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SKILLSMS116
SKILLSMS116
• Used for pts with atherosclerosis and heart disease Low Protein Diet:
Diet is the sum of the food consumed by a person or other • Limit foods high in saturated fats such as beef, libers, • Used for pts with certain kidney diseases and for
organism. pork, lamb, egg yolk, cream cheeses, shellfish, whole certain allergic conditions
Diet Therapy is concerned with recovery from illness and milk and coconut and palm oil products. • Regular diet with limited or decreased protein rich
prevention of disease. foods
Low Residue Diet:
What is Therapeutic Diet: • Used for patients with digestive and rectal disease Bland Diet:
• Planned diet such as colitis or diarrhea • Consists of easily digested foods that do not irritate
• Modification of normal diet • Eliminates or limits foods high in bulk or fiber such as the digestive tract
• Prescribed by doctor and planned by dietician raw fruits and veggies, whole grains and cereals, nuts, • Used for pts with ulcers and other digestive diseases
• Used to supplement the medical or surgical treatment seeds, beans and peas, coconut and fried foods. • Avoid coarse foods, fried foods, highly seasoned
• Removing or adding foods foods, pastries, raw fruits and veggies, alcohol,
• Change nutrients, caloric content and/or texture Diabetic Diet: carbonated beverages, nuts, coffee, tea, smoked and
• Increase or decrease the energy values • Goods are grouped according to type, nutrients and salted meats and fish.
• Increase or decrease bulk in the diet e.g., high or low calories.
fiber diets • Pts are allowed a certain number of items from each Therapeutic Diet for Malnutrition:
exchange list according to individual needs. • High energy and high protein
Purposes of Therapeutic Diets: • Energy and nutrient dense foods
• Regulate amounts of food Calorie Controlled Diet: • Pick foods from the menu which can be fortified
• Assist body organs to maintain normal function Low Calorie Diet: • Used of supplements
• Aid in digestion • Used for patients who are overweight • Recipe fortification
• To improve specific health conditions • Avoid or limit high calories foods such as: • Examine what a resident like to eat and encourage
• Increase or decrease body weight • Butter, cream, whole milk, cream soups or gravies, those types of foods.
• Modify the intervals of feedings sweet soft drinks, alcoholic beverages, salad
dressings, fatty meats, candy and rich desserts Dietary Guidelines:
Significance: • Also eat a variety of food
• Useful in managing disease High Calorie Diet: • Maintain ideal weight
• Promote greater resistance to specific conditions • Used for patients who are underweight, or who have • Avoid excess fat (total and unsaturated) and
• Prevention or supplemental treatment anorexia nervosa, hyperthyroidism, or cancer cholesterol
• Indication: • Extra protein and carbs are included • Eat foods with adequate dietary fiber
• Kidney failure • Avoid high-bulk foods such as green salads, • Avoid excess sugar
• Lower serum cholesterol watermelon and fibrous fruits • Avoid excess salt
• Control elevated blood sugar levels • Avoid high-fat foods such as fried foods, rich pastries,
• Treat celiac disease – a disease where the small and cheese cake because they digest slowly and spoil Conclusion:
intestine can’t absorb nutrients appetite. • Therapeutic diets to be used when necessary
• For example: gluten-free diets • Ensure that residents with malnutrition are eating
Low Cholesterol Diet: foods which taste good and full of flavor
Types of Therapeutic Diets: • Restricts foods containing cholesterol • Menu design should aim for diet integration so that
• Regular diet • Used for pts with atherosclerosis and heart disease everyone eats the same type of foods
• Liquid diet • Limit foods high in saturated fats such as beef, liver, • Portion control is an essential tool in menu planning
• Soft diet pork, lamb, egg yolk, cream cheese, natural cheeses, • Standard recipes help with the delivery of nutritional
shellfish, whole milk and coconut and palm oil
• Diabetic diet care
products.
• Calorie controlled diet
• Low cholesterol diet Gastric and Intestinal Decompression
Fat Restricted or Low-Fat Diet:
• Intended for pts with gastric distension receiving
• Used for pts with gallbladder and liver disease, aggressive ventilatory resuscitative measures prior to
Regular Diet:
obesity, and certain heart diseases
• Balanced diet usually used for ambulatory patients intubation
• Avoid cream, whole milk, cheese, fats, fatty meats, • Nasogastric tube may be used to perform gastric
• At times it has a slightly reduced caloric content
rich desserts, chocolates, fried foods, salad dressings,
• Foods such as rich desserts, cream sauces, salad decompression for the patient with known or
nuts and coconut. suspected gastric distension.
dressings and fried foods may be decreased or
omitted.
