basic procedures in healthcare 1 (sol / vca81) topics: 13a) nutrition and feeding of patients 13b)...

Basic procedures in healthcare 1 (SOL / VCA81)

TOPICS:13a) Nutrition and feeding of patients13b) Dietary system in the Czech Republic13c) Parenteral and enteral nutrition13d) The introduction of nasogastric tube (NGT)

term explanation

food and its components

factors influencing nutrition

pathologies of nutrition

principles when serving food

feeding of bedridden patients

13a) Nutrition and feeding of patients


Nutrition nutrition = food intake and processing of nutrients,

nutrients = substances which participate in the metabolism,- basic – proteins, fats, sugars,- additives – vitamins, minerals, water.

*

http://www.google.cz/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRw&url=http://www.caes.ucdavis.edu/students/future/academics/majors/images/clinical-nutrition.jpg/view&ei=ScCCVZSpGMnaU8bRgPgN&bvm=bv.96041959,d.d24&psig=AFQjCNH52SSXv6v773ZTeXxRtO3HZcG6jQ&ust=1434718646631776


Food and its components

Proteins:

they disintegrate into amino acids by digestion,

protein supply 10-15% of all the necessary calories,

legumes, almonds, walnuts, pork, veal, chicken meat.

*

Fats:

compounds of fatty acidsand glycerol,

energy source,

bearers of fat-soluble vitamins,

daily consumption of not more THAN 66g*,

prefer vegetable fats of animal fats,

saturated fatty acids - sunflower oil, soya, wheat germ, nuts, olives.

* daily dose for an adult


*

Carbohydrates:

the main energy source,

supply up to 60% of total calories,

daily consumption 275 - 375g*.

Division:

monosaccharides – glucose, fructose (fruit, honey… ),

disaccharides – sucrose, lactose, maltose (banana, pineapple, milk of mammals, cereals),

polysaccharides – starch, cellulose - plant fiber (seeds, fruits, vegetables, whole grains.

* daily dose for an adult


*

Vitamins:

organic substances needed in very small quantities,

- water-soluble – B, C,- fat-soluble – A, D, E, K.


*

Minerals:

involved in the compositionof our organism,

78 elements is in the body(21 most important).

Water:

creates 70-75 % of our body,

daily water consumption approx. 2,5-3 l,

best - pure water, mineral water, tea, fruit juices,

expenditure – breathing (0,5l), skin (0,6l), urine (1,5l), faecal (0,15l).


*

Factors influencing nutrition

Biological factors: the function of the digestive system (disturbed function of the

digestive system), age, gender, health condition (diseases of the oral cavity, dental status… ).

Psychological factors: stress, psychosomatic conditions (anorexia, bulimia).

Social factors: culture, the environment, customs, economic conditions,

the natural environment…


anorexia – loss of appetite,

cachexia – pathological emaciation,

refusing food – active form of anorexia,

hyperorexia – excessive feel of hunger,

special appetite – e.g. pregnancy, stress,

dysphagia – disorder of swallowing,

dyspepsia – upper X lower dyspeptic syndrome + a summary of symptoms (belching, heartburn, nausea… ),

anorexia nervosa – eating disorder, deliberate reduction in body weight,

bulimia nervosa – eating disorder, recurrent episodes of binge eating involving the deliberate vomiting,

alnutrition, marasmus, obesity, obesity, overweight, and others.

13a) Nutrition and feeding of patientsPathologies of nutrition

*

Principles when serving food:

each patient receives the right diet,

the food is hot and suitably prepared,

regular meals (5 times a day),

we supply plenty of fluids,

capable patients are able to eat in the dinning hall or at a table in the room,

patients who can not leave bed, eat in it.


*


Feeding of lying (infirm) patients:

the patient assumes the position semi sitting,

we tie a bib or cloth around the neck,

we move the dining table and serve food,

we fed slowly, patiently, we supply enough fluids.

After the meal:

we wipe the patient's mouth,

we clean dishes,

we adjust the position of the patient and a bed,

if the patient has dentures, we take it out and clean.

*

hospital diet system

dietary system in the Czech Republic

13b) Dietary system in the Czech Republic


Hospital diet system given by directive,

nutritional questionnaire on admission of the patient,

therapeutic diets,

special diets – described, addition,

delivering meals to the treatment unit via tablet system.

*


1B mushy saving

1 ground saving

2 saving

4 with fat reduction

4S with strict fat reduction

4/SP with strict fat reduction + animal protein

4/AL when food allergy

5 with reduction of residue

6 with protein reduction

6/9 with protein reduction, diabetic

8 reduction (175g carbohydrates)

9 diabetic

9/S diabetic saving (225g carbohydrates)

9B diabetic with milk protein reduction

9W diabetic Warfarin (225g carbohydrates)

3 rational

3X rational special

11/P rational reducing flatulence

12 toddler

12K infant

13 children diet

GER geriatric

GER/9 geriatric diabetic

VEG vegetarian

term explanation

indications for enteral nutrition

dividing of products for enteral nutrition

contraindications of enteral nutrition

method of enteral feeding

indications for parenteral nutrition

way of parenteral nutrition administration

products for parenteral nutrition

contraindications of parenteral nutrition

13c) Parenteral and enteral nutrition


Artificial nutrition

- indicated in patients who are not able to eat for a longer period,or in patients suffering from malnutrition.

