English. Lesson number 5

SUBJECT: «Organization of nutrition in the treatment-and-

prophylactic institution»

Nutrition - one of the most important human needs.                 

Depend on the character of nutrition:

1. Metabolism

2. Structure and function of cells, tissues, organs

Eating provides:

1. Vital functions2. Growth and development3. Physical and intellectual

performance4. Endurance5. Resistance to adverse

environmental factors

The main components of food:

1. Proteins - the daily caloric value of 10 - 15%  2. Fats - daily energy value of 30 - 35%3. Carbohydrates - the daily energy requirement

of 50 - 60%

Functions of water:

1. transport

2. maintenance of homeostasis

3. thermoregulatory

4. metabolic

5. detoxication

Principles of rational nutrition of healthy human

Rational nutrition - provides growth, development and normal human activity, promotes to the improvement of health and prophylaxis of disease.

PRINCIPLES OF TREATMENT NUTRITION                   Dietology - the science of treatment nutrition

Subject of study:1. Сauses of diseases.2. Mechanism and forms of flow of various

diseases.3. Features of digestion and metabolism in healthy

and ill human.

DIET THERAPY – method of treatment of various diseases by a special diet.

There are 15 diets for various diseases.

DIET - the daily amount of food for the patient for the period of the disease or to prophylaxis.

Important for the diet:1. Increase of frequency of eating to 5 - 6 times a day.2. Various menu. Monotonous food reduces appetite.3. Correct cooking of foods:• mechanical sparing - crushing of food• chemical sparing - exception annoying and

indigestible products (smoked food, marinades, spicy and fatty meals)

• thermal sparing - exception of very cold or very hot- food. Temperature of the food 15 ° C to 60 ° C.

• heat treatment process – boiling in water or by steam.

Organization of nutrition in the hospital

General leadership of dietetics is carried out by head doctor of hospital.

Responsible for organizing of nutrition are dietarian or dietary nurse.

Duties of dietarian:1. control for the work of the nutrition unit2. formation of the menu3. control for the product quality 4. control for correct storage of products5. Control for the quality of prepared food6. Сontrol for sanitary-and-hygienic regime

Treating physician appoints the diet.Ward nurse forms a list of patients and the number of diet.

Senior nurse of the department forms the document for kitchen (requirement with indicating the diet for each patient).

Nurse-barmaid receives and distributes the prepared food.

Ward nurse helps her to feed seriously ill patients.

Наименование отделения Количество больных Стандартные диеты

10 2 3 4 5

cardiological 30 20 2 5 3

There are several types of nutrition: active, passive, artificial nutrition.

1. Active feeding - the patient takes the food itself.2. Passive feeding - the patient takes the food with the

help of nurse.3. Artificial feeding - feeding the patient the nutrient

mixtures by probe (enteral nutrition) or by intravenous infusion (parenteral nutrition).

Feeding critically ill with a spoon or invalid's cup Algorithm of action:

1. Hygienic processing of hands.2. To prevent the patient about the procedure and have his

consent. 3. Ventilate the room, fix bedside table.4. Give the patient a comfortable position - half-sitting

(Fowler's position).5. Wash hands of patient, put on chest napkin.6. Wash hands and bring food to the patient (temperature of

the food 50 ° C).

7. Bring the spoon to his mouth, to feed in small portions, slowly. 

8. Offer a drinking, drink from a invalid's cup small portions. 

9. Wipe the patient's lips with a napkin after eating.

10. Offer to rinse mouth after eating.

11. Remove dishes.

12. Give the patient a comfortable position.

13. Wash hands.

Feeding the patient by a nasogastric probe

Purpose: To provide the patient by nutrition  Equipment: Janet’s syringe volume 300 ml, forceps (or lid),

tray, phonendoscope, nutrient mixture (38 - 40° C), warm boiled water 100 ml.

Algorithm of actions:

1. Warn the patient about the procedure, to obtain the consent.

2. Give the patient a comfortable position - position of Fowler.

3. Conduct hygienic processing of hands, put on gloves.4. Prepare the nutrient mixture (temperature 38 - 40 °C)5. Dial into the Janet‘s syringe the nutrient mixture (300

ml), connect syringe with the probe. Raise it to 50 cm above the patient's body.

