Routine is an applicable order established within the affected person care establishments of out-patient or in-patient kind with the aim of making the most effective situations for the restoration of sufferers. The routine is equally compulsory for sufferers and personnel, however personnel actively make and help it, however sufferers undergo it.
The routine of the affected person care establishments consists of:
Inside laws.
Sanitary-hygienic routine of the affected person care establishment.
Private hygiene of the affected person and personnel.
Temperature, illumination and air flow routine.
Balanced food plan routine.
Therapy of sufferers.
The routine on the departments and hospitals of various constructions has its personal peculiarities. The routine of the infectious hospital differs from the routine of the surgical hospital, the routine of the maternity hospital and gynaecology unit differs from the routine of the kids’s and therapeutic division. Contained in the hospital, the routine of departments and even wards can also have its personal options. Every affected person, relying on the illness, is arrenged a person routine regarding motion, meal, and so forth. A prescribed routine is entered into the prescription listing and medical card: “mattress relaxation”, “lively”, and so forth. Walks, interval of exercise, therapeutic massage, food plan and extra meals for sufferers are indicated.
The best significance for profitable therapy of sufferers is the situation of the nerve system, perception in restoration, confidence in his hospital physician and medical personnel.
Group and conducting of therapeutic-protective routine in hospitals have nice worth in creating situations, which have a great affect on the affected person’s nervous system. The premise of this routine encompass measures which shield the affected person from dangerous environmental components which might negatively have an effect on him, complicating the illness course, in addition to the measures, creating situations which favorably affect an organism, help religious vivacity, psychological tone of the affected person, assist him actively participate within the technique of remedy.
Primary components of therapeutic-protective routine:
Every time potential, painful sensations shoud be eradicated. Itis, particularly, precise on the surgical departments of hospitals the place virtually all sufferers really feel ache, every now and then reasonably intensive, which deprives them of sleep and relaxation.
Attempt to keep away from adverse feelings, brought on by aftervision, acoustical and olfactory sensations.
Mix the routine of relaxation with bodily exercise and increasethe affected person’s normal psychological tone.
Arrange such surrounding situations which favorably affect the affected person.
Even a easy listing of fundamental components of a therapeutic-protective routine proves that its affect entails all of the affected person’s keep on the hospital starting with the second of reception until discharge from the hospital.
The phrase of the physician and medical personnel, which might turn into for the affected person each the rationale of iatrogenic illnesses, and a supply of cheerfulness, is of nice significance. For instance, by accident learn and misinterpreted case historical past in addition to lab analyses outcomes can affect the mentality of a affected person and the therapy outcome.
It’s strictly forbidden for medical personnel to debate a affected person’s situation and have a chat on medical themes in wards. Case stories are stored in particular rooms, the place sufferers are prohibited to enter. It’s forbidden to speak to different sufferers in regards to the well being of their neighbors and the potential end result of their illness. The physician is obliged to present confidence to sufferers in good outcomes of therapy and beneficial end result of operation.
On the surgical hospital it’s essential to keep away from of adverse feelings, linked with the look of medical topics (blood-stained items of gauze, napkins, syringes and scalpels, clips with traces of blood, basins crammed with used dressings, drenched with pus and blood). The physician’s look, particularly the surgeon’s, is extraordinarily necessary. Within the working room, he mustn’t seem within the affected person’s presence in a blood-stained robe. Smoking is forbidden on the hospital territory too. A health care provider and smoking are incompatible. The physician’s face ought to be clear and shaved. It’s not essential to “maintain an actor’s smile”, however nonetheless, the physician’s face ought to appear to be well-wishing.
Relaxation, prolongation of physiological night time sleep and compulsory day relaxation have nice significance for the affected person. Personnel change, wards cleansing and taking the physique temperature are performed after the sufferers stand up, not sooner than 7 o’clock.
For decreasing noise, it’s mandatory to put in a soundproof door within the working and dressing rooms, and equip with silent sign system. Sufferers mustn’t groan, particularly scream throughout an operation or dressing the injuries. Due to achievements in anesthesiology screaming on the working and dressing-room shouldn’t be permissible. Whereas sufferers are sleeping and having relaxation, it’s expedient to carry medical procedures to minimal, and emergency assist ought to be supplied with silent efficiency of manipulations, utilizing native mild sources.
The routine of relaxation ought to be mixed with potential bodily exercise of the affected person — hygienic morning and healing gymnastics, strolling in contemporary air, the group of cultural entertainments.
