); all spicy and salty snacks, sour, insufficiently ripe, fiber-rich fruits and berries, ungrated dried fruits, chocolate, ice cream;
Indications: chronic gastritis with secretory insufficiency during mild exacerbation and during the recovery stage after exacerbation; acute gastritis, enteritis, colitis during the recovery period as a transition to a balanced diet; chronic enteritis and colitis after and without exacerbation without concomitant diseases of the liver, biliary tract, pancreas or gastritis with preserved or increased secretion.
Destination goals: provide adequate nutrition, moderately stimulate the secretory function of the digestive organs, normalize motor function Gastrointestinal tract.
General characteristics: a physiologically complete diet with moderate mechanical sparing and moderate stimulation of the secretion of the digestive organs. Dishes of varying degrees of grinding and heat treatment are allowed - boiled, stewed, baked, fried without forming a rough crust (do not bread in
breadcrumbs or flour); pureed dishes - from foods rich in connective tissue or fiber. Avoid foods and dishes that linger in the stomach for a long time, are difficult to digest, irritate the gastrointestinal mucosa, as well as very cold and hot dishes.
Chemical composition and energy value: proteins 90-100 g (60% animal), fats 90-100 g (25% vegetable), carbohydrates 400-420 g; energy value 11.7-12.6 MJ (2800-3000 kcal); sodium chloride up to 15 g, free liquid 1.5 l.
Diet: 4-5 times a day without large meals.
Excluded foods and dishes: fresh bread and flour products from butter and puff pastry; milk soups, pea, bean, millet, okroshka; fatty and connective tissue-rich meats, duck, goose, smoked meats, canned food (except dietary ones); fatty types, salted, smoked fish, canned fish snacks; hard boiled eggs; legumes; limit: millet, pearl barley, barley, corn grits, raw ungrated vegetables, pickled and salted, onions, radishes, radishes, bell peppers, cucumbers, rutabaga, garlic, mushrooms; very spicy and fatty snacks; fatty and hot sauces, mustard, pepper, horseradish; coarse varieties of fruits and berries in raw form, berries with coarse grains (raspberries, red currants) or coarse skins (gooseberries), dates, figs, chocolate and cream products, ice cream; grape juice, kvass; lard, pork, beef, lamb and cooking fats.
Diet No. 3
Indications: chronic intestinal diseases with constipation with mild and subsiding exacerbation and without exacerbation, hemorrhoids, anal fissures without inflammation.
Purpose of destination: normalization of impaired intestinal functions and associated disorders metabolic processes in organism.
General characteristics: a physiologically complete diet that includes foods and dishes that enhance motor function and bowel movements (vegetables, fresh and dried fruits, baked goods, cereals, fermented milk drinks, etc.). Exclusion of foods and dishes that increase fermentation and putrefaction in the intestines and negatively affect other digestive organs (rich in essential oils, fried foods, etc.). Food is prepared mostly unchopped, boiled in water or steamed, or baked. Vegetables and
fruits in raw and boiled form. The diet includes cold first and sweet dishes and drinks.
Chemical composition and energy value: proteins 90-100 g (55% animal), fats 90-100 g (30% vegetable), carbohydrates 400-420 g; energy value 11.7-12.6 MJ (2800-3000 kcal); sodium chloride 15 g, free liquid 1.5 l.
Diet: 4-6 times a day. In the mornings are desirable cold water with honey or juices of fruits and vegetables, at night - kefir, compotes from fresh or dried fruits, fresh fruits, prunes.
Excluded foods and dishes: bread made from premium flour, puff pastry and pastry; fatty meats, duck, goose, smoked meats, canned food; fatty fish, smoked fish; hard-boiled eggs, fried; rice, semolina, sago, vermicelli, legumes; radish, radish, garlic, onion, turnip, mushrooms; fatty and spicy foods; jelly, blueberries, quince, dogwood, chocolate, products with cream; hot and fatty sauces, horseradish, mustard, pepper; cocoa, natural coffee, strong tea; animal and cooking fats.
Diet No. 4
Indications: acute enterocolitis with diarrhea after fasting days, exacerbation of chronic enteritis, dysentery, condition after intestinal surgery.
Destination goals: providing nutrition for indigestion, reducing inflammation, fermentation and putrefactive processes in the intestines, normalizing the functions of the intestines and other digestive organs.
General characteristics: a diet of reduced energy value due to fats and carbohydrates with a normal protein content. Mechanical, chemical and thermal irritants of the gastrointestinal tract are sharply limited. Products and dishes that increase the secretion of the digestive organs, the processes of fermentation and putrefaction in the intestines are excluded. Dishes are liquid, semi-liquid, pureed, boiled in water or steamed. Very hot and cold dishes are excluded.
Chemical composition and energy value: proteins 90 g (60-65% animals), fats 70 g, carbohydrates 250 g (40-50 g sugar); energy value 8.4 MJ (2000 kcal); sodium chloride 8-10 g, free liquid 1.5-2 l.
Mode meals: 5-6 times a day in small portions.
Excluded foods and dishes: bakery and flour products; soups with cereals, vegetables, pasta, dairy
fresh, strong and fatty broths; fatty types and varieties of meat, pieces of meat, sausages and other meat products; fatty fish, salted fish, caviar, canned food; whole milk and other dairy products; hard-boiled, raw, fried eggs; millet, pearl barley, barley, pasta, legumes; snacks; natural fruits and berries, dried fruits, compotes, honey, jam and other sweets; coffee and cocoa with milk, carbonated and cold drinks.
Diet No. 4b
Indications: acute intestinal diseases during the period of improvement; chronic diseases intestines after a sharp exacerbation or with a mild exacerbation, as well as in combination with damage to other digestive organs.
Destination goals: providing adequate nutrition in conditions of moderately impaired digestion, reducing inflammation and normalizing the functions of the intestines, as well as other digestive organs.
General characteristics: in terms of energy value and chemical composition, a complete diet with a slight increase in protein content. A diet with moderate restriction of mechanical and chemical irritants of the gastrointestinal mucosa. Products and dishes that increase rotting and fermentation in the intestines, as well as sharply stimulating the secretion of the stomach, pancreas, bile secretion and irritating the liver are excluded. Dishes are pureed and chopped, boiled in water or steamed. Hot and cold dishes are excluded.
Chemical composition and energy value: proteins 100-110 g (60-65% animals), fats 100 g (mainly butter), carbohydrates 400-420 g (50-70 g sugar); energy value 12.2-12.6 MJ (2900-3000 kcal); sodium chloride 8-10 g, free liquid 1.5 l.
Diet: 5-6 times a day.
Excluded foods and dishes: rye bread, wholemeal wheat bread, fresh bread, pastry and puff pastry products; legume soup, milk soup, cabbage soup, borscht, rassolnik, cold soups (okroshka, beetroot soup); fatty types and varieties of meat, duck, goose, smoked meats, sausages, canned food; fatty fish, salted, smoked fish, canned food; milk in its natural form, all dairy products with increased acidity, sharp, salty cheeses; hard-boiled eggs
thuja, fried; legumes, porridge from pearl barley, barley, millet; white cabbage, beets, radishes, radishes, onions, garlic, cucumbers, rutabaga, turnips, sorrel, spinach, mushrooms; grapes, apricots, plums, dried fruits, ice cream, chocolate, cakes; hot, fatty sauces, mustard, horseradish, pepper; grape, plum, apricot juices, kvass, fruit drink.
Diet No. 4c
Indications: acute intestinal diseases during the recovery period as a transition to a balanced diet; chronic intestinal diseases during the period of recovery after an exacerbation, as well as outside of an exacerbation with concomitant lesions of other digestive organs.
Destination goals: providing adequate nutrition with some insufficiency of intestinal functions, restoring the latter and the activity of other digestive organs.