6. Remove the forceps (or lid) from the distal end of the probe and provide the gradual flow of nutritive mixture (300 ml). Nutrient mixture must be introduced during 10 minutes.

7. After evacuation of the syringe to pinch the probe by forceps or close lid. Disconnect the syringe from the probe.

8. Dial into the Jane‘s syringe the 50 ml with boiled water.

9. Connect the Janet’s syringe to the probe, remove the forceps or lid, rinse the probe.

10. Disconnect the syringe, close the distal end of the probe by probe.

11. Fix the probe by adhesive plaster, give the patient a comfortable position.

12. Remove gloves, wash hands.

Care for nasogastric probe

Purpose: prevent irritation of the mucous membranes of the nose, ensuring the patency of the probe.

Equipment. Sterile: Jane syringe, gauze napkins, tray, glycerin (vaseline), saline or a special solution for washing probe, tray. Non-sterile gloves, stethoscope, tray, adhesive plaster.

Algorithm of actions:

• Warn the patient about the procedure, obtain the consent.

• Conduct hygienic processing of hands, put on gloves.

• Сontrol the location of the probe: ask the patient to open the mouth (probe should be visible in the throat).

• Сarrying out auscultatory test. Dial into the Jane syringe 10 to 15 ml of air. Connect the syringe to the nasogastric probe and enter the air. Listen sounds in epigastrium using the stethoscope. (If the probe is in stomach, we hear gurgling sounds).

• Take care of the oral cavity: moisten with saline mouth and lips (to make every 3-4 hours).

• Rinse the probe with of saline. Fill the syringe with saline (20-30 ml). Connect the syringe to the probe, slowly introduce the liquid into the probe. Aspirate the liquid, to pay attention to her appearance and pour in a separate container (to make every 3 hours or prescription of doctor).

• Inspect the place of insertion of the probe (nasal passage), reveal for signs of irritation of the skin.

• Clear outer nasal passages by gauze napkins, moistened with saline.

• Apply glycerin (vaseline) on the mucous membrane of the nose of the contact area with the probe.

• If fixative adhesive plaster has peeled off or heavily soiled, replace it.

• Disinfect and dispose of used materials.

• Remove gloves, wash hands.

Feeding by gastrostomy       

 Purpose: To provide the nutrition of patientEquipment. Sterile: Jane’s syringe 300 ml, 50 ml syringe,

gauze napkins, tray. Non sterile: gloves, phonendoscope, nutrient mixture 38 - 40 ° C, warm boiled water 100 ml.

Algorithm of actions:

1. Warn the patient about the procedure, obtain the consent.

2. Give the patient a comfortable position - position of Fowler.

3. Conduct hygienic processing of hands, put on gloves.

4. Heat up nutrient mixture to a temperature of 38 - 40° C.

5.Put a towel under the outer part of the gastrostomy tube in epigastric area.6. Conduct a visual inspection of the outer part of the gastrostomy tube and

skin, surrounding the gastrostomy.7. Connect the Janet’s syringe with nutrient mixture to the distal foramen of

gastrostomy tube, remove the lid (forceps).8. Introduce the nutrient mixture in stomach by small portions.9. After the introduction of the nutrient mixture, rinse gastrostomy tube with

boiled water. Fill the syringe with boiled water (100 ml). Connect the syringe to the tube, slowly introduce the liquid into the tube.

10. Disconnect the syringe, cover the foramen of the tube with a sterile napkin, apply a lid (forceps).

11. Conduct toilet of gastrostomy: Wash skin with soap and water around the gastrostomy, dry with napkin, apply a layer of ointment or paste, apply a sterile napkin around the gastrostomy tube.

