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Nutrition and care in the gastro-intestinal disorders
Diet, dysphagia, heartburn, hiccups, flatulence, nausea, vomiting, Belch, constipation, diarrhea, involuntary defecation
For a cancer patient a correct diet is important. The patient should receive foods rich in vitamins and proteins, at least 4-6 times a day, and you should pay attention to the variety and taste of food. Adhere to any special diets should not be, just need to avoid excessively hot or very cold, rude, fried or spicy foods. Patients with advanced gastric cancer should be fed more gentle food (sour cream, cottage cheese, boiled fish, meat broth, steam burgers, fruit and vegetables in the form of crushed or mashed, etc.) During the meal is required reception 1-2 tablespoons 0.5 - 1% solution of hydrochloric (HCl) acid. Severe obstruction of solid food in patients with inoperable cancers gastric cardia and esophagus requires the appointment of high-calorie and vitamin-rich liquid food (sour cream, raw eggs, broths, liquid porridge, sweet tea, liquid vegetable puree, etc.). Sometimes it helps to improve the patency of the following mixture: rectified spirit 96% - 50 ml, glycerol - 150 ml (one tablespoon before eating). Acceptance of this mixture can be combined with the appointment of 0.1% atropine solution of 4-6 drops per tablespoon of water for 15-20 minutes before eating. With the threat of complete obstruction of the esophagus requiring hospitalization for palliative surgery. For patients with malignant tumors of the esophagus should be drinking bowl and feed it only liquid food. In this case, often using a thin gastric tube, held in the stomach through the nose.
Dysphagia - swallowing disorder caused by organic or functional barriers to promote food bolus along the esophagus. The main causes of dysphagia, are diseases of the pharynx (traumatic or inflammatory), nervous system and muscles involved in the act of swallowing, muffled (narrowing) of the esophagus (esophageal tumor and mediastinum, enlarged lymph nodes), the defeat of the esophageal mucosa (trauma, burns , inflammation). The main symptom is the inability to swallow dysphagia food, first solid, then liquid.
Functional dysphagia is characterized by episodic or intermittent occurrence over and provoked by swallowing annoying food (hot or cold). Dysphagia due to hysterical neurosis may occur and ingestion of liquid food and water, but absent in swallowing solid write. Functional dysphagia is usually not progressive.
Organic dysphagia characterized by a lack of remission and a link to swallow solid food. Zapivanie water food relief. When tumors of the esophagus accompanied by dysphagia and progressive retrosternal pain on swallowing. If you suspect that the organic nature of dysphagia showed a focused X-ray examination of the esophagus and stomach with a subsequent esophagoscopy. Diagnosis can help to subcutaneous injection of atropine sulfate, followed by X-rays. With functional disorders of the esophagus (spasm) of subcutaneous 1 ml of 0.1% solution of atropine sulfate is dysphagia, and when organic lesions - remains.
Heartburn - burning sensation along the esophagus. Appears in contact with acidic gastric contents on the mucosa of the esophagus. Most often occurs when an excessive amount of gastric juice with high acidity, but sometimes in those with normal and low acidity. Suffer from heartburn are usually patients with gastritis, with increased secretion of gastric juice, as well as patients with gastric ulcer. Sometimes, heartburn is regurgitation of stomach acid content. If you have heartburn, should determine the cause and for withdrawal, it is recommended to drink half a glass of milk or to alkali: a pinch of sodium bicarbonate (baking soda) mixed with magnesia. If heartburn occurs in people with labile nervous system and a violation of gastrointestinal motility, it is advisable to appoint agents, soothing the nervous system.
Hiccup - a reflex act, manifested in a sudden spasmodic contraction of the diaphragm, accompanied by a strong breath with a characteristic sound. Can last from several minutes to several days. Incessant hiccups - an extremely serious condition that requires emergency care. Short-term hiccups often occurs in response to the rapid filling of the stomach, especially dry food. Longer is a hiccup in the gastrointestinal tract, especially the gall bladder in the postoperative period after the interventions in the peritoneal cavity, and encephalitis, stroke, bowel obstruction, neurosis and TE Treatment is symptomatic: 1-2 tablespoons 0.5 % solution of novocaine in, belladonna (0.015 g), chlorpromazine (0.025-0.05 g), valerian, etaperazin (0.005-0.01 g)
Flatulence - abnormal flatulence, causing a dramatic swelling of the abdomen. Sometimes there is enhanced when swallowed air or intestinal dyskinesia (violation of contractility), and occasionally - at a reduced suction gas intestine. Enhances flatulence eating black bread, sauerkraut, and milk. As a rule, bloating occurs in enterocolitis, heart failure with liver cirrhosis, as well as after surgery in the abdominal cavity. To reduce bloating appoint activated charcoal for several pills a day, with the infusion of chamomile enemas, diet. Good result the introduction of the vapor tube.