General characteristics: a physiologically complete diet with a slight increase in protein content and a moderate limitation of table salt, mechanical and chemical irritants of the intestines, with the exception of foods and dishes that increase fermentation and putrefaction in the intestines, sharply increasing its secretory and motor functions, the secretion of the stomach, pancreas, and bile secretion. Food is given uncut, steamed, boiled in water or baked. The food temperature is normal.
Chemical composition and energy value: proteins 100-120 g (60% animal), fats 100 g (15-20% vegetable), carbohydrates 400-420 g; energy value 12.2-12.6 MJ (2900-3000 kcal); sodium chloride 10 g, free liquid 1.5 l.
Power mode: 5 once a day.
Excluded foods and dishes: rye bread, fresh, butter and puff pastry products; strong, fatty broths, milk soups, cabbage soup, borscht, rassolnik, okroshka, bean and mushroom soup; fatty meats, duck, goose, most sausages, smoked meats, canned food; fatty fish, salted and smoked fish; sharp, salty cheeses, dairy products with high acidity; hard-boiled eggs, fried; bean porridge; radishes, radishes, onions, garlic, cucumbers, rutabaga, turnips, sorrel, spinach, mushrooms; spicy and fatty snacks; apricots, plums, figs, dates, berries with rough skin, ice cream, chocolate, cakes; hot and fatty sauces, mustard, horseradish, pepper; grape, plum, apricot juices.
Diet No. 5
Indications: acute hepatitis and cholecystitis in the recovery stage; chronic hepatitis without exacerbation; cirrhosis of the liver without liver failure; chronic cholecystitis and cholelithiasis without exacerbation. In all cases - without severe diseases of the stomach and intestines.
Destination goals: chemical sparing of the liver in conditions of adequate nutrition, improvement of liver function and activity of the biliary tract, bile secretion.
General characteristics: physiologically normal content of proteins and carbohydrates with a slight restriction of fats (mainly refractory). Avoid foods rich in nitrogenous extractives, purines, cholesterol, oxalic acid, essential oils and fat oxidation products that arise during frying. The content of lipotropic substances, fiber, pectins, and liquids is increased. Dishes are prepared boiled, baked, and sometimes stewed. Only pureed meat and fiber-rich vegetables are pureed; flour and vegetables are not sautéed. Very cold dishes are excluded.
Chemical composition and energy value: proteins 90-100 g (60% animal), fats 80-90 g (30% vegetable), carbohydrates 400-450 g (70-80 g sugar); energy value 11.7-12.2 MJ (2800-2900 kcal); sodium chloride 10 g, free liquid 1.5-2 l. You can include xylitol and sorbitol (25-40 g).
Diet: 5 times a day; kefir at night.
Excluded foods and dishes: very fresh bread, puff pastry and pastry, fried pies; meat, fish and mushroom broths, okroshka, green cabbage soup; fatty meats, duck, goose, liver, kidneys, brains, smoked meats, most sausages, canned food; fatty fish, smoked and salted fish; hard-boiled and fried eggs; legumes; spinach, sorrel, radish, radish, green onions, garlic, mushrooms, pickled vegetables; spicy and fatty snacks, caviar; chocolate, cream products, ice cream; mustard, pepper, horseradish; black coffee, cocoa, cold drinks; pork, beef, lamb lard, cooking fats.
Diet No. 5a
Indications: acute hepatitis and cholecystitis; exacerbation of chronic hepatitis, cholecystitis and cholelithiasis; cirrhosis of the liver with moderate liver failure; chronic
hepatitis or cholecystitis in combination with peptic ulcer, severe gastritis, enterocolitis with diarrhea.
Destination goals: chemical, mechanical and thermal sparing of all digestive organs, creating maximum liver rest; improvement of impaired liver and biliary tract functions.
General characteristics: the diet is limited to fats (mostly refractory), proteins and carbohydrates within the physiological norm. Products and dishes rich in extractives, purines, oxalic acid, cholesterol, coarse fiber, and fried foods are excluded. Increased content of lipotropic substances, vitamins, and fluids. Dishes are prepared boiled, pureed, some baked without a rough crust. Food is given warm, cold dishes are excluded.
Chemical composition and energy value: proteins 90-100 g (60% animal), fats 70-75 g (20-25% vegetable), carbohydrates 350-400 g (80-90 g sugar); energy value 10.5-10.9 MJ (2500-2600 kcal); sodium chloride 8 g, free liquid 2-2.5 l.
Diet: 5-6 times a day, in small portions.
Excluded foods and dishes: fresh and Rye bread, butter and puff pastry; meat, fish, mushroom broths, legume broths, duck, goose; fried, stewed and pieced meat; liver, brains, kidneys, sausages, smoked meats, canned food; fatty, salted, fried, stewed fish, caviar; cream, fatty and high-acid cottage cheese, salty, spicy cheese; legumes; pasta, millet, crumbly porridge; mushrooms, salted, pickled, pickled vegetables, cabbage, turnips, radishes, sorrel, garlic, onions; sour and fiber-rich fruits, chocolate, ice cream, cream products; spices; cocoa, black coffee, cold and carbonated drinks.
Diet No. 5p
Indications: chronic pancreatitis during the recovery period after an exacerbation and outside of an exacerbation.
Destination goals: normalization of pancreatic function, providing mechanical and chemical sparing of the stomach and intestines, reducing excitability of the gallbladder, preventing fatty infiltration of the liver and changes in the pancreas.
General characteristics: a diet with a high protein content, reduced fat and carbohydrates, in particular sugar. Sharply limited
Extractive substances, purines, refractory fats, cholesterol, essential oils, coarse fiber are excluded, fried foods are excluded. The amount of vitamins and lipotropic substances has been increased. Dishes are mainly pureed and chopped, boiled in water or steamed, baked. Hot and very cold dishes are excluded.
Chemical composition and energy value: proteins 110-120 g (60-65% animal), fats 80 g (15-20% vegetable), carbohydrates 350-400 g (30-40 g sugar; 20-30 g xylitol instead of sugar in sweet dishes); energy value 10.9-11.3 MJ (2600-2700 kcal); sodium chloride 10 g, free liquid 1.5 l.
Diet:
Excluded foods and dishes: rye and fresh bread, puff pastry and pastry products; soups with meat and fish broths, decoctions of mushrooms and vegetables, with millet, milk soups, borscht, cabbage soup, okroshka, beetroot soup; fatty meats, duck, goose, fried and stewed meat, smoked meats, sausages, canned food, liver, brains, kidneys; fatty fish, fried and stewed, smoked, salted fish, caviar; dairy products with high fat content and added sugar; dishes made from whole eggs, especially hard-boiled and fried; legumes, crumbly porridges; white cabbage, eggplant, radish, turnip, radish, onion, garlic, sorrel, spinach, sweet pepper, mushrooms; raw unprocessed fruits and berries, grapes, dates, figs, bananas, confectionery, chocolate, jam, ice cream; all spices; coffee, cocoa, carbonated and cold drinks, grape juice.
Diet No. 6
Indications: gout, urolithiasis disease with the formation of stones from salts of uric and oxalic acids.
Destination goals: normalization of purine metabolism, reduction of formation in the body uric acid and its salts, shift the urine reaction to the alkaline side.
General characteristics: exclusion of foods containing a lot of purines and oxalic acid; moderate restriction of sodium chloride, increasing the amount of alkalizing foods (dairy, vegetables and fruits) and free fluid [in the absence of contraindications from the cardiovascular system (CVS)]. A slight decrease in the diet of proteins and fats (mainly refractory), and with concomitant obesity - carbohydrates. Cooking is common, but meat, poultry and fish must be boiled. The food temperature is normal.
