Feeding the sick Patients:
The aim of feeding patients is to provide adequate nourishment to help and not to hinder restoration of health. In some cases artificial feeding (Feeding given other than through the mouth) may be necessary. Here we will deal with feeding the patients who are allowed to have food or fluids by mouth.
An important responsibility of the nurse who is caring for the sick is to see that patients get the right diet at the proper time, to see that they take the food and to give necessary help in feeding helpless patients.
1.Points to Remember:
Meals for special diets must be served regularly and on time, making sure that the patient gets enough in 24 hours. Foods should be served hot as hot and cold as cold.
a. Whenever possible, let patients have the foods they like best, but it should also be nutritious and suitable for their digestion.
b. Prepare the environment. The ward should be quiet, well ventilated and free from all unpleasant sights and smells.
c. Prepare the patient both mentally and physically to enjoy the food served. See that dressings or painful treatments are finished at least an hour before food is served. Help the patient to feel fresh and ready for the meal by washing face, hands and mouth.
d. Cleanliness of the food served and of all equipments is very important. The person serving the food must wear clean cloths and should have washed their hands well. Otherwise besides being distasteful to the patient, there is danger of introducing infection.
2. Procedure - Feeding the patient:
1. Prepare a covered tray containing the diet, drinking water, kidney tray, spoon, towel and a rubber sheet if needed.
2. Help the patient into a comfortable position and arrange the towel to protect the clothing and bed linen.
3. Talk with the patient, telling him what is being served.
4. Make sure liquids are not too hot and use a feeding cup if needed. Ask the patient to open the mouth and pour it little.
5. To give solids or soft diet, use a spoon and feed slowly, allowing the patient time to breathe and to masticate.
6. When finished, give the patient some water to drink and to wash the mouth, receiving into the kidney tray.
7. Wipe the lips with the towel, and leave the patient comfortable.
8. Remove the tray, clean, dry and replace the articles.
Record the time and amount of diet taken by the patient.
Procedure - Feeding the children:
1. Children may eat best when allowed to sit at a small table with other children. Attractive coloured dishes and tumblers may help.
2. Before the food is served, the hands and faces should be washed, and bibs tied on to protect clothing.
3. It is the best if the mother helps her small child to feed.
4. Serve little quantity at first and let the child have more if he will eat it.
5. Encourage the child to finish the diet, but never force a child to eat. Food should never be offered when a child is upset.
6. Record the diet and time of food taken when the child has taken.
7. Teach the child good eating habits when appropriate.
Ryle' s Tube-feeding. (Refer practicals) Purpose:
To introduce liquid food through the nostril into the stomach, when the patient cannot or will not take food in the ordinary way. Some conditions are:
1. When the patient is unconscious.
2. Patients who are refusing food, e.g, in hysteria and mental illness.
3. When the pharynx is paralyzed for any cause.
4. After surgery of the mouth.
5. In Tetanus when there is difficulty in opening the mouth.
6. Premature babies who are too weak to suck.
1. A sterile Ryle' s tube or naso-gastric tube.
2. A 20 ml syringe.
3. Lubricant such as liquid paraffin
4. Litmus paper.
5. Container of sterile water.
6. Swab sticks
7. Kidney tray
8. Adhesive plaster
9. Clip or spigot to close the end of the tube.
10. Rubber or plastic sheet and treatment towel.
11. Mouth wash if the patient can use it. Required feed in a measuring glass, a bowl of warm water (any liquid food that is strained and will pass through the tube with out blocking can be given).
1. Explain to the patient and get his co-operation.
2. Position the patient usually sitting upright and supported.
3. Bring the tray to the bedside and screen the bed.'
4. Drape the plastic sheet and towel around the patient' s neck.
5. Clear the nostril.
6. Wash the hands then take the tube, lubricate it and make sure it is empty.
7. Insert the tube along the floor of the nostril and gently pass it into the naso-pharynx.
8. Ask the patient to swallow repeatedly while the nurse advance the tube quickly into the stomach.
9. Attach the syringe to the end of the tube and aspirate the stomach contents.
10. If there is doubt about the position of the tube, test the fluid aspirated with litmus paper. Blue litmus paper turns red when the tube is in the stomach, because of the acid in the gastric juice.
11. Secure the tube to the nose or forehead with adhesive tape.
12. If the patient can understand, talk to him about the food to be given as this may help his appetite and digestion.
13. Before and after the feed introduce a little water. Ordered medicines may also be given through the tube.
14. Give the food slowly. Instead of forcing it in through the syringe, the plunger may be removed and the food poured into the barrel.
15. Give a mouthwash and make the patient comfortable with the tube clamped.
16. Record the time, quantity and type of food given and the route.
If a milk drip is ordered, for eg. a patient with peptic ulcer, connect the nasogastric tube to a container of milk (covered) hung on a stand and use a drip bulb and clip to regulate the flow. See that the milk is fresh.