Question 2: What problems may occur during nasal feeding and how to deal with diarrhea?
Diarrhea is the most common complication, the incidence rate can be as high as 62%, and the incidence rate in this group is 26%. Generally, when nasal feeding begins to use hypertonic diet, the gastrointestinal tract secretes a lot of water to dilute the concentration of the solution, which accelerates intestinal peristalsis and is prone to diarrhea. Nasal feeding should adopt the method of gradual adaptation, and add anti-spasm and astringent drugs to control diarrhea. In addition, intestinal fungal infection can also cause diarrhea.
Nausea and vomiting
Too fast and too much nasal feeding can easily cause nausea and vomiting, which can slow down the infusion speed. Input the liquid volume in an incremental way, and keep the temperature of the solution at about 40 degrees Celsius to reduce the * * * effect on the gastrointestinal tract.
gastric retention
The patient's gastrointestinal peristalsis is slow, and the input nutrient solution stays in the gastrointestinal tract. Before each infusion of the solution, he should suck it to know whether the stomach has been emptied. After eating for 4 hours, he can draw food from the stomach cavity through the stomach tube, indicating that there is gastric retention. Need to extend the infusion interval, he can take gastric motility drugs to promote gastric emptying.
Hyperglycemia and hypoglycemia
Hyperglycemia is related to a large amount of nasal feeding hypertonic sugar diet. Because family members put too much emphasis on nutritional supplement, the formula has high sugar content. The determination methods of blood sugar and urine sugar should be correctly mastered in nursing to avoid hyperglycemia aggravating the condition. Hypoglycemia mostly occurs when the long-term nasal feeding diet suddenly stops. In order to avoid hypoglycemia, we should slowly stop the elemental diet or supplement other forms of sugar at the same time.
dehydrate
Dehydration can be caused by diarrhea, urine sugar or insufficient water intake. Nursing should gradually increase the concentration and quantity of diet, and often monitor the changes of electrolyte and urea nitrogen levels, and strictly record the intake and discharge of patients.
inhale air
Inhalation is one of the more serious complications. Patients who are weak, old or unconscious, especially those with esophageal reflux, are particularly prone to liquid diet reflux and inhalation of trachea. When nursing, the bedside should be raised 30 degrees, pay attention to the infusion speed of nasal feeding tube, monitor gastric retention, mark the outlet of gastric tube, and move gently when sucking sputum to minimize * * *. In case of aspiration and dyspnea, the patient should immediately stop nasal feeding, take the right lateral position and lower his head to suck the contents of the stomach to prevent reflux and cause serious consequences.
Removal and blockage of pipelines
The fallen tube is often pulled out by the patient when he is upset, or accidentally falls off when he turns over. Fine-hole, soft and stable nasal feeding tube should be used in nursing, taking comfort and safety as the principle, and the nasal feeding tube should be properly fixed. After each infusion, the nasal feeding tube should be cleaned immediately to avoid blockage.
Question 3: Matters needing attention after nasal feeding 1. Explain to patients, reduce fear and get cooperation. 2. Sitting position can reduce the vomit discharge when the stomach tube passes through the nasopharynx, which makes the stomach tube easy to insert. 3. The correct lateral position can make the gastric tube easy to insert with the help of anatomical position. 4. The insertion length is generally the distance from the forehead hairline to the sternal xiphoid process, or the distance from the tip of the nose to the sternal xiphoid process through the earlobe. 5. The average insertion length of adults is 45 ~ 55cm. When intubating, the movement should be light and steady to prevent the esophageal mucosa from being damaged, and the tip of tweezers should not touch the patient's nasal mucosa to avoid pain and injury. 6. Swallowing action can help the stomach tube quickly enter the esophagus, reduce discomfort, and let the patient swallow and insert with the password of "swallowing". When necessary, let the patient drink a small amount of warm water to help the stomach tube enter the esophagus smoothly. 7. Deep breathing can distract patients' attention and relieve tension. 8. Check the oral cavity when the insertion is not smooth to find out whether the gastric tube is in the oropharynx; Or pull the tube back for a short time and then insert it carefully. 9. Coma patients can avoid the stomach tube being mistaken for trachea by looking up from the back. 10. The mandible near the sternal stalk can increase the curvature of the throat passage, which is convenient for the gastric tube to pass through the epiglottis smoothly. 1 1. Make sure that the gastric tube is in the stomach before each feeding. 12. Warm boiled water can lubricate the lumen and prevent the nutrient solution from sticking to the tube wall. 13. The amount of nasal feeding should not exceed 200ml each time, and the interval should not be less than 2h. 14. Tablets should be ground and dissolved before filling. 15. Avoid pouring too fast, and avoid the nasal feeding liquid from being too cold or too hot. 16. If fresh juice is poured, it should be poured separately from milk to prevent coagulation. 17. When nasal feeding, avoid filling people with air to prevent bloating. 18. Wash the stomach tube to avoid the deterioration of nasal feeding liquid accumulated in the lumen, causing gastroenteritis or blocking the lumen. 19. Prevent the injected food from flowing back. 20. Prevent the stomach tube from falling off. 2 1. Keeping the original supine position can promote the digestion and absorption of food and prevent vomiting. 22. Long-term nasal feeders should have oral care every day. 23. Nasal feeding materials should be replaced and disinfected every day. 24. Long-term nasal feeders should change the gastric tube regularly, pull out the tube when feeding for the last time, and insert it from the other nostril the next morning. 25. Clamp the gastric tube to prevent the liquid in the tube from flowing back when extubating. 26. Pull it out quickly at the throat to avoid liquid dripping into the trachea. 27. After extubation, move the items out of the patient's sight to avoid patients' displeasure and pollution to the bed unit. 28. Gasoline and turpentine can be used to remove traces of adhesive tape. Is this ok?