Chemical composition and energy value: proteins 70-80 g (50% animal), fats 80-90 g (30% vegetable), carbohydrates 400 g (80 g sugar); energy value 11.3-11.7 MJ (2700-2800 kcal); sodium chloride 10 g, free liquid 1.5-2 l or more.
Diet:
Excluded foods and dishes: meat, fish and mushroom broths, sorrel and spinach soups; liver, kidneys, tongue, brains, meat of young animals and birds, sausages, smoked meats, salted fish, canned meat and fish, caviar; salted cheeses; legumes; mushrooms; fresh legume pods, spinach, sorrel, rhubarb, cauliflower; salty snacks; chocolate, figs, raspberries, cranberries; sauces based on meat, fish, mushroom broths, pepper, mustard, horseradish; cocoa, strong tea and coffee; beef, lamb, cooking fats. Limit pork fat.
Diet No. 7
Indications: acute nephritis during the recovery period (from the 3-4th week of treatment); chronic nephritis without exacerbation and without kidney failure.
Destination goals: moderate sparing of renal function, weakening arterial hypertension and reducing edema, improving the excretion of nitrogenous and other metabolic products from the body.
General characteristics: the protein content is somewhat limited, fats and carbohydrates are within the physiological norm. Food is prepared without sodium chloride. Salt is given to the patient in the amount specified by the doctor (3-6 g or more). The amount of free liquid is reduced to an average of 1 liter. Exclude extractive substances from meat, fish, mushrooms, sources of oxalic acid and essential oils. Meat and fish (100-150 g per day) are boiled. The food temperature is normal.
Chemical composition and energy value: proteins 80 g (50-60% animal), fats 90-100 g (25% vegetable), carbohydrates 400-450 g (80-90 g sugar); energy value 11.3-12.2 MJ (2700-2900 kcal); free liquid 0.9-1.1 l.
Diet: 4-5 times a day.
Excluded foods and dishes: regular bread, flour products with added sodium chloride; meat, fish and mushroom broths; fatty meats, fried and stewed dishes without boiling, sausages, sausages, smoked meats, canned food; fatty fish, salted, smoked fish, caviar; cheeses; legumes; garlic, radish, radish, sorrel, spinach, salted, pickled and pickled vegetables, mushrooms;
chocolate; meat, fish and mushroom sauces, pepper, mustard, horseradish; strong coffee, cocoa, mineral waters rich in sodium.
Diet No. 7a
Indications: acute nephritis in severe form after fasting days and moderate severity from the first days of illness; chronic nephritis with severe chronic renal failure (CRF).
Destination goals: maximum sparing of kidney function, improved elimination of metabolic products from the body, weakening of arterial hypertension and reduction of edema.
General characteristics: predominantly plant-based diet with a sharp restriction of proteins, with the exception of sodium chloride. The amount of fats and carbohydrates is moderately reduced. Avoid products rich in extractives, essential oils, and oxalic acid. Culinary processing: boiling, baking, light frying. Food is prepared without salt, bread is salt-free. The amount of liquid should correspond to or no more than 300-400 ml exceed the amount of urine excreted by the patient over the previous day.
proteins 20 g (50-60% animal, and with chronic renal failure - 70-75%), fats 80 g (15% vegetable), carbohydrates 350 g (80 g sugar); energy value 8.8-9.2 MJ
(2100-2200 kcal).
Diet: 5-6 times a day; the diet is prescribed for 5-6 days.
Excluded foods and dishes: ordinary bread, flour products with added salt; meat, fish, mushroom broths, milk soups, cereals (except sago) and legumes; all meat and fish products (sausages, canned food, etc.); cheese; cereals (except rice) and pasta, legumes; salted, pickled and pickled vegetables, spinach, sorrel, cauliflower, mushrooms, radish, garlic; chocolate, milk jelly, ice cream; meat, fish, mushroom sauces; mustard, pepper, horseradish; cocoa, natural coffee, mineral waters rich in sodium.
Diet No. 7b
Indications: acute nephritis after diet No. 7a or immediately with a mild form; chronic nephritis with moderate chronic renal failure.
Destination goals: maximum sparing of kidney function, improved elimination of metabolic products from the body, reduction of arterial hypertension and easing of edema.
General characteristics: a diet with a significant reduction in protein and a sharp restriction of sodium chloride.
Fats, carbohydrates and energy value are within the physiological norm. Culinary processing, list of excluded foods and dishes - see diet No. 7a. Food is prepared without salt. Compared to diet No. 7a, the amount of protein has been doubled, mainly due to the inclusion of 125 g of meat or fish, 1 egg, up to 125 g of milk and sour cream. Meat and fish can be replaced with cottage cheese, taking into account the protein content in these products. The amount of protein-free, salt-free cornstarch bread, sago (or rice), as well as potatoes and vegetables (300 g and 650 g, respectively), sugar and vegetable oil has been increased to 150 g to ensure adequate fat and carbohydrate content. Energy value and chemical composition:
Diet: 5-6 times a day.
proteins 40-50 g (50-60% animal, with chronic renal failure - 70-75%), fats 85-90 g (20-25% vegetable), carbohydrates 450 g (100 g sugar); energy value 10.9-11.7 MJ (2600-2800 kcal). Free fluid under the control of the amount of urine and other clinical indicators (see diet No. 7a), on average 1-1.2 liters.
Indications: Diet No. 7b
Destination goals: nephrotic syndrome in chronic kidney pathology and other diseases.
General characteristics: replenishment of protein lost in urine, normalization of protein, fat, cholesterol metabolism, reduction of edema.
Chemical composition and energy value: a diet of physiologically normal energy value with an increase in proteins, a moderate decrease in fats (at the expense of animals), and a normal carbohydrate content. Sharp limitation of sodium chloride, liquids, extractives, cholesterol, oxalic acid, limitation of sugar, increase in the amount of lipotropic substances. Meat and fish are boiled. Food is prepared without salt. The food temperature is normal.
Diet: proteins 120-125 g (60-65% animal), fats 80 g (30% vegetable), carbohydrates 400 g (50 g sugar); energy value 11.7 MJ (2800 kcal); free liquid 0.8 l.
Excluded foods and dishes: 5-6 times a day; kefir at night.
regular bread, butter and puff pastry; meat, fish, mushroom broths; fatty meats, liver, kidneys, brains, sausages, smoked meats, canned meat and vegetables;
fatty fish, salted, smoked fish, caviar; salty, sharp cheeses; radish, garlic, sorrel, spinach, salted vegetables; chocolate, cream products; meat, fish, mushroom sauces, mustard, horseradish, pepper; cocoa, sodium-rich mineral waters.
Indications: Diet No. 7g
Purpose of destination: ensuring a balanced diet, taking into account the characteristics of metabolism in case of severe kidney failure and side effects hemodialysis.
General characteristics: moderate restriction of proteins (mostly vegetable) and potassium, sharp restriction of sodium chloride and a significant decrease in free fluid.
Chemical composition and energy value: A diet of normal energy value from fats and carbohydrates. Food is prepared without salt, bread is salt-free. In the absence of arterial hypertension and edema, the patient is given 2-3 g of sodium chloride. Limit potassium-rich foods. A sufficient supply of essential amino acids is provided by meat, fish, eggs and limited dairy products. Meat and fish are boiled. The taste of dishes is improved with sauces, spices, and citric acid. The food temperature is normal.
Diet: proteins 60 g (75% animal), fats 100-110 g (30% vegetable), carbohydrates 400-450 g (100 g sugar and honey); energy value 11.7-12.1 MJ (2800-2900 kcal); potassium up to 2.5 g, free liquid 0.7-0.8 l.
Excluded foods and dishes: 6 times a day.
ordinary bread (except wheat and salt-free) and flour products; meat, fish, mushroom broths; sausages, salted fish, smoked meats, canned food, caviar; cheese; legumes; salted, pickled, pickled vegetables, mushrooms, rhubarb, spinach, sorrel; chocolate, dried fruits, confectionery; meat, fish, mushroom sauces; cocoa; refractory fats.