Gas abduction conducted at a large amounts of gas in the intestine through a special thick-walled soft rubber tube length of 30-50 cm and a diameter of 3-5 mm. One end of the tube is rounded and has a hole, and the second cut obliquely. Before the introduction of the tube should be boiled. To better the tube is placed on a patient's left side, pushing the buttocks. Greased with petroleum jelly or any other fat pipe circular movements gently injected into the anus. If the patient can not be rotated, then the manipulation is carried out on the back with knees bent and feet spread apart somewhat. Generating the manipulation of the left hand slightly raises the sacrum and the right to introduce the vapor-tube 20-30 cm so that the outer end was lowered into the bedpan, which is under the patient, because of the bowel together with the gases and particles can depart feces. In the gut can hold up to 2 hours, then it is removed to avoid pressure ulcers of the intestinal wall. During the day you can repeat the procedure several times at regular intervals (1-2 h).
The introduction of the vapor tube is hampered by the dense cluster in the intestines of feces. In such cases put before the introduction of glycerin microclysters or camomile.
After extraction, the tube circumference anus wiped with cotton wool, and in case of irritation smeared with Vaseline. The tube should be washed with soap and warm water, wipe and sterilized by boiling. In no case can not be used neprosterilizovannymi vapor tubes. At hand must always be in stock clean, boiled vapor tube for emergencies.
Nausea - unpleasant sensation in the epigastrium, feeling of heaviness, sometimes accompanied by blanching of the face, sweating, palpitations, salivation and slow breaths. Nausea often precedes vomiting. Nausea in patients with low acidity of gastric juice administered 1 tablespoon of natural or artificial gastric juice at mealtimes. Patients with irritation of the mucous membrane of the gall bladder is prescribed bezzondovy tyubazh: 1 teaspoon of salt to throw in a bitter 1 / 4 cup hot water, slowly drinking his patient falls on the right side for 40 minutes with a hot water bottle. This achieves a choleretic effect and reduced nausea.
Vomiting - a complex reflex act involving the muscles of stomach, diaphragm, abdominal wall and the epiglottis and soft palate, which results in the eruption of vomit from the stomach out through your mouth. Vomiting may be due to gastro-intestinal toxicity, irritation of the tongue and soft palate. Vomiting can also occur if increased intracranial pressure, brain tumors, hypertension, etc. For food to the masses with severe vomiting associated bile from the duodenum. For intentional vomiting reflex influence use: annoy the tongue with a spatula or injected 0.5 ml of 1% solution of apomorphine subcutaneously.
The task of caring - as easy as possible for the patient vomit. It needs to sit comfortably, close the chest with a towel or a piece of oilcloth, bring your mouth clean tray, bowl, or put a bucket. Dentures must be removed. If the patient is weak or is not allowed to sit, turn his head to one side so that it was slightly below the torso, and bring to the corner of the mouth tray. You can also put a towel folded several times, or a sheet to protect from contamination pillow and linens. During vomiting all the time caregiver should be near the patient. The appearance of vomiting should be reported to your doctor.
After vomiting the patient should be given to rinse your mouth with warm water and wipe the lips and mouth corners. In very frail patients after each vomiting should wipe your mouth cotton swab moistened with water or a disinfectant solution (boric acid, a light solution of potassium permanganate and 2% sodium bicarbonate (baking soda), etc.) to stop the vomiting can be given to the patient a few drops of peppermint, ostuzhennoy sip of water, a piece of ice, 5 ml of 0.5% novocaine solution.
The vomit usually contain particles of undigested food, the admixture of bile and have a sour smell. Vomiting "coffee grounds" refers to gastric bleeding, due to the nature of its action of gastric juice in hemoglobin. Vomiting "coffee grounds" or bloody vomit and immediately call a doctor has a first aid. The patient should be immediately put to bed in a horizontal position, is placed on the stomach and lightweight ice pack. Ice melting at least change. The patient should not be fed, and given water by mouth medications. Caregiver must complete a patient physical and mental rest and not leave him alone until the doctor arrived. Transportation of patients is carried out on a stretcher in compliance with all safety precautions during transport and shipping.
The vomit is left to the doctor arrived, and if necessary refer to the laboratory in a clean jar with a graduated wide mouth and lid, pointing to the label of the necessary information about the patient and the purpose of the study. If you can not send vomit immediately to the laboratory, they are stored in a cool place. If the patient is vomiting during the night several times to collect vomit every once in a separate bowl, as the qualitative and quantitative difference between them has diagnostic significance.
