NURSING PROCEDURE - DIET FOR PATIENTS (Feeding the Helpless Patient, Nasogastric Tube Insertion, Gastric Gavage)

NURSING PROCEDURE – DIET FOR PATIENTS (Feeding the Helpless Patient, Nasogastric Tube Insertion, Gastric Gavage)

A diet for patients varies based on their specific health condition, medical history, and dietary restrictions.

A variety of menus is needed in hospitals to cover the requirements of many different types of patients. It is important to emphasize that the national healthy eating guidelines are rarely appropriate for the hospitalized patient.

Guidelines are aimed at maintaining a healthy weight and helping to prevent long-term diseases such as heart diseases. But patients admitted to hospital generally have nutritional needs that would not be met by following such guidelines. They often have higher energy needs or small appetites than healthy people and many patients entering hospital have already lost weight due to their illness.

FEEDING THE HELPLESS PATIENT

It is assisting a dependent patient to take food and fluids.

Purpose

To assist the patient to eat meal
To meet the nutritional need
To promote health
To prevent dehydration
To improve appetite

General Instructions

The diet is prescribed by doctor planned by dietician and sewed by nurse
Food should be sewed at correct time in a pleasant manner and in a pleasant atmosphere
Small and frequent meals are preferable for a sick person
Maintain a chart for intake of food and fluids for seriously ill patients
The patient should be free from pain and other discomfort during meal time
Food should be sewed in an attractive manner so that the sight and smell of should increase his appetite
Food should not be too hot or too cold
Meals should be sewed in clean and covered vessels
Give enough time for the patient to enjoy his food
Encourage the patient to develop a taste to his therapeutic regimen of diet
Be careful not to spill food. Wipe the patient’s mouth and chin whenever necessary
Wash patient’s hand and make him brush his teeth after meals

Preliminary Assessment

Check

Doctors order for any specific precautions
Patient’s likes and dislikes and socioeconomic status
Find out the food habits of the patient
General condition and the ability for self-care
Patient’s ability to follows instructions
Ensure that the ordered diet is prepared properly and safety
The articles available in the patients unit

Preparation of the Patient and the Environment

Create a pleasant environment for the patient by well-ventilated, free from noise, odor and unpleasant sight
Send the visitors away tactfully
Give bed pan or urinal to patient if required before meals
If patient can sit help him to have flowers position with cardiac table or over bed table
Provide hand washing facilities to patient and if necessary help him, so that he will feel fresh
Place the towel over the chest and the under the chin to protect clothing

Equipment

A tray containing

A glass of water to give at the end of the meal
Napkin to wipe the face in between
Mackintosh and towel
Feeding cup or spoon
The required amount of feed in a mug at the right temperature
Kidney tray

Procedure

Wash hands thoroughly
Make sure that patient is not starving for any procedure
Explain procedure to patient
Make sure that therapeutic restriction are considered
Cover patient below chin with face towel
Feed the patient either by using spoon or fingers
Offer water as required
After meal, after water to rinse mouth and spit into K-basin
Complete feed and wipe mouth
Record the procedure in the nurse record sheet and intake output chart

After Care

Help the patient to wash his mouth and hands
Remove towel around the neck
Make the patient comfortable
Take all the articles to utility room discard the waste, clean the articles and replace it
Record the procedure in the nurse’s record sheet and intake output chart

NASOGASTRIC TUBE INSERTION

Nasogastric (NG) tube insertion is a method of introducing a tube through nose into stomach

Purpose

To feed patient with fluids when oral intake is not possible
To dilute and remove consumed position
To instill ice cold solution to control gastric bleeding
To prevent stress on operated site by decompressing
To relieve vomiting and distention
To collect gastric juice for diagnostic purposes

Equipment

A tray containing

Nasogastric tube of appropriate size
K-basin
Stethoscope
Bowl with water
Adhesive scissors
Syringe 20 cc or 10 cc

Preliminary Assessment

Check

Doctors order for any specific instruction
Patient’s ability to follow instructions
General condition of the patient
Articles available in the unit

Preparation of the Patient and Unit

Explain the sequence of procedure
Arrange the articles at the bedside
Provide privacy
Provide comfortable position
Place the Mackintosh and towel across the chest
Remove the dentures, if any and place it in a bowel of clean water
Give mouthwash and help him to clean the teeth
Clean the nostrils, if there are secretions or crust formation, using swab stick dipped in saline

Procedure

Wash hands thoroughly
Measure distance of tube from tip of patient’s ear lobe to nose to tip of xiphoid process
Mark the distance of the tube
Lubricate the tube for about 6 to 8 inches with the lubricant using a rag pieces or a paper square
Hold the tube coiled in the right hand and introduces the tip into the left nostril
Pass the tube gently but quickly backwards momentary resistance may occur as the tube is passed into the nasopharynx
When the tube reaches the pharynx the patient may gag. Allow him to rest for a movement
Have the patient take sips of water on command advance the tube 3 to 4 inches each time patient swallows
Make sure tube is in stomach
Once location of nasogastric tube insured close other end of tube with spigot, secure tube on nose using adhesive in “T” or butterfly