Indications: Diet No. 8
Purpose of destination: obesity as a primary disease or concomitant with other diseases that do not require special diets.
General characteristics: impact on metabolism to eliminate excess fat deposits.
Chemical composition and energy value: a decrease in the energy value of the diet due to carbohydrates, especially easily digestible ones, and to a lesser extent fats (mainly animals) with a normal or slightly increased protein content. Restriction of free fluid, sodium chloride and appetite-stimulating foods and dishes. Increased dietary fiber content. Dishes are prepared boiled, stewed, baked. Fried, pureed and chopped products are undesirable. They use sugar substitutes for sweet dishes and drinks (xylitol and sorbitol are taken into account in the energy value of the diet). The food temperature is normal.
Diet: proteins 90-110 g (60% animal), fats 80-85 g (30% vegetable), carbohydrates 150 g; energy value 7.1-7.5 MJ (1700-1800 kcal); sodium chloride 5-6 g, free liquid 1-1.2 l.
Excluded foods and dishes: 5-6 times a day with sufficient volume to feel full; at night low-fat kefir. products from highest and first grade, butter and puff pastry; milk, potato, cereal, legume, and pasta soups; fatty meats, goose, duck, ham, sausages, boiled and smoked sausages, canned food; fatty, salted, smoked fish, canned fish in oil, caviar; fatty cottage cheese, sweet cheeses, cream, sweet yogurt, fermented baked milk, baked milk, fatty and salty cheeses; fried eggs; cereals (except buckwheat, pearl barley and barley); pasta; legumes; fatty and spicy snacks; grapes, raisins, bananas, figs, dates, very sweet varieties of other fruits, sugar, confectionery, jam, honey, ice cream, jelly; fatty and spicy sauces, mayonnaise, all spices; grape and other sweet juices, cocoa; meat and cooking fats.
Diet No. 9
Indications: mild to moderate diabetes mellitus; patients with normal or slightly overweight who do not receive insulin or receive it in small doses (20-30 units); Diet No. 9 is also prescribed when selecting doses of insulin or other glucose-lowering drugs. Options for diet No. 9 have been developed, taking into account the nature of insulin therapy, concomitant diseases and other factors.
Destination goals: improvement of carbohydrate metabolism and prevention of lipid metabolism disorders, determination of carbohydrate tolerance (how much carbohydrate food is absorbed).
General characteristics: a diet with a moderately reduced energy value due to easily digestible carbohydrates and animal fats. The protein content corresponds to the physiological norm. Sugar and sweets are excluded. Moderately limited content of sodium chloride, cholesterol, extra active substances. The content of lipotropic substances, vitamins, and dietary fiber has been increased. It is recommended to eat foods such as cottage cheese, lean fish, seafood, vegetables, fruits, whole grain cereals, and wholemeal bread. Boiled and baked products are preferred, to a lesser extent fried and stewed. For sweet dishes and drinks, xylitol or sorbitol are used instead of sugar, which are taken into account in the energy value of the diet. The food temperature is normal.
Chemical composition and energy value: proteins 90-100 g (55% animal), fats 75-80 g (30% vegetable), carbohydrates 300-350 g (mainly polysaccharides); energy value 9.6-10.5 MJ (2300-2500 kcal); sodium chloride 12 g, free liquid 1.5 l.
Diet: 5-6 times a day with an even distribution of carbohydrates.
Excluded foods and dishes: products made from butter and puff pastry; strong, fatty broths, milk soups with semolina, rice, noodles; fatty meats, duck, goose, smoked meats, most sausages, canned food; fatty, salted fish, canned food in oil, caviar; salty cheeses, sweet curd cheeses, cream; rice, semolina and pasta; salted and pickled vegetables; grapes, raisins, bananas, figs, dates, sugar, jam, sweets, ice cream; fatty, spicy and salty sauces; grape and other sweet juices, sugar-based lemonades; meat and cooking fats.
Diet No. 10
Indications: CVD diseases without clinical signs of heart failure.
Destination goals: improving blood circulation, functioning of the cardiovascular system, liver and kidneys, normalizing metabolism, sparing the cardiovascular system and digestive organs.
General characteristics: a slight decrease in energy value due to fats and partly carbohydrates. Significantly limiting the amount of sodium chloride, reducing fluid intake. The content of substances that excite the cardiovascular and nervous systems, irritate the liver and kidneys, and excessive
burdening the gastrointestinal tract, promoting flatulence. The content of potassium, magnesium, lipotropic substances, and foods that have an alkalizing effect (dairy, vegetables, fruits) has been increased. Meat and fish are boiled. Avoid hard-to-digest foods. Food is prepared without salt. The food temperature is normal.
Chemical composition and energy value: proteins 90 g (55-60% animal), fats 70 g (25-30% vegetable), carbohydrates 350-400 g; energy value 10.5-10.9 MJ (2500-2600 kcal); sodium chloride 6-7 g (3-5 g per hand), free liquid 1.2 l.
Diet: 5 times a day in relatively even portions.
Excluded foods and dishes: fresh bread, butter and puff pastry products, pancakes, pancakes; legume soups, meat, fish, mushroom broths; fatty meats, goose, duck, liver, kidneys, brains, smoked meats, sausages, canned meat; fatty, salted, smoked fish, caviar, canned fish; salty and fatty cheeses; hard-boiled eggs, fried; legumes; salted, pickled, pickled vegetables; spinach, sorrel, radish, radish, garlic, onions, mushrooms; spicy, fatty and salty snacks; fruits with coarse fiber, chocolate, cakes; sauces based on meat, fish, mushroom broth, mustard, pepper, horseradish;
natural coffee, cocoa; meat and cooking fats.
Indications: Diet No. 10a
Destination goals: diseases of the cardiovascular system with severe symptoms of heart failure.
General characteristics: reduction in energy value due to proteins, carbohydrates and especially fats. The amount of sodium chloride and liquid is sharply limited. Food is prepared without salt, bread is salt-free. Foods and substances that excite the central nervous and cardiovascular systems, irritate the liver and kidneys, and promote flatulence (extractive substances from meat and fish, fiber, fatty foods, cholesterol, tea and coffee, etc.) are sharply limited. Sufficient content of potassium, lipotropic substances, foods that alkalize the body (dairy products, fruits, vegetables). Dishes are prepared boiled and pureed, giving them
sour or sweet taste, flavored. Fried foods are prohibited. Hot and cold dishes are excluded.
Chemical composition and energy value: proteins 60 g (70% animal), fats 50 g (20-25% vegetable), carbohydrates 300 g (70-80 g sugar and other sweets); energy value 7.9 MJ (1900 kcal); sodium chloride is excluded, free liquid is 0.6-0.7 l.
Diet: 6 times a day in small portions; The diet is prescribed for a limited time - no more than 4 weeks.
Excluded foods and dishes: fresh and other types of bread, baked goods; fatty, stringy meat, pork, lamb, duck, goose, sausages, smoked meats, canned food; fatty, salted, smoked fish, caviar; cheese; hard-boiled eggs, fried; millet, barley, pearl barley, legumes, pasta; fruits with coarse fiber, hard skin, grapes; chocolate, cream products; sauces based on meat, fish, mushroom broths, fatty sauces, horseradish, pepper, mustard; natural coffee, cocoa, grape juice, carbonated drinks, kvass; fats (except for fresh butter and, if tolerated, refined vegetable oils, 5-10 g per dish).
Diet No. 10c
Indications: atherosclerosis with damage to the vessels of the heart, brain or other organs; myocardial infarction in the scarring stage, hypertension.
Destination goals: slowing down the development of atherosclerosis, reducing the severity of metabolic disorders, improving blood circulation, reducing excess body weight, providing nutrition without overloading the cardiovascular system and central nervous system (CNS), liver, kidneys.