The therapeutic-protective routine wants strict observance of an applicable day routine. On the majority of hospitals of our nation the routine is roughly alike. Right here is an approximate day routine of the surgical division and an inventory of the nurse’s useful duties.
| 7.00 | Time for getting up. The nurse activates the lights within the wards, reminds the sufferers that it’s essential to undergo the analyses that the physician ordered (urine, feces). |
| 7.05–7.30 | Taking the physique temperature. The nurse palms spherical thermometers, watches for proper measurement of the physique temperature, writes down the outcomes to the temperature sheet and stories for the common physician. |
| 7.30–8.00 | Morning wash up. The nurse helps severely unwell sufferers with washing. She cleans the mouth, eyes, and nostril, brushes sufferers’ hair, makes the mattress, places the affected person within the right mattress place, sends urine and feces to the laboratory, prepares sufferers for operation: evacuates the intestines, shaves the operational space. |
| 8.00–8.30 | Medicines meting out. The nurse dispenses medicines to sufferers and watches taking them over. The affected person is obliged to take the medication within the pre- sence of the nurse (tablets, powder and uncommon medical types) who explains how they need to be taken. |
| 8.30–9.00 | Breakfast. The nurse helps giving the meals, and feeds the sufferers in mattress. |
| 9.00–10.00 | The physician’s spherical. Along with physician the nurse takes half within the spherical; stories on the affected person’s situation, writes down the physician’s orders to the prescription listing. |
| 10.00–13.00 | Following the medical indications based on the prescription listing. She accompanies the sufferers to the X-ray room, consultations, probing, taking of gastric juices, places on mustard plasters, heat com presses, makes injections, takes care of the infirm sufferers and postoperative sufferers, accompanies sufferers to wound dressings. |
| 13.00–13.30 | Medicines meting out. She distributes medicines once more and watches the sufferers taking them. |
| 13.30–14.30 | Dinner. Helps in giving meals, feeds severely unwell sufferers. |
| 14.30–16.30 | After-dinner relaxation. Airs the wards, takes care of severely unwell sufferers. |
| 16.30–17.00 | Day-time taking the physique temperature. She dispenses thermometers, writes down the outcomes of measurements within the temperature sheets and within the case information. |
| 17.00–17.30 | After-dinner tea. |
| 17.30–19.00 | Visits of relations, free time. |
| 19.00–19.30 | Medicines meting out. The nurse provides medicines earlier than supper and watches taking them. |
| 19.30–20.00 | Supper. Helps with supper, feeds severely unwell sufferers. |
| 20.00–21.30 | Efficiency of night indications. The nurse prepares sufferers for operations and X-ray exams (clyster, abdomen cleaning, and so forth.), making use of cups, compresses, mustard plasters, and so forth. |
| 21.30–22.00 | Night wash up. Helps sufferers brush their tooth, wash them, makes the mattress, places sufferers in a handy place on the mattress, airs the ward. |
| 22.00–7.00 | Sleep time. The nurse is on responsibility within the division with out the correct to sleep. |
The sanitary-hygienic routine is various legal guidelines, which decide the sanitary situation of the territory and wards within the hospital.
The territory of the hospital ought to be protected, entrances and roads between constructions — paved or asphalted. Water provide and sewerage are mandatory. For dry rubbish it’s essential to have bins with closing lids, the place underneath the bins and round them ought to be concreted. It’s mandatory, in due time, to evacuate bins and periodically disinfect them. The territory of the hospital ought to be repeatedly tidied up. Doing up hospital rooms ought to be damp and finished a minimum of 3–4 occasions per day with specifically marked inventory. These intervals ought to be particular person for wards, working and dressing rooms, buffet, bathtub and toilet rooms. Panels are washed in medical institutions with a humid duster 1 time each three days. As soon as a month the window, plafonds, ceiling, doorways ought to be cleaned of mud. The surfaces of radiators and pipes of the central heating ought to be wiped with a humid duster each day.