Question 4: What should I pay attention to when feeding through a nasal feeding tube? 1. Check whether the gastric tube is in the stomach before feeding, which can be confirmed by sucking gastric juice. If the gastric juice is pulled out, it proves that the gastric tube is indeed in the stomach. Then, take a bowl of water and put one end of the stomach tube into the water to see if there are bubbles overflowing. If there are bubbles, it proves that the stomach tube may be in the trachea, and it is normal without bubbles.
2. Don't inject too much food at a time, 200ml-300ml is appropriate, and the interval is 2 hours. The food must be liquid food, and the temperature should be controlled at 37-4 1 Celsius. Rinse food with a little warm water before each injection, and rinse with warm water after each injection.
3. Observe the patient's reaction at any time during the injection, and stop the injection if you feel uncomfortable.
After feeding, fold the end of the stomach tube with a clean handkerchief or gauze, paper towel, etc. Tie it with a rubber band and fix it on the patient's clothes with a pin
5. The gastric tube should be replaced every half month and reinserted.
Question 5: What are the precautions for nasal feeding? Insertion length? 1. Explain to patients, reduce fear and get cooperation. 2. Sitting position can reduce the vomit discharge when the stomach tube passes through the nasopharynx, which makes the stomach tube easy to insert. 3. The correct lateral position can make the gastric tube easy to insert with the help of anatomical position. 4. The insertion length is generally the distance from the forehead hairline to the sternal xiphoid process, or the distance from the tip of the nose to the sternal xiphoid process through the earlobe. 5. The average insertion length of adults is 45 ~ 55cm. When intubating, the movement should be light and steady to prevent the esophageal mucosa from being damaged, and the tip of tweezers should not touch the patient's nasal mucosa to avoid pain and injury.
Question 6: How often should the nasogastric tube be replaced? Nursing before intubation
2. 1. 1 Before psychological nursing, give psychological nursing to conscious patients, relieve their nervousness and fear, patiently explain the purpose and method of nasal feeding, and demonstrate to patients how to cooperate with intubation. Coma patients should communicate with their families to explain the importance of nasal feeding to the rehabilitation of the disease and the possible accidents during the operation, so as to obtain the understanding and cooperation of their families.
2. 1.2 *** Place appropriate * *, lie on your back, straighten the esophagus as far as possible, and ensure successful intubation [1].
2.2 Nursing during intubation
2.2. 1 preparation 1 nasal feeding tube, 2 sterile tweezers, 2 curved plates, and an appropriate amount of paraffin oil.
2.2.2 Observe whether the patient has symptoms such as choking cough and dyspnea during intubation, and stop intubation immediately if there is any. After successful intubation, it is necessary to confirm that the gastric tube is in the stomach before nasal feeding.
2.3 Nursing after intubation
2.3. 1 Nursing of gastric tube After the gastric tube is inserted, it should be properly fixed. The proximal end can be fixed on the patient's nose and cheeks with a sticky 3M ribbon, and the distal end can be placed on the pillow next to the patient's ear and closed. For patients who are delirious, fidgeting or uncooperative, in order to prevent patients from pulling out the gastric tube by themselves, they can fix their hands with restraint bands, pay attention to tightness and relax regularly, and explain to their families for understanding and cooperation.
2.3.2 Selection of nasal feeding solution
2.3.3 Injection time and method Before each operation, the gastric juice was sucked out to ensure that the gastric tube remained in the stomach. Generally, the method of intermittent moderate injection and drip is adopted, the injection amount is less than 200ml each time, the interval is 2 hours each time, and the continuous drip speed is 60 ~ 80ml/h..
2.3.4 Do oral care twice a day to observe the changes of oral mucosa and prevent oral fungal infection and other complications. For patients with long-term indwelling gastric tube, a small amount of paraffin oil should be dripped into nasal cavity every day to prevent nasal mucosa from cracking, and the gastric tube should be replaced every 2 weeks 1 month.
2.4 Nursing care of common complications
2.4. 1 Diarrhea is the most common complication, which is mainly caused by intestinal peristalsis or extensive use of broad-spectrum antibiotics when a large amount of liquid enters the gastrointestinal tract, resulting in intestinal flora imbalance [2]. If the patient's stool frequency increases, the stool is irregular or watery, it is necessary to slow down the speed of tube feeding, appropriately reduce the amount of tube feeding, and give an appropriate amount of digestive or antidiarrheal drugs. Don't stop nasal feeding in a hurry, pay attention to keep the perianal skin clean and dry to prevent skin complications.
