Variants with increased protein (high-protein diet №4,5,7c,7d,9,10i)

Prescribed: stomach (gastric) resection (after 2-4 months); ulcerous disease (with jejunal(postgastrectomy) syndrome; cholecystitis; hepatitis; chronic enteritis with digestive organs dysfunction; chronic pancreatitis in remission phase; chronic glomerulonephritis in its nephrotic variant during the decreasing exacerbation without kidneys nitrogen-excretion dysfunction; diabetes mellitus type 1 and 2 without obesity or kidneys nitrogen-excretion dysfunction; rheumatism during prolonged clinical course without blood circulation disturbance; pulmonary tuberculosis; suppurative processes; anemia; burn disease)

Decreased protein diet (low-protein diet № 7a, 7b)

Prescribed: chronic glomerulonephritis with sharp or moderately expressed kidneys nitrogen-excretion dysfunction.

Decreased calories diet (low-caloric diet №8,9,10c)

Prescribed: different degrees of alimentary obesitywith the absence of expressed complications in the digestive organs, blood circulation; diseases that require special nutrition: diabetes mellitus type 2 with obesity, cardio-vascular diseases on the background of excessive body mass (overweight).

Forms of food intake

· Active nourishment – the patient eats by himself

· Passivenourishment – the patient eats with the help of medical nurse (Gravely ill patients are fed by the medical nurse and paramedical personnel)

· Artificial feeding – feeding of the patient with special nutrient formulas through mouth or tube (gastric or intestine) or with intravenous drop infusion.

Artificial feeding

Artificial feeding is insertion of food (nutrient elements) into the organism of the patiententerally, i.e. through GIT, and parenterally – not through GIT. General indications for artificial feeding:

· lesion of tongue, pharynx, larynx; esophagus edema, trauma, injury, tumor, burns, cicatricial changes, etc.

· aglutition: after surgery, brain damage, brain blood circulation disorder, botulism, craniocerebral injury, etc.

· gastric diseases with obstruction

· comatose state

· psychiatric disease (refusal to eat)

· terminal phase of cachexia

Enteral feeding

It is a type of nutritive therapy that is used when there is no natural way of providing the organism with energetic and plastic elements. The nutrient substances are inserted either orally using gastric probe, or by means of intestine probe.

General indications:

· neoplasms, especially in head, neck or stomach areas;

· CNS disorders: comatose state, brain blood circulation disorder;

· radiation and chemotherapy;

· GIT diseases: chronic pancreatitis, nonspecific ulcerous colitis, etc.;

· liver and bile-excreting tracts diseases;

· nutrition before and after surgery;

· trauma, burns, acute poisonings;

· infectious diseases: botulism, tetanus, etc.;

· psychiatric disorders: neuropsychic anorexia (strong disease-caused refusal to eat), severe depression.

General contra-indications: intestine obstruction, acute pancreatitis, severe forms of malabsorption (poor absorption in small intestine of one or several elements), continuing gastric-intestine hemorrhage; shock; anuria (in the absence of acute substitution of kidneys functions); food allergy to the components of the nutrient formula; unstoppable vomiting.

Parenteral feeding

Feeding is done by means of intravenous drop infusion. The technique is identical to intravenous injections.

General indications:

· Mechanical obstruction for passing food in different parts of GIT: tumor neoplasms; burn or after-surgery constriction of esophagus, entry or exit site of intestine.

· Pre-surgical preparations of patients with abdominal operations, weakened patients.

· After-surgical treatment of GIT patients.

· Burns disease, sepsis.

· Massive bloodloss.

· Disorder of digestive and absorption processes in GIT (cholera, dysentery, enterocolitis, etc), unstoppable vomit.

· For parenteral feeding we use the following nutrient formular; proteins – protein hydrolyzates, aminoacid solutions.

· Fats – fatty emulsions.

· Carbohydrates – 10% solution of glucose, usually with the addition of microelements and vitamins.

· Blood products, plasma, plasma substitutes

There are three major parenteral ways of feeding:

· Full – all the nutrients are injected into blood stream, the patient does not even drink water.

· Partial – only major nutrients are used (e.g. proteins and carbohydrates).

· Auxillary – oral feeding is not enough, that is why additional nutrients are injected.

Large doses of hypertonic glucose solution (10% solution), which are prescribed for parenteral feeding, irritate peripheral veins and can cause phlebitis, that is why they are only injected into central veins (subclavicular) through constant catheter, that is placed punctually strictly following aseptics and antiseptics rules.

Fever

There are several types of medical thermometers which are used to measure body temperature:

· mercury maximum thermometer;

· digital (with memory);

· instant.

Rules of disinfection and storage of medical thermometers:

· Wash thermometers in running water.

· Prepare a container (a glass) made of dark glass, put cotton wool on the bottom (to prevent mercury reservoir from breaking) and pour disinfectant solution (e.g., 0,5% chloramine).

· Put thermometers inside the container for 15 minutes.

· Take out the thermometers, wash in running water, wipe dry.

· Put these thermometers in another container which is also filled with disinfectant solution and marked with the label “Clean thermometers”.

Body parts to measure temperature:

· axillary creases

· oral cavity (thermometer is put under the tongue)

· inguinal folds (for children)

· rectum (usually for seriously ill patient; the temperature inside the rectum is usually 0,5-1% higher than in axillary creases)

Measuring body temperature:

Before measuring body temperature we need to take the thermometer from the disinfectant solution, wash it in running water (because some patients may have allergic reaction or skin irritation to chloramine B), then wipe it dry and shake it. The usual place to apply thermometer is axillary crease; the skin must be dry, because the presence of sweat can cause thermometer to show temperature 0,5% lower than the actual body temperature. The duration of measurement using mercury thermometer – no less than ten minutes. After it the thermometer is shaken and put into disinfectant solution.

Before giving the thermometer to another patient it is washed in running water, wiped dry and shaken till the mercury line is below 35⁰C.