Sanitary-Hygienic Routine within the Admission Workplace
The physician examines everybody who enters the admission workplace, in order that in due time sufferers with pyo-septic wounds might be revealed and remoted. The affected person’s pores and skin and temperature are checked. Picket spatulas are destroyed after use; metallic ones are disinfected (immersed in a 2% formalin resolution by 30 min or boiled for 30 min). Thermometers are stored for disinfection in a 0.5% resolution of chloramine (30 min) or a 3% resolution of hydrogen peroxide (80 min), or a 0.1% resolution of desoxyne-1 (15 min). Inspection of a affected person is performed on a sofa coated with oilcloth: after each affected person’s examination the oilcloth is wiped with a duster moistened in chloramine resolution with a 0.5% resolution of washing liquid, or a 3% resolution of hydrogen peroxide with a 0.5% resolution of washing liquid (desoxyne-1). After the affected person is examined, a wound inspected and bandages modified the personnel disinfects the palms — washes them in heat working water with cleaning soap for two min. For this objective, bars of laundry or bathroom cleaning soap in small packing (for one use) are used. After the affected person’s inspection for pyo-septic illnesses, purulent wounds are cleaned, the personnel disinfect the palms with bactericidal preparations (80% ethyl spirit, resolution of chlorhexidine bigluconate in 70% ethyl spirit, 0.5% resolution of chloramine). The working options for the talked about above preparations are ready on the drugstore of the treatment-prophylactic institution. The container with the answer is positioned close to the washstand, within the dressing-room, for disinfecting palms with ethyl spirit or chlorhexidine preparations; it’s placed on the palmar floor of the palms by 5–8 ml and rubbed into the pores and skin for two min. Such an answer is utilized 10 occasions. Brushes for palms processing are washed and boiled in 2% soda resolution for 15 min. Clear brushes are stored in sterile drums. They’re taken out with sterile forcepts.
Every worker of the admission workplace has a person towel. Towels are modified as soon as a day. Inspection of wounds and altering of bandages are carried out solely in dressing robes, slippers, hats, masks, gloves. When cleansing purulent wounds, abscesses, phlegmons, and so forth., moreover oil-cloth apron are placed on, that are disinfected after every use, in addition to oilcloths on couches (resolution chloramine or 3% resolution of hydrogen peroxide with 0.5% resolution of washing liquid).
The affected person within the admission workplace passes full sanitary cleansing — takes a bathe or bathtub, cats the nails. For laundry, a affected person receives a clear wash fabric. After sanitary cleansing, he places on clear hospital linen, dressing robe or pajamas, slippers.
The admission room is tidied up a minimum of two occasions a day in a humid approach with disinfect options: 1% resolution of chloramine, 0.2% resolution of desoxyne-1, 0.5% resolution of chlordesine, and so forth. Cleansing materials (buckets, basins, and so forth.) are marked and strictly used based on the aim. Dusters are strictly stored based on cleansing objective. After use, cleansing materials is disinfected (soaked in 1% resolution of chloramine for 60 min, 0.2% resolution of sulphochlorantine — 60 min, 2% resolution of dichloride-1 — 60 min, 1% resolution chlordesine — 60 min).
Sanitary-Hygienic Routine within the Surgical Division
After the sufferers’ discharge, the mattress, bedside-table, help for urine vessel, wiped with a moistened duster with disinfectant resolution (1% resolution chloramine B or 0.75% resolution chloramine B, 0.5% resolution of detergent, 0.2% resolution of desaxon-1, 0.5% resolution of chlordesine, and so forth.).
It’s not allowed to simply accept to the surgical division smooth toys which couldn’t be disinfected.
Sufferers with pyo-septic illnesses and postoperative purulent problems are remoted in separate wards or departments. In these wards, ultra-violet bactericidal irradiators of the shut kind ought to be established.
The personnel who work in purulent models and wards, after work, change surgical coats, masks and hats.
Arms are disinfected with 70% spirit or chlorhexidine for two min.
The division is stored so as. Cleansing is carried out not lower than twice per day by a humid approach with a soap-soda resolution. Disinfectants are used after linen is modified and within the case of prevalence of hospital infections. In wards for sufferers with pyo-septic illnesses and postoperative purulent problems, day by day cleansing is carried out with mandatory utility of disinfectant options (1% resolution of chloramine, 3% resolution of hydrogen peroxide with 0.5% resolution of detergent, 0.2% resolution of desaxone-1, chlordesine).
Sanitary-Hygienic Routine on the Working Block, Wards and Resuscitation Departments
The working block is separated from different rooms of the surgical division by a tambour, geared up with a supply of bactericidal ultra-violet irradiators. The door to the working room is consistently held shut. The working block is provided with stationary bactericidal irradiators and ventilating gadgets with prevailing of air influx over drawing out. Within the air influx system bacterial filters are set. Within the working, dressing-rooms, wards and departments of intensive remedy for lowering microbic fertilization, the next air-filters are really useful — AFMR-0.9, AFMR-1.5 (air filters cell recirculatory).
