Caring for critically ill patients requires tremendous patience, skill and compassion from a nurse. Such patients are very vulnerable, often capricious in their desires, 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, his behavior. This should be regarded as symptoms of a serious illness. For a sick person, food and drink are of particular importance, often determining either the recovery or the progression of the disease. For example, according to recent research by nursing professionals in England, fluid-poor patients suffer from insomnia, and their wounds take much longer to heal than other patients. Malnutrition increases the risk of pressure sores by several times, slows down recovery, and promotes the progression of the underlying disease.

Before starting feeding, it is necessary to do all the medical procedures, to carry out the physiological administration of the patient. After that, it is necessary to ventilate the room and help the patient to wash their hands. The nurse can help with this. It is best, if the condition permits, to give the patient a semi-sitting position or raise the headboard. If this cannot be done, then it is necessary to turn the patient's head to one side. Of great help in feeding a seriously ill patient is a functional bed, equipped with a special bedside 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 an oilcloth. Food should be semi-liquid and warm.

There are many reasons why a patient cannot eat and drink on their own. They can be divided into two large groups:

1. The patient, due to his general condition, cannot eat or drink.
2. The patient has reduced or no desire to eat and drink.

Depending on the reason, the nurse's tactics in feeding the patient are determined:

1) General serious condition when the patient lies and cannot reach out to the bedside table. Such a patient should be drunk from a drinking cup or a tube inserted into a glass. At the same time, first give water in a teaspoon and ask him to swallow to make sure that the patient does not swallow. It is necessary that the food is homogeneous (that is, the same consistency). It is impossible to water the sick, lying with their head thrown back, so the epiglottis opens the entrance to the trachea, and the patient may suffocate. It is necessary, as far as possible, to bend the head to the chest or slightly raise the patient. Particularly weakened patients should be given time to rest between sips. It is necessary to give water to such patients a little, but often.

If the patient cannot independently take a cup or spoon in his hand, for example, with severe deformation of the joints of the hand, it is advisable to adapt a cup and a spoon for him (a spoon with a curved handle).

When feeding a patient, it is necessary to remember that you need to help him when he cannot cope on his own.

2) The patient has no desire to eat or drink.

Lack of appetite often occurs when the patient has depression associated with the severity of the underlying disease, with bedriddenness. In this case, a more active motor regime is desirable (in accordance with the state), communication with relatives, other patients, some kind of business, and so on.

Appetite often disappears with poor oral care, when putrefactive processes develop in the patient's mouth. When chewing food, the patient cannot feel either the taste or the very presence of food in the mouth. Therefore, after each meal, the patient needs to toilet the oral cavity.

Often a lack of appetite is associated with the unsightly appearance of the food offered, poorly washed dishes, and so on. Many patients often refuse to eat and especially drink, as they understand that if they eat and drink enough, they will have to use the boat more often. Try to explain to the patient that he needs to eat and drink as much as possible, and that a nurse or nurse will always come to his aid at the right time, as soon as they are called.

After feeding, it is necessary to remove food debris and utensils. It is also necessary to help the patient to rinse the mouth or, if he is not able to do it himself, to irrigate the oral cavity with warm boiled water.

Artificial nutrition

Sometimes the normal nutrition of the patient through the mouth is difficult or impossible (some diseases of the oral cavity, esophagus, stomach, unconsciousness). In such cases, artificial feeding is organized.

Artificial nutrition can be carried out:

1. With a tube inserted through the mouth or nose, or through a gastrostomy tube
2. Administer nutrient solutions with an enema.
3. Administer nutrient solutions by parenteral route (intravenous drip).

With the help of an enema, 300-500 ml of warm (37-38 C) glucose solution, isotonic sodium chloride solution, and amino acid solutions are dripped through the rectum. For more information on the nutritional enema, see the Enemas module.

Parenteral nutrition is prescribed for patients with symptoms of the patency of the digestive tract, in the impossibility of normal nutrition (tumor), as well as after operations on the esophagus, stomach and others. For this, amino acid solutions, glucose solution are used. In addition, electrolyte solutions, B vitamins, ascorbic acid are administered. Means for parenteral nutrition are administered by intravenous drip. Before the introduction, warm up in a water bath to body temperature. The rate of administration of drugs must be strictly observed. For details on parenteral fluid administration, see the Parenteral Drug Administration module.