General characteristics: the diet reduces the content of animal fat and easily digestible carbohydrates. The protein content corresponds to the physiological norm. The degree to which the intake of fats and carbohydrates is reduced depends on body weight (see two diet options below). Table salt, free liquid, extractives, cholesterol are limited. The content of vitamins C and group B, linoleic acid, lipotropic substances, dietary fiber, potassium, magnesium, microelements (vegetable oils, vegetables and fruits, seafood, cottage cheese) has been increased. Dishes are prepared without salt; food is added at the table. Meat and fish are boiled, vegetables and fruits with coarse fiber are chopped and boiled. The food temperature is normal.
Option I: proteins 90-100 g (50% animal), fats 80 g (40% vegetable), carbohydrates 350-400 g (50 g sugar); energy value 10.9-11.3 MJ (2600-2700 kcal).
Option II (with concomitant obesity): proteins 90 g, fats 70 g, carbohydrates 300 g; energy value 9.2 MJ (2200 kcal); sodium chloride 8-10 g, free liquid 1.2 l.
Diet: 5 times a day in small portions; kefir at night.
Excluded foods and dishes: products made from butter and puff pastry; meat, fish, mushroom broths, legume broths; fatty meats, duck, goose, liver, kidneys, brains, sausages, smoked meats, canned food; fatty fish, salted and smoked fish, caviar; salty and fatty cheese, heavy cream, sour cream and cottage cheese; radish, radish, sorrel, spinach, mushrooms; fatty, spicy and salty seafood; limited or excluded (for obesity): grapes, raisins, sugar, honey (instead of sugar), jam, chocolate, cream products, ice cream; meat, fish, mushroom sauces, pepper, mustard; strong tea and coffee, cocoa; meat and cooking fats.
Diet No. 10i
Indication: myocardial infarction.
Destination goals: facilitating recovery processes in the heart muscle, improving blood circulation and metabolism, reducing the load on the cardiovascular system, normalizing intestinal motor function.
General characteristics: a diet with a significant reduction in energy value due to proteins, carbohydrates and especially fats, a decrease in food volume, and a limitation of sodium chloride and free fluid. Avoid foods that are difficult to digest, cause fermentation in the intestines and flatulence, are rich in cholesterol, animal fats and sugar, as well as extractive substances from meat and fish. Inclusion of foods rich in lipotropic substances, vitamins C and P, potassium, as well as foods that gently stimulate intestinal motility (to combat constipation).
Diet No. 10 consists of three sequentially prescribed diets.
I diet is given during the acute period (1st week).
Diet II is prescribed in the subacute period (2-3 weeks).
III diet is indicated during the scarring period (4th week).
In ration I, the dishes are pureed, in ration II - mostly chopped, in ration III - chopped and in pieces. Food is prepared without salt, in boiled form. Avoid cold (less than 15 °C) foods and drinks.
Chemical composition and energy value
I diet: proteins 50 g, fats 30-40 g, carbohydrates 150-200 g; energy value 4.6-5.4 MJ (1100-1300 kcal); free liquid 0.7-0.8 l; diet weight 1.6-1.7 kg.
II diet: proteins 60-70 g, fats 50-60 g, carbohydrates 230-250 g; energy value 7.1-7.5 MJ (1600-1800 kcal); sodium chloride 3 g (on hands), free liquid 0.9-1 l; diet weight 2 kg.
III diet: proteins 85-90 g, fats 70 g, carbohydrates 300-350 g; energy value 9.2-10 MJ (2200-2400 kcal); sodium chloride 5-6 g (on hands), free liquid 1-1.1 l; diet weight
Diet: I-II rations - food is given 6 times a day, III ration - 5 times a day in small portions.
Excluded foods and dishes: fresh bread, baked goods, baked goods, fatty types and varieties of meat, poultry, fish, liver and other meat by-products, sausages, canned food, caviar, whole milk and cream, egg yolks, millet, pearl barley, barley, legumes, white cabbage , cucumbers, radishes, onions, garlic, spices, animal and cooking fats, chocolate and other confectionery products, natural coffee and cocoa, grape juice.
Diet No. 11
Indications: tuberculosis of the lungs, bones, lymph nodes, joints with a mild exacerbation or its subsidence, with low body weight; exhaustion after infectious diseases, operations, injuries; in all cases - in the absence of damage to the digestive organs. Options for diet No. 11 have been developed, taking into account the localization and nature of the tuberculosis process, the state of the digestive organs, and the presence of complications.
Destination goals: improving the nutritional state of the body, increasing its defenses, enhancing recovery processes in the affected organ.
General characteristics: a diet of high energy value with a predominant increase in the content of proteins, vitamins, minerals (calcium, iron, etc.), a moderate increase in the amount of fats and carbohydrates. Cooking and food temperature are normal.
Chemical composition and energy value: proteins 110-130 g (60% animal), fats 100-120 g (20-25% vegetable), carbohydrates 400-450 g; energy value 12.6-14.2 MJ (3000-3400 kcal); sodium chloride 15 g, free liquid 1.5 l.
Diet: 5 times a day; kefir at night.
Excluded foods and dishes: very fatty meats and poultry, lamb, beef and cooking fats; spicy and fatty sauces, cakes and pastries with a lot of cream.
Diet No. 12
Indications: diseases of the central nervous system accompanied by increased nervous excitability; transition period of nutrition from diet No. 10 to normal nutrition.
Destination goals: decreased excitability of the central nervous system, gentle transition to an expanded diet.
General characteristics: sufficient calorie content with normal protein, fat and carbohydrate content; increased calcium content. Maximum restriction of stimulant products nervous system. Culinary processing is varied, without restrictions.
Chemical composition: proteins 100-110 g, fats 90-100 g, carbohydrates 450-550 g; sodium chloride 12-15 g, calcium 1-1.2 g. Diet: 5-6 times a day.
Excluded foods and dishes: strong meat and fish broths; spicy dishes, snacks and spices (mustard, pepper, etc.); strong tea, coffee, chocolate, alcoholic drinks.
Diet No. 13
Indications: spicy infectious diseases in acute febrile periods, sore throats.
Destination goals: maintaining the general strength of the body and increasing its resistance to infection, reducing intoxication, sparing the digestive organs in conditions of a feverish state and bed rest.
General characteristics: a diet of reduced energy value due to fats, carbohydrates and, to a lesser extent, proteins; increased content of vitamins and fluids. With a diverse food set, easily digestible foods and dishes that do not contribute to flatulence and constipation prevail. Avoid sources of coarse fiber, fatty, salty, indigestible foods and
dishes.
Chemical composition and energy value: Food is prepared chopped and pureed, boiled in water or steamed. Dishes are served hot (no more than 55-60 °C) or cold (but not less than 12 °C).
Diet: proteins 75-80 g (60-70% animal, especially dairy), fats 60-70 g (15% vegetable), carbohydrates 300-350 g (30% easily digestible); energy value 9.2-9.6 MJ (2200-2300 kcal); sodium chloride 8-10 g (increase with heavy sweating, profuse vomiting), free liquid 2 liters or more.
Excluded foods and dishes: 5-6 times a day in small portions.
rye and any fresh bread, muffins, baked goods; fatty broths, cabbage soup, borscht, legume and millet soups; fatty meats, duck, goose, lamb, pork, sausage, canned food; fatty fish, salted, smoked fish; whole milk and cream, full-fat sour cream, sharp, fatty cheeses; hard-boiled and fried eggs; millet, pearl barley, barley, corn grits, legumes, pasta; white cabbage, radishes, radishes, onions, garlic, cucumbers, rutabaga, mushrooms; fatty and spicy snacks, smoked meats, vegetable salads; fruits rich in fiber, with rough skin, chocolate, cakes; hot, fatty sauces, spices; cocoa.