The working rooms are strictly divided for clear and purulent operations. If there are not any situations for these necessities observance, operations regarding purulent processes are carried out on specifically alloted days with the next disinfection of the operational block and all tools. Surgeons, scrub nurses and all of the personnel collaborating within the operation take a hygienic bathe earlier than the operation, placed on operational linen (pajamas, slippers, cap and surgical coat). Earlier than getting into the operational room, the surgical coat is postpone, a masks, shoe covers are placed on, after which they go into the preoperating room, the place palms are cleaned and a sterile surgical coat, masks and gloves are placed on. The “rule of the pink strip” is strictly stored. Everybody who enters the working room (over the pink strip) ought to have sterile linen on. College students and all different individuals earlier than getting into the working room placed on a 4-layered masks and diligently disguise their hair underneath the medical cap, then they placed on shoe covers. For utilized shoe covers, a bucket with a lid is put. It’s prohibited to be within the working room in road footwear and for individuals who don’t take part within the operation.
Sufferers are dropped at the working room within the surgical transport, which belongs to the division. In entrance of the working block, he’s put in to the surgical transport of the working block and delivered to the operational desk. The working room’s barrow is within the preoperating room on the similar place. Day-after-day the barrows are cleaned with a duster moistened in disinfectant resolution (1% resolution of chloramine, and so forth.). The whole lot that’s introduced within the working room (gadgets, equipment and different objects) is disinfected (1% resolution chloramine, and so forth.). A desk for sterile devices is roofed with a sterile fabric straight earlier than the operation, sterile devices are positioned on it and it’s coated with a sterile cowl from above. A dressing materials and devices used throughout the operation, are collected in particular bowls. It’s strictly forbidden to maintain within the operational room the objects which aren’t used throughout operation.
On the surgical division pure and purulent dressing rooms are strictly distinguished. If there is just one dressing room, the cleansing of purulent wounds is carried out after pure manipulations are finished with the next cleaning of the room and all of the tools with disinfectant options (1% resolution chloramine B, 3% hydrogen peroxide and 0.5% washing resolution, and so forth.). Workers of the dressing rooms, resuscitation and intensive remedy departments have to alter surgical coats, caps and masks each day. Nurses, whereas dressing the affected person’s purulent wound should placed on an oilcloth apron, which is disinfected after each dressing (wiped with a duster moistened in a 1% resolution of chloramine B), and their palms are cleaned with 70% spirit or 1% resolution of chlorhexidine.
After dressings, the dressing materials is put in particular containers, and damp cleaning with the applying of disinfectant options is performed (1% resolution chloramine, 6% resolution of hydrogen peroxide and 0.5% resolution of detergent, and so forth.). Contaminated dressing materials is burned. The personnel who don’t work within the dressing room, wards and departments of intensive remedy is forbidden to enter the postoperative ward. Earlier than a affected person is moved from the working room to the intensive remedy ward, the mattress and bedside-table are processed with disinfectant options (1% resolution of chloramine or 0.2% resolution of desoxine-1). The mattress should be made with mattress linen, which has undergone processing.
Cleaning of the operational block, dressing rooms and intensive remedy, and resuscitation departments is finished in a humid approach a minimum of twice a day with disinfectants (chloramine, desoxine, chlordesine, and so forth.). Normal cleaning within the operational block and dressing room is performed as soon as per week. The operational block and dressing room are first cleared of issues and tools, ventilators, medicines, and so forth. As a disinfectant, a fancy, which consists of a 6% resolution of hydrogen peroxide and 0.5% resolution of detergent, is used. After disinfection, the working room and dressing-room are irradiated with ultra-violet mild (direct or mirrored), hanging or ceiling bactericidal lamps are switched on.
For utilization of dressing and waste merchandise after operations, muffle furnaces are established.
Private Hygiene of Sufferers and Personnel
The personnel ought to have working garments and accurately use them: outer and dealing garments ought to be stored individually, in numerous wardrobes; they need to not depart the hospital territory in working garments and put on it over the working time. The linen ought to be stored in a dry, mild, ventilated room and clear individually from soiled ones. The soiled linen ought to be disinfected. At admission the sufferers are carried out cleaning and afterward ought to comply with the foundations of private hygiene. It’s essential to make the mattress and to alter bed-clothes and underwear as soon as per week. Every affected person ought to have a person towel, a glass for medicines, a mug. Objects of take care of sufferers ought to be washed after each use and hold in a closed dresser. Whereas strolling, sufferers mustn’t depart the hospital territory.