Patients with a stroke often have the problem of impaired swallowing - dysphagia. This term denotes any difficulty or discomfort in moving food from the mouth to the stomach, and is a generic term for disorders of the act of swallowing.
The act of swallowing is a sequence of voluntary and involuntary (reflex) movements subtly and precisely coordinated by the brain, ensuring the movement of the contents of the oral cavity through the pharynx and esophagus into the stomach.

Signs indicating impaired swallowing:

• difficulty swallowing fluids;
• drooling or frequent saliva spitting;
• sticking of food in the throat or pharynx;
• choking or coughing when eating or drinking, or swallowing saliva;
• weakening (or absence) of voluntary or involuntary cough;
• wet or gurgling voice;
• discomfort in the pharynx and recurrent bronchopulmonary infections;
• the need for repeated sips to empty the throat;
• weight loss, changes in trophological status.

Due to the fact that half of patients with stroke have swallowing disorders, they are fed through a nasogastric tube and with a Janet syringe designed for a large volume of fluid.
1. For feeding, use liquid, semi-liquid or pureed food: sweet juices (in the absence of an increase in blood sugar), with diabetes mellitus, you can give tomato juice; tea; not fatty broths, pureed soups. Kefir is very useful for stimulating intestinal motility. You can give mashed meat, vegetables, raw eggs.
2. Use a plate to collect food. The required amount of food is sucked in with Janet's syringe (as a rule, 200-300 ml is injected for 1 feeding). It is more physiological for the patient to feed more frequent (up to 6 times a day), but small in volume portions.
3. Janet's syringe is attached to the tip of the probe. Slowly carry out the introduction of the calculated volume of the portion (as a rule, 1-2 syringes), the introduction of the volume of 1 syringe is carried out within 5-10 minutes.
4. The syringe is disconnected, 100-150 ml of pure boiled water is taken into it and the probe is washed with liquid, after which the syringe is disconnected again and the tip of the probe is closed with a plug.

If the patient does not need tube feeding, but occasionally chokes when swallowing, it is necessary to use chopped food (liquid porridge, mashed potatoes, jelly, soufflé). Food should contain a lot of vitamins and minerals. Limit the use of table salt, sweet and fatty foods. Strong coffee, strong tea, and alcoholic beverages are excluded from the diet. For bedridden patients with a tendency to constipation, vegetables, dried fruits, and sour-milk products are useful. Caregivers should ensure that they have daily bowel movements and give laxatives if necessary.

The position that provides the most effective and safest swallowing for the patient:

• feeding is carried out only in a sitting position (with support under the back);
• head tilt forward;
• turning to the healthy side at the time of swallowing.

Diet principles:

• the food should look appetizing;
• food should be warm enough as it takes a long time for swallowing patients to consume it. If the patient does not feel warm food in his mouth, feed the food at room temperature;
• offer solid and liquid foods at different times. In this case, the liquid will not push solid food down the pharynx, and the patient will not swallow poorly chewed food or choke on the liquid;
• semi-liquid food is best tolerated: casseroles, thick yogurt, pureed vegetables and fruits, thin porridge;
• it is necessary to select the consistency of food (soft food, thick puree, liquid puree) and liquid (consistency of mousse, yogurt, thick jelly, syrup, water). It should be remembered that the thinner the food and drink, the more difficult it is to take a safe sip;
• exclude products from the diet that, when inhaled, can enter the respiratory tract: liquid of ordinary consistency (water, juices, tea), bread, cookies, nuts, etc.
• when feeding, food is laid on the unaffected side in small portions;
• control over the need to use dentures;
• thorough revision of the oral cavity after the end of feeding;
• after feeding, the patient remains in an upright position for 45-60 minutes.

Remember:

• only a small amount of food can be given at a time;
• do not give drinks with food. Drinks must be given before or after it;
• you cannot feed a lying person;
• the patient's head should not be thrown back during feeding;
• teeth and dentures must be cleaned at least twice a day in full consciousness, and taken out at night and washed thoroughly.

Feeding seriously ill patients requires a special approach and can be difficult due to a decrease in appetite and weakness in chewing and swallowing movements, which appear due to limited physical activity. In such cases, the patient needs to be fed more often, in small portions, with a spoon. In the food regimen, allowed and prohibited foods should be taken into account. Thick food should be diluted with milk, broth or juice and, after swallowing, given to drink from a sippy cup or spoon.