12. Fix the end of the tube to the skin by plaster13. Remove gloves, wash hands.

Medications for parenteral nutrition are divided into two groups:

1. Donor of energy - solutions of carbohydrates - monosaccharides and spirits, fatty emulsions     

2. Donor of plastic material - amino acid solutions

Remedies for parenteral nutrition compose from the following components:

1. Carbohydrates and spirits - the main sources of energy.

2. Sorbite 20% and xylite - additional sources of energy with glucose and fat emulsions.

3. Fats - the most effective energy substrate is introduced in the forme of a fat emulsion.

4. Proteins - an important part to build tissues, blood, synthesis of hormones, enzymes.

5. Saline solutions - simple and complex, introduced for normalize water-electrolytic and acid-base balance.

6. Vitamins, microelements, anabolic hormones also include in complex of parenteral nutrition.

Variants of admission:

1. Through a peripheral vein

2. Through a central vein with the help of central catheter

3. Through alternative vascular and extravascular admissions (peritoneal cavity)

Regims of parenteral nutrition:

1. Twenty-four-hour introduction of nutrients2. Prolonged infusion (during 18 - 20 hours)3. Cyclic (infusion during 8 - 12 hours)

Parenteral nutrition should be conducted under doctor’s supervision.

At the introduction of parenteral nutrients necessary to observe strictly the recommended temperature and rate of administration - 37 - 38 ° C.

Characteristics of medical diet Diet number 1

Indications: gastric ulcer and duodenal ulcer with mild exacerbation and at the convalescence, exacerbation of chronic gastritis with saved or increased secretion, acute gastritis during an exacerbation.

General characteristics: significant mechanical, chemical, thermal sparing of the gastrointestinal tract, limitation of stimulation of secretion, gastric mucosal irritants; food is prepared mashed, boiled in water or by steam, gently limited salt, excluded very hot and cold dishes, eating 5 - 6 times a day.

DIET number 2Indications: chronic gastritis with secretory deficiency at

the mild exacerbation and in convalescence stage, chronic enteritis and colitis after and out of exacerbation.

General characteristics: physiologically complete diet with gently mechanical sparing and gently stimulation of gastric secretion, allowed dishes various degrees of grinding and heat treatment. It is boiled, steamed, baked, fried without rough crust, pureed meals from foods rich in cellulose. Excluded products that irritate the mucous membrane and hard to digest, very cold and hot meals, eating 4 - 5 times a day in small portions.

DIET number 3

Indications: chronic intestine disease with constipation at the mild exacerbation and out of exacerbation.

General characteristics: physiologically complete diet with foods which intensify motor function and defecation; food is not crushed, boiled or steamed, baked, vegetables and fruits (raw or cooked), allowed the first cold and sweet meals, drinks at night – sour-milk products. Products are excluded which intensify fermentation and putrefaction in the intestine, eating - 4 - 6 times a day.

DIET number4

Indications: acute diseases and exacerbation of chronic intestinal diseases

with frequent diarrhea.

General characteristics: normal protein content, reduced content of fat and carbohydrate, significant mechanical, chemical, thermal sparing of gastrointestinal tract, prepared liquid, semi-liquid, pureed meals, cooked in water or steamed. Excluded very hot and cold meals, products which intensify secretion of the digestive system, processes of fermentation and putrefaction in the intestine. Recommended plentiful drink, eating 5 - 6 times a day in small portions.

DIET number 5

Indications: acute hepatitis, cholecystitis in the stage of convalescence, chronic hepatitis, liver cirrhosis without liver deficiency, chronic cholecystitis and cholelithiasis without exacerbation.

General characteristics: physiologically normal content of proteins and carbohydrates, small limitation of fats. It is recommended plenty of vegetables and fruits. Excluded the stimulants of secretion, infusible fats, fried foods, foods rich in cholesterol, purines, cold dishes; food is served boiled, baked and stewed forms, eating 5 - 6 times a day.

DIET number 6

Indications: gout, urine acid diathesis, urolithiasis with formation of urine acid calculus.

General characteristics: protein and fat content is reduced. Patients with adiposity are limited in carbohydrates, table salt. Excluded products which content purines, oxalic acid, meat, fish products. Introduce the products containing alkaline radicals - vegetables, fruits, berries, milk. Increase the amount of fluid. Temperature of food is usual, excluded decoction of meat, fish, poultry. Eating 5 time a day

DIET number 7

Indications: acute nephritis in the period of

convalescence, chronic nephritis out of exacerbation and renal deficiency.