Indications: Diet No. 14
Destination goals: restoring the acidity of urine and thus preventing sedimentation.
General characteristics: In terms of energy value, protein, fat and carbohydrate content, the diet corresponds to physiological standards; the diet is limited to alkalizing products and calcium-rich foods (dairy products, most vegetables and fruits); foods that change the urine reaction to the acidic side predominate (bread and flour products, cereals, meat, fish). Cooking and food temperature are normal. If there are no contraindications, drink plenty of fluids.
Chemical composition and energy value: proteins 90 g, fats 100 g, carbohydrates 380-400 g; energy value 11.7 MJ (2800 kcal); sodium chloride 10-12 g, free liquid 1.5-2.5 l.
Diet: Drink 4 times a day, in between and on an empty stomach.
Excluded foods and dishes: milk, vegetable and fruit soups; smoked meats; salted, smoked fish; milk, fermented milk
drinks, cottage cheese, cheese; vegetables (except peas and pumpkins), potatoes; vegetable salads, vinaigrettes, canned vegetables; fruits and berries (except for sour varieties of apples, cranberries, lingonberries); fruit, berry and vegetable juices.
Diet No. 15 (“common table”)
Indications: no indications for prescribing a special diet, transitional diet to normal nutrition during the recovery period and after the use of therapeutic diets. “Common table” is prescribed to patients without dysfunctions of the gastrointestinal tract.
Purpose of destination: providing physiologically adequate nutrition in a hospital setting.
General characteristics: energy value and content of proteins, fats and carbohydrates almost completely correspond to nutritional standards for healthy person not engaged in physical labor. Vitamins are administered in increased quantities. All methods of culinary food processing are allowed. The food temperature is normal. The most indigestible and spicy foods are excluded from the diet.
Chemical composition and energy value: proteins 90-95 g (55% animal), fats 100-105 g (30% vegetable), carbohydrates 400 g; energy value 11.7-12.1 MJ (2800-2900 kcal); sodium chloride 15 g, free liquid 1.5-2 l.
Diet: 4 times a day.
Excluded foods and dishes: fatty meats, duck, goose, refractory animal fats, pepper, mustard.
Standard diet system
Currently, the Order of the Ministry of Health of the Russian Federation dated August 5, 2003 “On measures to improve therapeutic nutrition in medical institutions of the Russian Federation” has approved a new range of therapeutic diets - a system of standard diets, including five options.
The formation of variants of standard diets is carried out not according to the main nosological forms (diseases), which underlay the formation of diets (tables) as such, as described above, but in relation to mechanical and chemical sparing, the amount of protein and calorie content.
1. The main version of the standard diet, combining numbered diets Nos. 1, 2, 3, 5, 6, 7, 9, 10, 13, 14 and 15. Indications for use: chronic gastritis in remission, gastric ulcer
ca and duodenum in remission, chronic intestinal diseases with a predominance of irritable bowel syndrome with predominant constipation, acute cholecystitis and acute hepatitis in the recovery stage, chronic hepatitis with mild signs of functional liver failure, chronic cholecystitis and cholelithiasis, gout, uric acid diathesis, nephrolithiasis, hyperuricemia, phosphaturia, type 2 diabetes mellitus without concomitant overweight or obesity, cardiovascular diseases with mild circulatory disorders (hypertension, ischemic heart disease, atherosclerosis, cerebral and peripheral vessels), acute infectious diseases, febrile conditions.
2. Diet option with mechanical and chemical sparing(diets No. 1b, 4b, 4c, 5p). Indications for use: peptic ulcer of the stomach and duodenum in the acute stage, acute gastritis, chronic gastritis with high acidity in the stage of mild exacerbation, gastroesophageal reflux disease, dysfunction of the masticatory apparatus, acute pancreatitis in the stage of subsiding exacerbation, severe exacerbation of chronic pancreatitis, recovery period after acute infections, after operations (not on internal organs).
3. High Protein Diet Option(high-protein diet - diets No. 4, 5, 7c, 7d, 9, 10, 11). Indications for use: condition after gastric resection 2-4 months due to peptic ulcer in the presence of dumping syndrome, cholecystitis, hepatitis; chronic enteritis in the presence of a pronounced impairment of the functional state of the digestive organs, chronic pancreatitis in the remission stage, chronic glomerulonephritis in the nephrotic version in the stage of subsiding exacerbation without impairment of the nitrogen excretion function of the kidneys, diabetes mellitus type 1 or 2 without concomitant obesity and impairment of the nitrogen excretion function of the kidneys, rheumatism with low the degree of activity of the process during a protracted course without circulatory disorders, pulmonary tuberculosis, suppurative processes, anemia, burn disease.
4. Low Protein Diet Option(low-protein diet - numbered diets No. 7a, 7b). Indications for use: chronic glomerulonephritis with severe and moderate impairment of nitrogen excretory function of the kidneys.
5. Reduced calorie diet option(low-calorie diet - numbered diets No. 8, 9, 10c). Indications for use: various degrees of nutritional obesity in the absence of pronounced complications from the digestive system, blood circulation, as well as diseases requiring special diets; diabetes mellitus type 2 with obesity, cardiovascular diseases in the presence of excess body weight.
Along with the basic standard diet and its variants, in accordance with the profile of the medical institution, surgical diets are also provided (diet No. 0, diet for ulcer bleeding, gastric stenosis, etc.), fasting diets and special diets(potassium, magnesium diets, diets for myocardial infarction, feeding through a tube, diets for fasting-dietary therapy, vegetarian diet, etc.). The Order of the Ministry of Health of the Russian Federation provides for average daily food sets depending on the diet option.
Based on the importance of the nation’s health for the development and security of the country, as well as based on the importance of healthy nutrition of the younger generation for the future of Russia, the Decree of the Government of the Russian Federation (1998) approved the “Concept of state policy in the field of healthy nutrition of the population of the Russian Federation for the period until 2005.” One of the priorities of this concept is the development of production related to the production of new high-tech drugs, including biological active additives(dietary supplement) to food. Dietary supplements are concentrates of natural or natural-identical biologically active substances intended for consumption along with food or for inclusion in food products. Supplements serve as a means of improving the health of the body, reducing morbidity, increasing the effectiveness of drug therapy, prolonging active longevity, etc.
Pharmaconutrition
Hippocrates in the 5th century BC said: “Food should be medicine, and medicine should be food.” Nowadays, this thesis is true both in relation to the diets listed above and in relation to the so-called dietary supplements * (BAA). The branch of science that studies dietary supplements
* The term is used abroad "Food Supplements*.
called pharmaconutrition. This area of knowledge, bordering between nutrition and pharmacology, has been rapidly developing in recent years. The relevance of pharmaconutritiology is due to the fact that the nutritional structure (nutritional status) of a modern (urbanized) person (especially Russians) is characterized by a deep year-round deficiency of so-called micronutrients- vitamins, minerals, especially microelements (in particular, selenium), polyunsaturated fatty acids, many organic compounds that are important in the regulation of metabolic processes, that is, there are significant deviations from the so-called balanced nutrition formulas. Deviations from this balanced nutrition formula lead to dysfunctions of the body, especially if these deviations are quite pronounced and prolonged over time. They are largely “responsible” for the high mortality rate from cardiovascular and cancer diseases and the low life expectancy of Russians.
Human health depends on the satisfaction of physiological needs for energy supply and for the entire complex of nutritional and biologically active substances, primarily irreplaceable (essential). The indispensability (essentiality) of certain nutrients for modern man is a reflection of the nutritional status of ancient man. These substances were readily available ancient man due to their widespread distribution in the environment. Ancient man used mainly plant foods, and due to high energy consumption (about 6 thousand kilocalories per day), he absorbed it in large volumes. Subsequently, during the 10th century BC, with a sedentary lifestyle, the development of cattle breeding, the use of fire and food storage, the plant component in the diet decreased, thereby increasing the shortage of many necessary nutritional and biologically active substances. However, due to the fact that energy consumption remained even greater (about 5 thousand kilocalories), people of that time continued to consume large amounts of food, which compensated for the already existing “evolutionary” lack of essential substances.