It is necessary to feed the patient in a calm environment, without distracting his attention, for example, with light stimuli or conversations.

The seriously ill are fed in bed. To do this, they should be given a comfortable sitting or half-sitting position, or their heads should be raised, placing it on the nurse's outstretched hand.

Do not rush, otherwise the patient may choke. It is important to make sure that the food is not too hot or cold. The number of feedings is usually increased to 5-6 times a day with a relatively small amount of food per meal. Food for seriously ill patients should be complete in terms of nutritional components and enriched with vitamins.

Tube feeding

In case of an unconscious state of the patient or mental disorders, accompanied by a complete refusal to eat, as well as traumatic injuries of the oral cavity organs, they resort to feeding through a tube. This method also feeds children with deep prematurity, when they do not have sucking and swallowing reflexes.

For feeding, prepare a thin gastric tube without olive, a funnel with a capacity of 150-200 ml, Janet's syringe and 1-2 glasses of liquid or semi-liquid food. The probe, funnel and syringe should be sterilized by boiling and cooled to the patient's body temperature. The probe is inserted through the nasal passage. Previously, the nasal passages are examined, cleaned of crusts and mucus; the rounded end of the probe is lubricated with glycerin.

When the probe reaches the posterior wall of the oropharynx, the patient (if he is conscious) is asked to make a swallowing movement or, gently pushing the index finger through the patient's mouth, gently press the probe to the posterior wall of the pharynx, moving it further along the esophagus, bypassing the larynx and trachea.

When the probe enters the larynx and trachea, stenotic wheezing and coughing usually occur. In this case, the probe must be pulled back a little, let the patient calm down and, as indicated above, carefully move the probe along the esophagus into the stomach - up to about 35-45 cm, depending on the patient's height. To make sure that the probe has not entered the trachea, a piece of cotton or tissue paper is brought to its outer end. If cotton wool or paper does not move in sync with the patient's breathing, cooked food is introduced. Food is poured into the funnel in small portions or slowly, with stops, injected through a probe using Janet's syringe. During feeding it is necessary to ensure that the lumen of the probe does not fill up, and regularly "rinse" it with tea, juice or broth.

After feeding, the funnel and syringe are washed and boiled. The probe is left in the stomach for 4-5 days. The outer end of the probe is attached with an adhesive plaster to the patient's cheek and head. Care must be taken to ensure that the patient does not pull out the probe.

Rectal feeding

In case of poisoning with salts of heavy metals, the patient's food intake is carried out through the rectum.

For this purpose, the following are most often introduced:

Isotonic solutions: 0.85% sodium chloride solution, 5% glucose solution;

Preparations: liquid aminopeptide for microbiological nutrient media, alvezin, hydrolysates of casein containing a full set of amino acids.

Before the introduction of the nutrient solution, the patient is given a cleansing enema. After that, the intestines should be given time to calm down. Nutrient solutions and liquids are injected heated to a temperature of 38-40 ° C by drip or at once, 50-100 ml 3-4 times a day. For weakened, elderly, patients with damage to the large intestine and fecal incontinence, it is preferable to use the drip method, since they poorly retain nutrient solutions when injected simultaneously.

Updated: 2019-07-09 23:51:00

• Dry skin is quite common. She requires particularly skillful and attentive care, as she is very sensitive and ages quickly.

A stroke does not only strike a person's brain. Life changes in all areas of the patient - from intellectual abilities and social circle to sex and nutrition. The meaning of life after a stroke in some patients who have not returned to work boils down to survival. And it depends on the treatment and quality of care in the family. To restore the patient's body, it is important for relatives to know how to properly feed him.

Consider ways of feeding patients during and after a stroke. We will learn how to feed patients through a tube and with self-feeding.

Bedridden patients require careful care, including proper feeding

Feeding Methods for Patients After Stroke

In most patients, swallowing is impaired during a stroke. In the first few days immediately after a stroke, a parenteral method is used to feed a lying patient - intravenous administration of essential nutrients. In addition, give water to drink from a small spoon. In the acute period, a few days after the stroke, the patient is given only water. For another 2-3 days they are given juices diluted with water.

A few days after the stroke, fruit juices and liquid dairy products are injected through a tube. When expanding the diet, vegetable soups are passed through a blender and poured in small portions into the funnel of the probe. Meals are supplemented with broths and fresh juices. Vitamins are added to food in liquid form. Patients are given drugs along with food by probe.