Belching - gas output from the stomach through the esophagus. If you can go burp the air that enters the esophagus and stomach if swallowed (aerophagia), as well as carbon dioxide, hydrogen sulfide and methane produced in the process of protein decomposition and fermentation. In these cases the regurgitation is usually a foul odor. The mechanism of regurgitation is that in an open part of the cardiac stomach and pyloric spasm omitted when you inhale the diaphragm and abdominal muscles tight jam in the stomach, is important as reducing the gastric wall. Belching is caused by reflections from the stomach and abdomen. In a healthy person may experience regurgitation of stomach overflow food. With the increased acidity of gastric juice regurgitation may be acidic, and gallbladder disease - rotten, when large amounts of air in the stomach - the air. Belching is not a disease but a symptom, so the appearance of parts of the burp that bothers the patient should be treated with underlying disease. If belching is caused by eating too much, you should eat small portions.
Constipation - a delay due to deceleration chair stool. Most often occurs due to weakening of the intestinal musculature and motility, atony of the intestines and abdominal muscles or toning circular muscles in some parts of the colon.
Atonic constipation contribute to a sedentary lifestyle, eating easily digestible foods (porridge, sour cream) with a small amount of fiber.
Spastic constipation are the result of tonic contraction of circular muscles, which leads to the cessation of peristalsis in the corresponding segment of the intestine. In the development of spasms of the intestine plays an important role over-the autonomic nervous system. Spastic constipation contributes coarse food, rich in fiber (grain, vegetables, etc.).
Mechanical locks occur at the bends gut, blockage of the various departments of the intestine tumors, hemorrhoids, fecal stones. In the presence of fecal stones caregiver puts on a rubber glove, lubricate it with Vaseline well and by introducing two fingers into the anus patient tries to remove fecal stones. The patient lies on his back with legs bent at the knees. Under the sacrum put a bedpan. Sometimes mechanical constipation can lead to partial bowel obstruction. In such cases, put an enema siphon until the stool (see Siphon enema).
Habitual constipation occur at a constant suppression of the normal reflex to defecate due to haste, employment, shyness, etc., in connection with which the intestine becomes accustomed to the rare evacuation. In 3-4-day constipation nausea, bloating in the abdomen, discomfort in the abdomen, decreased appetite, there is bad breath.
Treatment of constipation.
When habitual constipation should adopt a daily reflection or give laxative agents: rhubarb, buckthorn bark, zhoster, etc. In some cases, helps 25% magnesium sulfate solution (1 tablespoon daily on an empty stomach). Patients prescribed a diet that contains large amounts of fiber - beets, cabbage, prunes, black bread. Diet № 3.
Spastic constipation prescribe drugs, calms the nervous system (valerian, bromides, belloid, etc.), as well as preparations containing atropine. Well to treatment on the thermal bath spas. Patients who are in bed, we recommend periodically cleaning enema set of room temperature water with 1 cup of a standard infusion of chamomile, soap shavings of baby soap (5-10 g) or 20 g of glycerin.
When sedentary lifestyle should move more, play sports, they learn how to act in the stool certain time of day.
In cancer patients are often constipated view of what should make greater use of enemas and laxatives (phenolphthalein, magnesium sulfate, rhubarb, vaseline, etc.). This is particularly important for tumors of the rectum, where the progression of the cancer process leads to an increase in intestinal obstruction, fecal stones formation, increased toxicity. Such patients should be prescribed a liquid high-calorie diet without fat, systematically use laxatives. With an increase in intestinal obstruction the patient should be referred to the surgical hospital for the imposition of fecal fistula.
Diarrhea occurs when increasing intestinal motility and increased secretion of bowel function. Observed in inflammation of the intestinal mucosa, decreasing the acidity of gastric juice, the excitation of the nervous system, poor absorption of nutrients and water, and therefore do not form solid stool. The presence of blood and mucus in the stool may indicate an infection. In all cases, a medical consultation to determine the cause of diarrhea and treatment purposes.
Bedpan, ducks and disinfect pots bleached bleach solution and rinsed under running hot water. Inside the current disinfection is carried out.
Need to monitor the patient's diet: it should be easily digestible, with lots of protein, vitamins B and C and a liquid. Exclude from the diet of milk, fat and fried foods, as well as fiber.
Patients with diarrhea should wash away after every bowel movement and to avoid irritation dry cleaned and lubricated with petroleum jelly or any fat, the skin around the anus.
Involuntary defecation caused by relaxation of the sphincter anus. In patients with permanent implies a small amount of liquid faeces, which contaminate the bed, release unpleasant fecal odor, irritating others, and macerate the skin around the anus that can cause pressure sores. Caregiver should be especially careful to monitor the cleanliness of bed and underwear in patients with involuntary defecation and when needed to change it. The mattress is covered with oilcloth, which put the diaper and if it is polluted, it is often changed. Under the sacrum to the patient enclose rubber bedpan, which simultaneously serves as a bed-around to prevent bedsores. It is desirable to place the patient on a special bed, which consists of three parts, the average of which (mobile) contains a bedpan.
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