Sodium Restricted Diet (Low Sodium or Low Salt Diet): Gastric Decompression is the removing of the contents of
• Used for pts with cardiovascular diseases such as the stomach through the use of a nasogastric tube. This
Liquid Diet:
hypertension or congestive heart disease, kidney may be performed if a person has ingested some sort of
• Nutritionally inadequate and should only be used for
disease and edema toxins, such as in cases of too much alcohol, or in cases of
short periods of time:
• Avoid or limit addition of salt to any foods, smoked bowel obstruction where the person needs to be put on
• Uses:
meats or fish, processed foods, pickles, sauerkraut, bowel rest.
• After surgery or heart attack
olives and processed cheeses.
• Pts with acute infections or digestive problems
• To replace fluid lost by vomiting or diarrhea Gastric Distension
High Protein Diet: • Is the enlargement of the stomach, and can be due to
• Before some Xrays of digestive tract • Used for children and adolescents who need a number of causes
additional growth, pregnant or lactating women, • Physiologic (normal) gastric distension occurs when
Clear Liquid Diet: before and/or after surgery, pts suffering from burns,
• Water, apple or grape juice, fat-free broths, plain eating.
fevers or infections
gelatin, popsicles, ginger ale, tea, coffee • Regular diet with added protein rich foods such as
• Low Cholesterol Diet: meats, fish, milk, cheese and eggs.
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• Distension of the upper stomach stimulates the • Experience has shown that it is much easier to predetermined length. Check tube placement before
secretion of stomach acid, while distension of the prevent distention of the gastrointestinal tract by evacuation by air insufflation into the stomach with a
lower stomach stimulates gastrin secretion. suction applied to indwelling tube than to relieve a large syringe.
distention already present.
Other causes include: • Various types of tubes have been developed in an Which tube is used for gastrointestinal decompression?
• Binge eating associated with bulimia nervosa attempt to obtain more effective and quicker • Cantor Tube
• Tumors causing obstruction decompression of the small bowel. Ideally, • This is a 10-foot long, single-lumen tube used for
• Diabetic neuropathy gastrointestinal decompression of the small bowel. intestinal decompression. The cantor tube has a
• Scarring due to pyloric gastritis Ideally, gastrointestinal decompression should be mercury-weighted rubber tab attached to its
• Delayed gastric emptying obtained by maintaining an effective suction perforated tip to help carry the tube through the
• To identify the cause of gastric distension, an upper simultaneously in both the stomach and small bowel. stomach and intestine.
endoscopy or barium upper GI imaging should be An acceptable practical solution to this problem is not
done available at present. What is the suction setting for gastric decompression?
• Gastrointestinal decompression has been found to be • When using a one lumen gastric tube to decompress
Nasogastric Tube particularly useful in two clinical entities: the gastrointestinal tract, a regulator that has an
• A nasogastric tube is a flexible tube of rubber or ▪ Intestinal obstruction intermittent suction setting, with preset on-and-off
plastic that is passed through the nose, down through ▪ Paralytic ileus. As a definitive means of treating cycles must be used. Set the initial level of suction
the esophagus, and into the stomach. It can be used patients with simple small bowel obstruction within the “low range” (0-80mmHg), starting between
to either removes substances from or add them to the without operation, it has an important but 40-60mmHg. The suction level should not exceed
stomach. An NG tube is only meant to be use on a somewhat limited role. In general, these 80mmHg.
temporary basis and is not for long-term use. limitations depend upon the difficulty in Gastrostomy Feeding and J-tube Feeding
• Is a special tube that carries food and medicine to the distinguishing with certainty between simple and
stomach through the nose. It can be used for all strangulation obstructions and the time and care What is jejunostomy tube?
feedings or for giving a person extra calories. necessary for the use of the method. • A jejunostomy tube or J-tube is a soft plastic feeding
• As an essential part of the surgical treatment of all tube that is placed through the skin of the abdomen
Types of Nasogastric Tubes: cases of obstruction, decompression should be into the jejunum (middle section of the small
LEVIN TUBE: routinely. intestine) bypassing the stomach entirely.
• Single lumen, hole near tip • In obstructions of the colon, decompression by means • The jejunostomy tube may be placed laparoscopically
• Prevents accumulation of intestinal liquids and gas of great extent, prevent a distention already present (through a microscope inserted through the belly
during and following surgery. Prevents nausea, from becoming greater. Decompression of a button) or surgically. Jejunostomy tube like the
vomiting and distension due to reduced peristaltic distention already present must be secured by gastrotomy tube (G-tube), may be an actual tube or a
action. operative means. button. Only liquids may pass through the
SUMP: (SALEM) • The greatest benefit of gastrointestinal jejunostomy tube.