After swallowing is restored, the patient is spoon-fed liquid dishes, then the diet is expanded with mashed potatoes and soft-boiled eggs. In the future, the patient's diet is expanded with steam cutlets and grated salads from fresh vegetables. It is better to give water and liquid juices from a special sippy cup with a spout. The patient will benefit from freshly squeezed juices from fruits and vegetables, which contain vitamins and minerals.

Tube feeding technique

For tube feeding, a special gastric tube and funnel are used. The outlet ends of the probe and funnel must match or food will spill from the joints. The capacity of the funnel made of glass is 200.0 ml.

The patient is fed and medicated through the tube

A gastric tube, the end of which is smeared with petroleum jelly, is inserted through the nose. If, having reached the nasopharynx, the patient does not have a cough or choking, then the probe goes into the esophagus. The probe continues to advance to the 40-45 cm mark. Then you should make sure that the probe is in the stomach - when suctioned with a syringe, gastric contents appear. A funnel is inserted into the top of the probe and warm liquid food is poured in small portions. After use, the probe is rinsed. Before use, the probe and funnel are boiled and cooled in cooled boiled water.

What food is used for tube feeding

In bedridden patients, intestinal motility is reduced. With prolonged bed rest, patients after a stroke develop atonic colitis. Therefore, plant fiber is introduced into the patient's diet to stimulate peristalsis. It is found in vegetables and fruits that are given by passing through a blender. Juices are prepared just before use.

For tube feeding, cream, jelly, milk, juices are used.

Vegetable soups are given through a probe, passed through a blender. Tube feeding is prepared with fresh ingredients before eating. If the patient does not take vegetables and fruits, it is recommended to use ready-made pharmaceutical fiber to stimulate intestinal motility, but it does not contain vitamins. In such cases, give the patient juices with pulp, pureed vegetables and fruits.

Feeding bedridden patients

A few days after the stroke, swallowing in patients is restored. Lying patients are fed in bed, giving the back an elevated position. A pillow is placed under the head. A napkin is placed on the chest.

It is convenient to use a mobile dining table for feeding patients. At such a bedside table on wheels, the patient can eat himself without an assistant.

Food is served with a spoon. Meals consist of mashed soups, raw vegetables and fruits passed through a blender. The diet includes milk, cream, cottage cheese. When swallowing is restored, give steamed meat and fish cakes. To avoid spilling food in bed, the patient uses a cocktail straw. Some patients use an ordinary teat with a large opening.

Patient Nutritional Principles

The World Health Organization provides general nutritional guidelines for stroke patients. The calorie content of the patient's food after a brainstroke does not exceed 2500 kcal. During the period of treatment and rehabilitation, nutrition is important for the full restoration of brain functions. The correct water-salt balance will ensure the functioning of the heart and kidneys at the physiological level. It is recommended to give 2 liters of liquid per day in broths, soups, jelly, mineral and drinking water. During a stroke, the patient needs the nutrients they need to recover.

Diet of stroke patients

The diet of patients after apoplexy is prescribed taking into account concomitant diseases. The diet is fractional, 5-fold. The menu includes vegetable carbohydrates, fats and proteins.

Products that are used in feeding patients after a stroke:

• fruits and vegetables in salads;
• lean beef and poultry;
• dairy products 5-9% fat;
• fish dishes;
• vegetable fats from sunflower, olives, flax;
• buckwheat porridge, oatmeal;
• flour products only from wholemeal flour;
• whole grain products.

After a stroke, it is important to follow a diet, fruits and vegetables must be present

Fish is a source of polyunsaturated fatty acids, which are essential for lowering cholesterol. Phosphorus is beneficial for the functioning of neurons in the brain. Among vegetables, cabbage, spinach and beets are useful as fiber. Eating beets will prevent constipation and increase brain activity. Berries, prunes, figs and apricots are recommended, which are simply necessary for bedridden patients with reduced intestinal motility. Berries are a natural antioxidant that removes harmful free radicals from the body. Meat is a source of protein and iron, without which it is impossible to restore cells in the body.

As a result, we emphasize the importance of patient nutrition for the restoration of brain function. In case of impaired swallowing and in the acute period, tube feeding is used. After swallowing is restored, a bedside table on wheels is used while feeding patients. The diet of stroke patients is low in calories and high in nutritional value.