2.4.2 Nausea and vomiting are often caused by too fast or too much nasal feeding. The speed of nasal feeding can be slowed down, the amount of nasal feeding can be gradually increased or the constant input can be controlled by infusion pump.
2.4.3 Misinhalation is one of the more serious complications, and patients who are weak, old or unconscious are prone to liquid reflux and aspiration into trachea by mistake. In order to prevent aspiration, the speed of nasal feeding should not be too fast and the amount should not be too much at a time. Bedridden patients should raise their heads 30 ~ 45 when nasal feeding, and semi-recumbent position can be used when conditions permit. When the patient has choking cough and dyspnea, he should immediately stop nasal feeding, take the right lateral position, suck the inhalant in the airway, and suck out the stomach contents to prevent further reflux.
3 experience
For patients with unconsciousness or dysphagia, nasal feeding should be used. Nasal feeding can provide enough energy and nutrition for the body, and cooperate with gastrointestinal drugs to enhance the body's immunity and promote the body's recovery. At the same time, the amount of intravenous infusion can also be reduced appropriately, and the medical expenses can also be reduced. Therefore, doing a good job in nursing gastric tube and preventing its complications plays an active and important role in cooperating with doctors' treatment and promoting patients' rehabilitation. At present, the textbook does not clearly specify the replacement time of gastric tube, and the product manual indicates weekly replacement 1 time. In order to reduce the injury caused by repeated intubation, the use time can be appropriately extended.
Question 7: How to care for patients with nasal feeding and how to feed balanced food? The requirements for nasal feeding are:
① Inject a small amount of warm water first, then feed the rice, and finally rinse the pipe with warm water.
② Fruit juice, vegetable juice and warm water can be added between meals to increase water content.
(3) gauze filtration should be applied before each pre-meal injection to prevent gastric tube blockage.
④ The temperature of meals and drinks should be 38 ~ 40 degrees Celsius, and the speed of flowing through the stomach tube should not be too fast, and the injection amount should be 200 ~ 300ml each time.
⑤ After the perfusion, fold back the end of the gastric tube, tie it tightly with string, wrap it with gauze, sort it out and record it.
Nasal feeding should pay attention to:
① Patients should have an adaptation period for nasal feeding. At the beginning, the diet should be light and light, and gradually increase. The food intake at noon is slightly higher than that in the morning and evening, 5 ~ 6 times a day.
(2) Too cold or too hot food can cause diarrhea or gastrointestinal reaction. So before perfusion, you can test the temperature of the skin on the back of your hand, and don't feel hot.
(3) Food, tableware and perfusion should be hygienic, and meals should be freshly prepared.
4 pay attention to the adjustment of diet, such as frequent defecation and sour stool, which may be caused by too much sugar; The stool is thin, smelly and alkaline, which may be protein's indigestion.
07: 00 (breakfast): 1 50g egg, 200ml milk, 50g sugar, 5ml soybean oil and 2g salt.
50g of eggs, 200ml of rice soup, 50g of sugar, 5ml of soybean oil and 2g of salt.
09: 30 mixed milk 150ml: fresh milk 100ml, 50ml thick rice soup.
12: 00 (Chinese food) 1 milk 150ml, lean pork 75g, lactone tofu 125g, carrot 100g,
Green vegetables 100g, sugar 50g, soybean oil 5ml, salt 2g.
2 thick soup or chicken soup 150ml, chicken 75g, lactone tofu 125g, carrot 100g, green vegetables 100g, sugar 50g, soybean oil 5ml, salt 2g.
14: 30 1 juice 150ml 2 vegetable juice 150ml
17: 30 (dinner) 1 200ml of rice flour, 75g of chicken, 30g of pork liver, 0/00g of carrot 100g of vegetables, 50g of sugar, 2g of soybean oil 10ml of salt.
200ml milk, 75g shrimp, 25g lactone tofu100g carrot100g vegetable100g sugar, 50g soybean oil10ml salt.
2 1: 00 mixed milk 150ml
23: 00 water 150ml
Preparation method: select specific foods according to the formula requirements, such as lean pork, chicken, fish, shrimp, vegetables, etc. Must be cleaned, boned, peeled and pricked, cut into small pieces and cooked. Eggs are cooked, shelled and cut into pieces, milk, rice flour broth, etc. Boiled and sweetened. Then, mix all the food needed for each meal, put it into an electric blender for grinding and stir it into a paste without particles.
The above formula should be constantly adjusted according to the specific conditions of the disease.
(1) When patients have diarrhea, rice soup and salted boiled water should be the main ingredients, and some vitamins and 10% potassium chloride should be supplemented appropriately.
(2) Patients with hypertension, hyperlipidemia, hypercholesterolemia and cardiovascular and cerebrovascular diseases should choose a mixture with low fat and cholesterol, and the daily salt content should not exceed 2g.
(3) When renal failure occurs, protein should not be used for the time being, and a high-quality low-protein diet should be given until the condition is stable. The amount of salt depends on the amount of urine (low salt or no salt).
for reference only
Question 8: What are the precautions for nasal feeding? 15. Don't feed too much.