Enteral nutrition:

administration of nutritional substrates to the stomach or intestines to provide nutrition (sipping, probe nutrition – NGT, NJT, PEG, PEJ),

it uses a natural way of nutrients delivery.

Parenteral nutrition:

administration of nutritional substrates to systemic circulation (solutions applied i. v.),

bypasses the liver, intestines.

Enteral nutrition - indication:

injury, surgery and disease of oropharyngeal and oesophageal areas,

diseases surgery on the digestive tract in area of the stomach and small intestine,

disorders of eating mechanism (stroke),

conditions requiring intensive care (postoperative period, craniocerebral injury),

refeeding treatment in malnutrition,

repeated vomiting (prevention of aspiration),

loss of appetite (geriatric, psychiatric patients).


Dividing products by content 1

Full-fledged polymeric:

it contains protein in the form of polymer,

partially digested,

Nutrison Standard, Nutrison Energy, Multifibre, Fresubin.

Full-fledged oligomeric:

protein is in the form of oligopeptide,

chemically defined diets,

contains completely resolved basic components of nutrition.


Dividing products by content 2

Synthetic:

amino acids.

Modified types of nutrition:

enriched with nutrients with therapeutic effect.


Contraindications of enteral nutrition:

in the acute phase of disease,

acute abdomen emergency,

complete bowel obstruction (ileus),

intestinal fistula,

haemorrhage GIT,

relative contraindications: inability to secure the entry into the GIT (burns, multiple trauma, uncooperative patient).


Methods for administration of enteral nutrition

Bolus application:

using Janett syringe, total amount of one portion 250 - 400 ml, only the stomach, it can not be administered into the intestine.

Intermittent:

one dose is divided in partial doses, it served intermittently throughout the day with a night break

(e. g. in 2h or 3h with a break from 24:00 to 6:00).


Methods for administration of enteral nutrition

Continual:

feeding from a bottle or bag,

with enteral pump,

speed of nutrition mostly determined in ml/hr (constant speed),

20 hrs without interruption, the night pause,

a special, manufacturer-recommended bags belong to the enteral pumps.


Parenteral nutrition - indication:

impossibility of using GIT,

ileus,

intestinal fistula,

acute abdomen emergency,

extensive intestinal surgery,

short bowel syndrome,

bleeding in GIT,

acute pancreatitis,

idiopathic bowel inflammation,

severe diarrhoea or vomiting,

liver failure.

Zdroj: http://www.rxkinetics.com/tpntutorial/fig_1_4.gif; 18.6.2015


Way of administration:

a) Into a peripheral vein

only short-term nutritional support,

the risk of phlebitis,

the solution for hydration correction(water, electrolytes),

adjustment of energy intake – 5% G,

adding vitamins,

adding of proteins.


*

b) Into a central vein

all other solutions which cannot be injected into PVC,

long-term nutritional support,

possibility to administer a concentrated solution in a small volume without the risk of phlebitis,

most cannulation v. subclavian,v. jugularis, end of the catheter is placed into the superior vena cava or the implantation of venous port.

Zdroj: http://www.stezen.cz/html/stezen/casopis/2014/01/clanky

/obr/clanek_06_3.jpg; 18.6.2015


Products of parental nutrition

System multi-bottle

administering of nourishment from several bottles at the same time,

separetly amino acids, lipids, glucose,

the possibility to change the composition, add pharmaceuticals,

more difficult manipulation,

higher risk of infection,

uneven nutrient intake.

System all-in-one

all components of nutrition in one bag,

↓ demands for nursing staff,

better utilization of nutrients,

↓ the risk of entry of infection,

more comfortable,

↑ price,

you can not change the composition of the bag.


Source: author´s pic

All in one

Clinimix

- 2-chamber bag, 1 chamber amino acid+ electrolytes,2 chamber glucose + calcium,

- application into the CVC.

Nutriflex lipid peri

- 3-chamber bag,- upper left chamber – glucose,- upper right chamber – fat emulsion,- lower chamber – amino acid,

- applications to the peripheral venous system.


*

All in one bag

Contraindications for parenteral nutrition

sufficiently functional digestive tract,

terminal disease status,

rejection of nutritional support from the patient,

there are no reasons on which the parenteral nutrition is clearly indicated.