How difficult it is at times to feed a seriously ill person! The reason can be all kinds of diseases of the gastrointestinal tract, intoxication, with loss of appetite and nausea, problems with the oral mucosa, etc. Frequent reasons and psychological nature - inadequate perception of reality, manifestations of depression, etc.

The nurse must overcome all difficulties with the patient's nutrition, try to fully and timely feed the ward (in accordance with the prescribed diet) and show maximum attention to his reaction to food. If the patient does not eat well, it is worth thinking, remembering what dishes were favorite for him before the illness, what seemed to him a delicacy, and offer this food. If the patient has completely stopped eating, you should inform the doctor about this for taking measures to organize feeding.

How to organize a meal in bed?

If the patient can sit down, then it is necessary to give him a sitting or semi-sitting position in bed. If the patient is able to use cutlery, then allow him to eat on his own, making sure he does it carefully, while helping. Otherwise, feed it from a spoon or from a sippy cup in which liquid food can be placed. Instead of a sippy cup, you can use a teapot with a wide spout. It is good to use a bed table for eating in bed. You can also use some kind of food stand. If the patient cannot sit up, turn him to the side to eat.

How should a nurse feed a patient?

Dishes for the bedridden patient are placed on the bedside table (bedside table), the nurse lifts the patient's head with her left hand, and feeds him with her right hand. Food should not be cold or hot (no more than 50 degrees) and its temperature should be checked. The spoon is brought to the mouth incomplete and placed first on the lower lip so that the patient can taste the food. It happens that only after tasting the dish, the patient begins to eat, although he has just categorically refused to eat. Feeding should be done slowly, making sure that the person does not choke, so that the food is chewed and swallowed. If the sick person is having difficulty eating, but he still tries to do it, praise and encourage him. I thanked my wards for eating, because it was a great joy for me ...

Nutrition of the bedridden patient. What kind of dishes to cook?

Elderly bedridden patients, who have difficulty chewing because of prostheses or because of their absence, often need liquid and semi-liquid food in the form of broths, jelly, mashed potatoes, mashed soups, etc. Cut solid food into small pieces. Do not be lazy to cook dishes of the desired consistency - it does not take too much time!

If possible, purchase a blender to grind food, if this is not possible, boil food, grind it with a pestle (crush), use meat grinders, graters and sieves. You can use ready-made baby food in jars. And more vegetables, fruits and dried fruits ... Constipation in bedridden patients is not uncommon.

With intoxication the enhanced water regime is useful. The patient should drink as much water as possible so that as much toxins as possible are excreted from the body along with urine.

What hygiene procedures should be used when feeding?

If the patient eats on his own, then he needs to wash his hands before eating, and after eating, rinse and dry them. A towel should be laid under the head of a lying patient, and if the patient eats while sitting, then a napkin should be fixed on his chest. Select a separate dish for the patient.

After eating, the patient must rinse his mouth. If food gets stuck between the teeth, then after eating it is necessary to clean the gaps between the teeth with a toothpick or with dental floss. A seriously ill person should be helped to rinse the mouth with water from a rubber can or a large syringe without a needle. After eating, napkins and all food debris are carefully removed.

How to care for the patient's oral cavity?

In bedridden patients, plaque, inflammation and even ulceration are often formed in the mouth. The reason may be medications that the patient did not swallow and that remained in the mouth, injuries from prostheses, dryness of the oral mucosa that occurs during sleep and snoring, food debris that was not removed from the mouth after eating, etc.

Pain in the mouth makes it difficult to eat, and often when asked "Why does the ward have no appetite?" you can answer like this: "It is necessary to put things in order in his oral cavity." Of course, in case of complications, it is better if the patient is examined and consulted by a dentist, but you should also take action in time.

Prepare a 2% soda solution, or a 0.5% potassium permanganate solution, or a 0.02% furacilin solution and, substituting a bowl, rinse the patient's mouth. Do this carefully, over the entire mouth, pulling slightly with a spoon or, if available, with a cheek spatula. I did this with cotton swabs well soaked and captured with tweezers. You can also clean your mouth with your index finger wrapped in a piece of gauze or cotton swab soaked in a medicinal solution. Pay attention to the patient's tongue too. Plaques from it and food debris can be carefully removed with a spoon or toothbrush, and then rinse the tongue. If the lips are dry, they are smeared with petroleum jelly or a special lip cream.

Hygienic treatment of dentures should also be carried out.