Nowadays, energy consumption has decreased to 2.5 thousand kilocalories per day, so their coverage is achieved by consuming already existing
significantly smaller amount of food. Such a relatively small volume of food cannot provide the body with substances that are initially present in food in extremely small quantities - vitamins, microelements and other biologically active substances, but they are biologically necessary for humans. In addition, there are “newly acquired” unfavorable trends in the nutritional structure of modern man: the consumption of animal fats, sugar, and salt is increasing; the consumption of plant fibers is reduced, etc. If the metaphor that seems to summarize the nutritional changes described above is true: “Food shaped man,” then it is also true that the imbalance of nutrition and the nature of modern man is at the same time a consequence of the active activity of the man himself: that is, man began to consume less energy, There is “less” and at the same time there is “not quite what is needed.”
It is impossible to quickly solve this problem by correcting the nutritional structure in the traditional way, that is, through educational work, as well as by simply increasing the consumption of natural products (without causing harm to health). The way out of this situation is the creation of new food technologies that allow small volumes of added “product” (BAA) to include sufficient quantities of essential nutrients necessary to meet human needs, that is, what modern man lacks “evolutionarily.”
Dietary supplements are not medicines, but compositions of natural or natural-identical biologically active substances obtained from plant, animal or mineral raw materials and, less often, by chemical or microbiological synthesis.
Based on their composition, dietary supplements are divided into 2 large groups:
1. Nutraceuticals are essential nutrients or their close precursors (for example, beta-carotene and other carotenoids; omega-3 and other polyunsaturated fatty acids; some microelements - selenium, iron, fluorine, zinc, iodine; macroelements - calcium, magnesium ; individual essential amino acids and their complexes; some mono- and disaccharides, dietary fiber, etc.), i.e. Dietary supplements used to correct the chemical composition of human food.
2. Parapharmaceuticals are systemic dietary supplements used for prevention, auxiliary therapy and support within the physiological boundaries of the functional activity of organs and
systems with a complex composition. They represent a composition of physiologically active substances predominantly of plant origin and have a wide spectrum pharmacological action on the body.
There are the following subgroups of dietary supplements:
Used to correct human nutrition (additional sources of nutrients - proteins, amino acids, fatty acids, vitamins, mineral elements, etc.);
Affecting functional activity individual organs and systems (gastrointestinal tract, cardiovascular, central nervous systems);
Increasing the digestibility of food (containing proteolytic and other enzymes that stimulate the secretory activity of the digestive glands);
Probiotics (eubiotics) that regulate intestinal microflora;
Promoting the removal of foreign toxic substances and metabolic products from the body;
Increasing the overall resistance of the body to environmental factors (general strengthening, tonic, adaptogenic).
It is known that the beginning of the production of medicines in the form of special pharmacological forms for the treatment of diseases by processing natural raw materials is associated with the works of Galen (130-200 AD) - the so-called Galenic drugs. However, even then (2nd century AD) Galen warned: “Man dies not from diseases, but from medicines.” In our time (XXI century!) we cannot fully agree with this thesis, but there is a rational grain in it. It is important to understand that modern drug therapy can be of great benefit to the patient if it is carried out against the background of proper dietary nutrition and using high-quality dietary supplements.
Diet
The general management of dietary nutrition in a medical institution is carried out by the chief physician, and in his absence - by the deputy chief physician for medical work. A nutritionist is responsible for the organization of therapeutic nutrition and its adequate use in all departments of a medical institution. He
supervises dietary nurses (diet nurses) and monitors the work of the catering unit. If there is no position of a dietician in a medical institution, a dietary nurse is responsible for this work.
Control for therapeutic nutrition carried out by a nutritionist and a nutritionist at a medical institution. The responsibilities of a nutritionist include the correct preparation of therapeutic diets, monitoring their correct use, advising doctors in the optimal prescription of the dietary table, monitoring the menu, and compliance with cooking technology dietary dishes, their quality and chemical composition. The dietary nurse is responsible for monitoring the operation of the catering unit and compliance with sanitary and hygienic standards.
Drawing up and writing out a portion plan
Therapeutic nutrition is prescribed (or canceled) by the doctor, writing down the diet number in the medical history and prescription sheet. Then (usually in the afternoon) the ward nurse selects information about diets from the prescription sheets and draws up a fasting portion plan in duplicate. The following information must be indicated in the portion holder (Table 4-3).
Last name, first name, patronymic of the patient.
Room number.
Diet table number (or fasting diet).
If necessary, prescribed additional nutrition.
Date of compilation of the portion plan.
Table 4-3. Sample of fasting portion plan
In the morning, the nurse hands over one copy of the fasting portion plan to the head nurse of the department, and another copy
hands it over to the distributing nurse at the buffet. The head nurse, based on the portion orders received from all ward nurses, draws up a portion requirement (Table 4-4), signs it herself and with the head of the department, and then transfers the portion requirement to the catering department. The request is filled out for patients, including those admitted to the department before 12 noon, 1-2 days in advance.
Table 4-4. Sample portion requirement
Order of food distribution
Food is distributed from the catering unit strictly according to the time established for each department. It begins only after the hospital doctor on duty takes a food sample. The barmaid places bins of food on special mobile tables and delivers them to the pantry, where tableware is stored and an electric stove for heating food (if necessary), titans for hot water (large-capacity water boilers) and a washing machine are installed. Then, after the food is delivered to the department in accordance with portion requirements, its distribution by the barmaid, junior nurse and ward nurse begins. If, before distributing food, the junior nurse carried out activities to care for the sick (helped with the morning toilet, cleaned the wards, etc.), she must change into special clothes and thoroughly sanitize her hands.
Medical personnel must be provided with separate gowns with special markings “For food distribution.”
Patients with a general (free) regime have lunch in the dining room, where they are seated according to the principle of dietary tables. After meals, tables are cleared, and after dinner they are washed with hot water and soap. The dishes are washed twice with hot water and mustard or soda, be sure to disinfect
Feeding the sick
Distribution of food by technical personnel cleaning hospital premises (nurses and cleaners) is not allowed.
Depending on the method of eating, the following forms of nutrition for patients are distinguished.
Active nutrition - the patient eats independently.
Passive nutrition - the patient eats with the help of a nurse. (Seriously ill patients are fed by a nurse with the help of junior medical staff.)
Artificial nutrition - feeding the patient with special nutritional mixtures through the mouth or tube (gastric or intestinal) or through intravenous drip administration of drugs.
Passive nutrition
During strict bed rest, weakened and seriously ill patients, and, if necessary, elderly and senile patients, are assisted in feeding by a nurse. When passive feeding, you should lift the patient's head with the pillow with one hand, and with the other hand, bring a sippy cup with liquid food or a spoon with food to his mouth. The patient should be fed in small portions, always leaving the patient time to chew and swallow; You should drink it using a sippy cup or from a glass using a special straw.
The order of the procedure (Fig. 4-1).
1. Ventilate the room.
3. Place a clean napkin on the patient’s neck and chest.
4. Place dishes with warm food on the bedside table (table).
5. Give the patient a comfortable position (sitting or half-sitting).
Rice. 4-1. Feeding the patient: a - bringing a sippy cup; b - feeding with a spoon.
6. Choose a position that is comfortable for both the patient and the nurse (for example, if the patient has a fracture or acute cerebrovascular accident).