Methods to Confirm NG Tube in the Stomach

Aspirate: attach the syringe to the end of NG tube and aspirate small amount of gastric contents
Immerse distal end of tube into bowel of water and check for air bubbles. If the tube is in the trachea, air bubbles will coincide with the expiration of each breath
Auscultate: attach syringe to free end of NG tube, place diaphragm of stethoscope over left hypochondrium. Inject 10 ml of air and auscultate abdomen for gushing sound

After Care

Offer a mouthwash. Clean the face and hands and try them
Remove the Mackintosh and towel
Make the patient comfortable in bed
Take all the articles to the utility room discard the waste, clean it and replace it in a proper place
Wash hands
Record the procedure in the nurse’s record sheet

GASTRIC GAVAGE

Gastric gavage or nasogastric tube feeding is given through tube which is inserted through patient’s nose into stomach, when patient is unable to take food orally

It is the administration of fluid food by means of tube passed into the stomach which is also called the gastric gavage

Purpose

To provide adequate nutrition
To give large amounts of fluids for therapeutic purpose
To assess tolerance of feeds in postoperative patients
To introduce food into stomach when the patient is not able to take food in the usual manner
When the condition of mouth or esophagus makes swallowing difficult

Indication for Tube Feeding

Unconscious patient or semiconscious
After certain surgeries of the mouth and throat
Patient’s unable to swallow
Premature babies
When the patient is unable to retain the food, e.g. anorexia nervosa

General Instructions

Give mouthwash frequently to avoid complications of a neglected mouth
Maintain intake and output chart accurate
Measure and drain the feed (fluid) to avoid blockage in the tube
Avoid introducing air into the stomach during each feed. Pinch the tube before the fluid run into the stomach completely forms the tube
Feeding may be given at intervals of 2, 3 or 4 hours and the amount is not exceeding 150 to 300 ml per feed
Observe for complications such as nausea, vomiting, distension, diarrhea, aspiration pneumonia, asphyxia, fever, and water and electrolyte imbalance

Advantages of Tube Feeding

An adequate amount of all types of nutrients including distasteful foods and medication can be supplied
Large amount of fluids can be given safety
Tube feeding may be continued for weeks without any danger to the patient
The stomach may be aspirated at any time is desired
Over loading of the stomach can be prevented by a drip method

Principle Involved in Gastric Gavages

A thorough knowledge of the anatomy and physiology of the digestive tract and respiratory tract, ensures safe induction of the tube (avoid misplacement of the tube)
Tube feed is a process of giving liquid nutrients or medications through a tube into the stomach when the oral intake is inadequate or impossible
Microorganism enters the body through food and drink
Introduction of the tube into the mouth or nostrils is a frightening situation and the preparation of the patient facilitates introduction of the tube
Systemic ways of working adds to the comfort and safety of the patient and help in the economy of material, time and energy

Preliminary Assessment

Identify the correct patient
Check the doctor’s order for any specific precautions
Check the level of consciousness of the patient
Check whether the feed is ready at hand
Articles available in the unit

Preparation of the Patient and Environment

Explain the sequence of the procedure
Provide adequate privacy
Position the patient in sitting or semi fowlers
Place the Mackintosh and towel around the neck
Arrange the articles at the bedside lockers
Clean the mouth by providing mouthwash

Equipment

A tray containing

Mackintosh and towel
20 cc syringe
Stethoscope
Bowel with water
Adhesive with scissors
Feeds and water
Ounce glass

Procedure

Syringe Method

Wash hands thoroughly
Place towels around neck in such a way that patients clothing and bed linen are protected
Make sure the tube is in stomach before giving feeds
Remove spigot. Pinch the tube to prevent air entry. Remove plunger from syringe and connect to tube
Keep syringe about 12 inches above patients head. Start feed with small measured amount of water and allow feed to follow slowly and steadily through tube in such a way, that air does not enter tube
Do not force fluid, allow to flow by gravity
At the end of feed flush tube by pouring small measured amount of water. Remove syringe and replace spigot

Siphon Method

Place towel around neck in such a way that patients clothing and bed linen are protected
Make sure that tube is in stomach before giving feeds
Immerse tip of tube is in stomach before giving feeds
Immerse tip of tube in prepared feed immediately by avoiding air entry into tube
Raise fluid container about 12 inches above patients head and observe flow of fluid
When feed is over flash tube with small quantity of water
Pinch tube and close with spigot

After Care