• Double lumen, radiopaque decompression have come from the effective control
• 1st lumen: suction of gastric contents od the distension and vomiting associated with The jejunostomy tube is put in place by one of these
• 2nd lumen: blue extension (pig tail) open to room air paralytic ileus. This method of treatment is most methods:
to maintain a continuous flow of atmospheric air into effective when used in prophylactic fashion. • 1. Surgical – the tube is secured to the skin by
the stomach. Considerable differences of opinion exist as to its stitching the tube’s external fixation disc to it.
• Controls the amount of suction pressure placed on exact role in postoperative care. In general, it is Occasionally, it may be secured by an internal fixation
indicated in the treatment of all patients undergoing disc.
• Stomach walls. Prevents injury, ulcers
major abdominal surgical procedures and particularly • 2. Via a percutaneous endoscopic gastrotomy (PEG)
in those patients having operations upon the tube (a feeding tube placed into the stomach) – much
Continue Types of Nasogastric Tubes:
gastrointestinal tract or in the treatment of any thinner jejunostomy extension tube is passed through
MOSS TUBE
patient in whom more than a minimal degree of ileus the PEG tube into the jejunum. Careful placement of
• Tri-lumen
can expected to follow operation. the jejunostomy tube is verified by X-ray. The
• 1st lumen: Balloon anchors it in the stomach
• This form of therapy should be an essential part of percutaneous endoscopic gastrotomy (PEG) tube is
• 2nd lumen: Feeding tube
treatment of any patient with peritonitis. Associated retained in the stomach by a disc to ensure it does not
• 3rd lumen: Aspiration and lavage
with control of distention and vomiting, fall out. However, the jejunostomy extension tube is
SENGSTAKEN-BLAKEMORE
decompression protects the patient against the only secured by an adaptor at the end of the PEG
• Triple Lumen
bronchial aspiration of the gastric contents, tube.
• 1st lumen: Inflates the balloon in the stomach to press
encourages the adequate and rapid healing of • Radiologically – the tube is placed under X-ray control,
against the esophagogastric junction.
intestinal suture lines, minimizes the incidence of and is usually secured by stitching external fixation
• 2nd lumen: Inflates the balloon in the esophagus to abdominal wound dehiscence and evisceration and disc to the skin.
press directly against varices. decreases the incidence of postoperative adhesive
• 3rd lumen: Used for aspiration and lavage obstruction. Cleaning the skin around the jejunostomy tube
MINNESOTA TUBE: • Associated with control of distention and vomiting • To clean the skin, you will need to change the
• 4 Lumen decompression protects the patient against the bandages once a day or more if the area becomes wet
NUTRIFLEX TUBE bronchial aspiration of gastric contents, encourages or dirty.
• Feeding tube: usually radiopaque the adequate and rapid healing of intestinal suture • The skin area should be always kept clean and dry.
• Mercury weighted lines, minimizes the incidence of abdominal wound You will need:
• Coated with lubricant dehiscence and evisceration, and decreases the • Warm soapy water and a washcloth
• Activated with gastric secretions to keep tube supple incidence postoperative adhesive obstruction. • Dry, clean towel
and not injure stomach lining.
• Plastic bag
• During the past twenty years, the beneficial effects of How to perform gastrointestinal decompression
• Ointment or hydrogen peroxide (if your doctor
gastrointestinal decompression have been recognized • Place the patient in high fowlers’ position and instruct recommends)
and accepted as an important part of surgical therapy. them to swallow on command. Insert the tube into an
• Q-tips
unobstructed nostril and slowly advance until at the
Steps Rationale
Check the physician’s A dependent function
order needs doctor’s order
Assemble all the To save time and effort
equipment in the client’s
bedside
Introduce yourself. To gain client’s
Identify the client and cooperation
explain the procedure
and reason why it is
necessary
Let the client void first Warm water might relax
before the procedure the urethral sphincter
and make the client void
in the solution
Place a chair covered
with blanket
Drape the client’s trunk
with bath towel and pin
opening of the towel
Undress the client by Covering client’s body
covering the entire body with bath blanket
with bath blanket. Place prevents chilling
crosswise with the
opening at the back
pin ends of the blanket
together at the back of
the blanket
Assist the client to sit in a This will be used as a
chair and note the pulse basis of comparison
and color of face during the procedure
Half fill the tube or chair
with water (110F)
Assists the client to sit in
the tub or chair opening
the blanket at the back to
envelope the client and
tub
Adjust ice cap to client’s The ice cap prevents the
head. rushing of blood to head
resulting in congestion
and headache
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