7. Feed small portions of food, be sure to leave the patient time to chew and swallow.
8. Give the patient something to drink using a sippy cup or from a glass using a special straw.
9. Remove the dishes, napkin (apron), help the patient rinse his mouth, wash (wipe) his hands.
10. Place the patient in the starting position.
Artificial nutrition
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.
Main indications for artificial nutrition.
* In this context, the term “enteral” should not be taken literally, i.e. not only “into the intestines,” but in the broad sense of the word - in the sense of “inside,” rather as opposed to the term “parenteral.”
Damage to the tongue, pharynx, larynx, esophagus: swelling, traumatic injury, wound, tumor, burns, scar changes, etc.
Swallowing disorder: after appropriate surgery, in case of brain damage - cerebrovascular accident, botulism, traumatic brain injury, etc.
Diseases of the stomach with its obstruction.
Coma.
Mental illness (food refusal).
Terminal stage of cachexia.
Enteral nutrition- type of nutritional therapy (lat. nutricium - nutrition), used when it is impossible to adequately provide the energy and plastic needs of the body in a natural way. In this case, nutrients are administered orally either through a gastric tube or through an intraintestinal tube. Previously, the rectal route of administration of nutrients was also used - rectal nutrition (administration of food through the rectum), but in modern medicine it is not used, since it has been proven that fats and amino acids are not absorbed in the colon. However, in some cases (for example, with severe dehydration due to uncontrollable vomiting), rectal administration of the so-called saline solution(0.9% sodium chloride solution), glucose solution, etc. A similar method is called a nutritional enema.
The organization of enteral nutrition in medical institutions is carried out by a nutritional support team, including anesthesiologists and resuscitators, gastroenterologists, therapists and surgeons who have undergone special training in enteral nutrition.
Main indications:
Neoplasms, especially in the head, neck and stomach;
Central nervous system disorders - comatose states, cerebrovascular accidents;
Radiation and chemotherapy;
Gastrointestinal diseases - chronic pancreatitis, nonspecific ulcerative colitis, etc.;
Diseases of the liver and biliary tract;
Nutrition in the pre- and postoperative periods;
Trauma, burns, acute poisoning;
Infectious diseases - botulism, tetanus, etc.;
Mental disorders - anorexia nervosa (persistent refusal to eat due to mental illness), severe depression.
Main contraindications: intestinal obstruction, acute pancreatitis, severe forms malabsorption (lat. malus - bad, absorption - absorption; malabsorption of one or more nutrients in the small intestine), ongoing gastrointestinal bleeding; shock; anuria (in the absence of acute replacement renal functions); presence of food allergies to the components of the prescribed nutritional mixture; uncontrollable vomiting.
Depending on the duration of the course of enteral nutrition and the preservation of the functional state of various parts of the gastrointestinal tract, the following routes of administration of nutritional mixtures are distinguished.
1. Drinking nutritional mixtures in the form of drinks through a tube in small sips.
2. Tube feeding using nasogastric, nasoduodenal, nasojejunal and two-channel tubes (the latter for aspiration of gastrointestinal contents and intraintestinal administration of nutritional mixtures, mainly for surgical patients).
3. By applying an ostomy (Greek. stoma - hole: an external fistula of a hollow organ created surgically: gastrostomy (opening in the stomach), duodenostomy (opening in the duodenum), jejunostomy (opening in the jejunum). Ostomies can be created by surgical laparotomy or surgical endoscopic methods.
There are several ways to administer nutrients enterally:
In separate portions (fractionations) according to the prescribed diet (for example, 8 times a day, 50 ml; 4 times a day, 300 ml);
Drip, slow, long;
Automatically regulating food supply using a special dispenser.
For enteral feeding, liquid food (broth, fruit drink, formula), mineral water are used; homogeneous* dietary canned foods (meat, vegetables) and
* Homogeneous - i.e. homogeneous (Greek) homos- part of compound words denoting equality, homogeneity, -genes- suffix meaning “generated”).
mixtures balanced in the content of proteins, fats, carbohydrates, mineral salts and vitamins. The following nutritional mixtures are used for enteral nutrition.
1. Mixtures that promote early restoration of the function of maintaining homeostasis in the small intestine and maintaining the water-electrolyte balance of the body: “Glucosolan”, “Gastrolit”, “Regidron”.
2. Elemental, chemically precise nutritional mixtures - for feeding patients with severe digestive dysfunction and obvious metabolic disorders (liver and kidney failure, diabetes mellitus, etc.): “Vivonex”, “Travasorb”, “Hepatic Aid” (with high content branched amino acids - valine, leucine, isoleucine), etc.
3. Semi-element balanced nutritional mixtures (as a rule, they also include a full set of vitamins, macro- and microelements) for feeding patients with digestive disorders: “Nutrilon Pepti”, “Reabilan”, “Peptamen”, etc.
4. Polymer, well-balanced nutritional mixtures (artificially created nutritional mixtures containing all essential nutrients in optimal proportions): dry nutritional mixtures “Ovolakt”, “Unipit”, “Nutrison”, etc.; liquid, ready-to-use nutritional mixtures (“Nutrison Standard”, “Nutrison Energy”, etc.).
5. Modular nutritional mixtures (a concentrate of one or more macro or microelements) are used as an additional source of nutrition to enrich the daily human diet: “Protein ENPIT”, “Fortogen”, “Diet-15”, “AtlanTEN”, “Peptamine”, etc. There are protein, energy and vitamin-mineral modular mixtures. These mixtures are not used as isolated enteral nutrition for patients, since they are not balanced.
The choice of mixtures for adequate enteral nutrition depends on the nature and severity of the disease, as well as on the degree of preservation of gastrointestinal tract functions.
Thus, with normal needs and preservation of gastrointestinal functions, standard nutritional mixtures are prescribed; in critical and immunodeficient conditions, nutritional mixtures with a high content of easily digestible protein, enriched with microelements, glutamine, arginine and omega-3 fatty acids are prescribed.
acids, in case of impaired renal function - nutritional mixtures containing highly biologically valuable protein and amino acids. In case of non-functioning intestines (intestinal obstruction, severe forms of malabsorption), the patient is prescribed parenteral nutrition. Parenteral nutrition
(feeding) is carried out by intravenous drip administration of drugs. The administration technique is similar to intravenous administration of drugs.
Main indications.
Mechanical obstacle to the passage of food in various parts of the gastrointestinal tract: tumor formations, burns or postoperative narrowing of the esophagus, inlet or outlet of the stomach.
Preoperative preparation of patients with extensive abdominal operations, exhausted patients.
Postoperative management of patients after gastrointestinal surgery.
Burn disease, sepsis.
Major blood loss.
Violation of the processes of digestion and absorption in the gastrointestinal tract (cholera, dysentery, enterocolitis, disease of the operated stomach, etc.), uncontrollable vomiting.
Anorexia and food refusal.
The following types of nutrient solutions are used for parenteral feeding.
Proteins - protein hydrolysates, amino acid solutions: “Vamin”, “Aminosol”, polyamine, etc.
Fats are fat emulsions.
Carbohydrates - 10% glucose solution, usually with the addition of trace elements and vitamins.
Blood products, plasma, plasma substitutes. There are three main types of parenteral nutrition.
1. Complete - all nutrients are introduced into the vascular bed, the patient does not even drink water.
2. Partial (incomplete) - only basic nutrients (for example, proteins and carbohydrates) are used.
3. Auxiliary - oral nutrition is not enough and additional administration of a number of nutrients is necessary.
* Hypertonic solution is a solution whose osmotic pressure is higher than the normal osmotic pressure of blood plasma. In medicine they use, for example, 3-10% aqueous solutions sodium chloride, 10-40% aqueous solutions of glucose.
** Asepsis - measures aimed at preventing the introduction of infectious agents; antiseptics - measures aimed at destroying microbes in a wound, pathological focus or the body as a whole.