DIET FOR PATIENTS – FEEDING THE HELPLESS PATIENTS – NURSING PROCEDURE

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

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

  • Remove the Mackintosh and towel
  • Place the patient in comfortable position
  • Replace the articles to utility room, clean it and replace it
  • Record the procedure in nurse’s record sheet and intake and output chart

FEEDING TYPES

DIET (NUTRITION) FOR SICK PATIENTS

NASOGASTRIC INSERTION

ENTERAL/NASOGASTRIC FEEDING

INSERTION OF SENGSTAKEN – BLAKEMORE

GASTRIC ANALYSIS

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)

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