General characteristics: protein content is limited, fats and carbohydrates in the normal range, cooking without salt with moderate chemical sparing. Temperature of food is normal, amount of liquid is reduced to 1 liter. excluded extractives meat, fish, mushrooms, sources of oxalic acid and the essential oils. eating 5 - 6 times a day.

At the acute glomerulonephritis and chronic nephritis with renal deficiency recommended diet without salt, with a limitation of proteins. Conduct strict control for the amount of fluid and the amount of urine.

DIET number 8

Indications: adiposity as an basic disease or concomitant at the other diseases.

General characteristics: limitation of carbohydrates and fats, increased the content of protein; limitation of salt, free liquid, flavoring spices, extractives which increase appetite; vegetables and fruits in enough amount. Use sugar substitutes for sugary foods and drinks. Meals are boiled, steamed, baked. Temperature of meals is usual. Eating 5 - 6 times a day with enough sense of satiation.

DIET number 9

Indications: diabetes of mild and moderate severity.General characteristics: moderate limitation of carbohydrates

and fats; proteins above the physiological norm. Excluded sugar and sweets, moderately limited content of salt, cholesterol, extractives, increased content of lipotropic substances, vitamins, vegetables. Cooked boiled, baked and stewed meals. Temperature is usual, for sweet meals and drinks - sugar is limited. Eating - 6 times a day. Carbohydrates distributed evenly throughout the day. Immediately after insulin injection the patient must receive the food containing carbohydrates.

DIET number 10

Indications: diseases of the cardiovascular system - rheumatism and cardiac defect, coronary heart disease, hypertension, atherosclerosis with lesions the vascular of heart, brain and other organs.

General characteristics: content of protein - physiologically norm. Reduced content of animal fat, limited salt, free liquid, extractives, cholesterol, increased content of vitamins, lipotropic substances, potassium, magnesium and dietary fibers. Food is crushed, boiled. Temperature of food is usual, liquid - 1.2 liters. Eating - 5 - 6 times a day in small portions.

DIET number 11

Indications: tuberculosis at the absence of internal diseases.  General characteristics: high-calorie diet with high content of protein and

vitamins, moderate increase fats and carbohydrates, vitamins, mineral substances. Salt and fluid is in the normal range. Usual cooking with saving of extractives; spices is allowed. Eating 4 - 5 times a day.

DIET number 13

Indications: acute infectious diseases.

General characteristics: content of protein at the lower boundary of the physiological norm, moderate limitation of fats, carbohydrates; fluid in large amount in the form of drinks with vitamins (juice). Food is prepared mashed, boiled in water or steamed. Excluded fatty, salty, indigestible products, crude cellulose. Increase the salt at the profuse sweating, profuse vomiting. Free fluid - 2 liters and more. Eating 5 - 6 times a day by large portions.

DIET number 14

Indications: phosphaturia with alkaline reaction of urine and precipitation of the phosphorus-calcium salts.

General characteristics: the content of proteins, fats, carbohydrates is normal. Introduced in the diet products which changes the reaction of urine in acid side (bread, baked food, cereals, meat, fish). Excluded dairy products, most vegetables and fruits. Cooking of food and temperature are usual. Free liquid 1,5 - 2 liters. Eating 4 - 5 times a day.

DIET number 15

Indications: various diseases in the absence of indications for special diets and at the normal condition of the digestive system (common table).

General characteristics: the content of proteins, fats, carbohydrates and calories correspond to nutritional standards of a healthy person not engaged in physical labor. Vitamins - in higher amount. Food consists of a various products. Excluded fatty meals, pastry. Spices is in moderate amount. Eating 4 - 5 times a day.

DIET number 0

Indications: operations on the digestive organs, soporose state.

General characteristics: liquid, low-calorie diet with limitation of salt. Recommended readily assimilable products - mucous cereal decoctions, weak meat-broth, jelly, broth of rose, unsweetened tea, gas-free mineral water. Eating through every 2 hours during the day and at night. Starvation for 1 - 3 days is appointed to patients with uncontrollable vomiting, gastric hemorrhage, acute inflammatory diseases of the organs of abdomenal cavity after operations on these organs.