*

probes for enteral nutrition

tools for NGT introduction

position when NGT introduction

procedure when NGT introduction

control of NGT introduction

videos (introduction of NGT, serving meals through NGT)

contraindications of NGT introduction

13d) The introductionof nasogastric tube (NGT)

13d) The introduction of NGT

Probes for enteral nutrition

different sizes, different average,

NGT, NJT, gastrostomy probe (PEG), jejunostomy probe (PEJ),

the average is color-coded (20 - yellow, 18 - red, 16 - orange,14 - green, 12 - white),

polyurethane, silicone rubber,

length 75 – 130 cm.

Probes of enteral nutrition

Zdroj:http://i00.i.aliimg.com/img/pb/370/929/717/717929370_735.JPG; 18.6.2015

Zdroj:http://g02.s.alicdn.com/kf/HTB1gHkRFFXXXXc4XVXXq6xXFXXXn/200683810/HTB1gHkRFFXXXXc4XVXXq6xXFXXXn.jpg; 18.6.2015


PEG passage through the abdominal wall

Tools:

probe of appropriate size if possible frozen,

local anaesthetic (Mesocain gel), Xylocain spray, nasal drops,

disposable gloves,

Janett syringe 50ml,

stethoscope,

adhesive plaster to fix NGT,

tea or water,

swabs, vomit bowl, oral scoop,

collecting bag for NGT connection,

or peg to close NGT.


Position for introduction

When the patient is conscious – semi sitting - sitting, the patient sits by himself / herself, we incite the patient to actively cooperate (e. g. when introducing the patient swallows – easier introducing of NGT, fluid support).

When the patient is unconscious – we position the patient,if his health condition allows it (beware of the head and spine injuries).


NGT introduction:

if possible, position the patient to the semi sitting position with slightly bent head on aside (Fowler´s position),

wash your hands and put disposable gloves on,

ask patient if he / she did not have any nose injury in the pastor if he / she is not after the nasal septum surgery,

check the loose of nostrils,

measure length of NGT from the end of the nose to the earlobe until the end of the sternum,

put Mesocain gel on NGT, apply nasal drops into the nasal passages,


patient, if possible, ask for swallowing and quickly introduce NGT into the stomach every time he / she swallows,

when nausea stop introducing NGT,

check the position after introducing NGT deep enough,

fix NGT with plaster to the nose,

close the end of the probe using pin or connect the collection bag,

regularly perform oral hygiene and nursing care (prevention of pressure ulcers),

if the patient is unconscious and NGT introducing is difficult, it is possible to use Magill forceps and laryngoscope.



NGT introduction

Control of NGT introduction: aspiration of gastric contents with Janett syringe,

listening with a stethoscope while injection the air with Janett syringe into the stomach – audible gurgle,

dyspnoea of the patient– sing of introduction into the lungs(if the patient is conscious),

NGT position can be checked in extreme cases by X-ray.

After the introduction of NGT: disposable tools clean up into a container which is intended for

contaminated waste, and disinfect the other tools or sterilize according to the department order.


The introduction of nasogastric tube (NGT)

https://www.youtube.com/watch?v=jP0WI9TNxxc

Feeding through NGT

https://www.youtube.com/watch?v=HF4lGo6AVLw


Contraindications of NGT introduction:

difficult introduction (uncooperative patient),

fear and anxiety of the patient,

intolerance of the tube as a foreign subject,

incorrect introduction,

perforation of the oesophagus, stomach, or respiratory,

kinking of the tube,

NGT is clogged with gastric contents,

aspirations while introducing,

epistaxis.


*

Revision

Name the fat-soluble vitamins.

What factors do affect nutrition?

Diet 9, 5, 1B, GER?

What is enteral nutrition? What are its advantages?

What will you do if your patient starts vomit during NGT introducing?

How will you find out that you introduced NGT into the lung when the patient is unconscious?

List the ways of enteral feeding.

Describe the introduction of NGT.

Why does the nutrition applied through NJT or PEJ have to be pharmaceutically prepared in advanced?

Reference:

LF a FZV UP Olomouc, klinické téma, umělá výživa [online]. 2015. [cit.8.6.2015]. Dostupné z http://pfyziollfup.upol.cz/castwiki2/?p=3303

MIKŠOVÁ, Zdeňka, Marie FROŇKOVÁ, Renáta HERNOVÁ a Marie ZAJÍČKOVÁ, kapitoly z ošetřovatelské péče 1. Aktualiz. a dopl. vyd. Praha: Grada, 2006, 90s. ISBN 80-247-1442-6

Multimediální trenažer plánování ošetřovatelské péče, vyuka-terapie, enterální výživa, parenterální výživa [online] 2015 [cit.9.6.2015].dostupné z: http://ose.zshk.cz/vyuka/terapie.aspx

VELKÝ LÉKAŘSKÝ SLOVNÍK [online]. 2015 [cit. 2015-06-8]. Dostupné z: www.lekarske.slovniky.cz

PICTURES * (if it is not listed differently): pinterest.com, google.com. Key words: „ok“, „not ok“, „nasogastric tube“…)

basic procedures in healthcare 1 (sol / vca81) topics: 13a) nutrition and feeding of patients 13b)...

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