The docs, nurses and support girls’ cloths ought to be of various colours.
Sanitary-Hygienic Routine of Sufferers Feeding
Within the group of vitamin, it’s mandatory to think about not solely the amount and high quality of a food plan but additionally a correctly serving desk, nice look of dishes, temperature of meals, quick service. We will discover that the centralized system of vitamin, which exists in hospitals, presents actual difficulties as for preservation of prepared meals high quality whereas delivering it from the kitchen to the sufferers’ wards. The meals temperature falls, flavoring qualities deteriorate, energy quantity reduces.
Group of sufferers’ vitamin is a vital factor within the complicated of medical measures. Tools of public catering group and the buffet departments of treatment-prophylactic institution are underneath physician’s duty. The doctor-dietician offers the management over sanitary necessities performing by public catering group’s employees handing out of meals to the wards is finished by the barmaid and responsibility nurses of the division from dishes marked “for meals handing out”. The technicians who’re occupied with wards and different rooms cleaning should not allowed handy out meals. Sufferers (besides the severely unwell sufferers) take meals in a particular room — a eating room. Private meals merchandise (house-made) are stored within the bedside-table (dry merchandise which don’t spoil) and in particular alloted fridges (merchandise which rapidly spoil). The vary and quantity ought to be authorised by the physician.
After every meals handing out, the cafeteria and eating room are diligently cleansed with disinfectants (1% chloramine resolution, and so forth.). Wisps of bast for tableware and wiping tables, after the tip of cleansing, are boiled or disinfected, after which dried and stored in particular clear containers with a canopy. The personnel of the general public catering group and cafeteria ought to hold the foundations of private hygiene: earlier than visiting the bathroom surgical coats are to be eliminated, after visiting the bathroom palms are to be washed and disinfected with 0.5% chloramine resolution or 0.5% chlorhexine resolution or different preparations.
The vast majority of surgical illnesses are accompanied by deterioration in vitamin. The situation of protein stability earlier than an operation, in lots of respects, is dependent upon the character and part of the fundamental pathological course of (irritation, trauma, and so forth.) and peculiarities of vitamin.
Throughout acute surgical illnesses, particularly intestinal obstraction a affected person inside some hours, and generally minutes, can lose an enormous quantity of protein, salt and water. Within the case of acute traumas the massive lack of liquid is specifically harmful. Throughout persistent illnesses essentially the most harmful is protein loss.
Malnutrition may be very harmful. It will possibly result in a extreme course of the hospital an infection, violation in wounds therapeutic, growth of protein-free oedemas. Malnutrition will increase a chance of shock growth, colloid-osmotic strain fall, immunobiological protecting reactions of an organism are disturbed, repairing processes in tissue and the blood cells regeneration decelerate, the synthesis of hormones and enzymes will increase, tendency to infectious problems rises. Helpful meals and efficient metabolism, tolerance to operational trauma will increase, postoperating problems incidence decreases, sufferers handle the an infection higher.
There are two methods vitamins supply to an organism — pure and synthetic. A large number of illnesses and postoperating situations make the traditional technique of pure vitamin is unattainable. In these instances synthetic vitamin utilized. Completely different types of synthetic vitamin are distinguished: parenteral, enteral (by a probe or ostomy) and mixed. The enteral kind is the closest to pure vitamin. It’s all the time utilized if there are not any direct contradictions to its utilization.
The affected person’s food plan throughout the preoperative interval ought to be enriched with nutritional vitamins, attributable to meals and nutritional vitamins. The merchandise which can trigger meteorism (leguminous, cabbage, entire milk, and so forth.) are excluded 3–5 days earlier than the operation.
As a way to keep away from aspiration of meals stays from abdomen to lungs, the final meal ought to be not lower than 8 h earlier than the operation.
Through the postoperative interval it’s essential to compensate the elevated bills of an organism each throughout the operation and first days after it. It’s mandatory to exchange the waisted liquid, protein, mineral substances, nutritional vitamins, particularly nutritional vitamins C, A, Okay. If mandatory parenteral vitamin is supplied. Relying on the extent and sort of operative intervention, pathogenetically grounded “surgical” diets are distinguished.
Surgical Diets
Zero surgical diets. The aim is mechanically and chemically preserving vitamin. It’s fluid, semifluid, jelly-like grated meals in three consecutive diets: 0 (0а), 0b (1a-surgical), 0c (1b-surgical).
Weight loss plan 0 (0а) is appointed on the 2nd, third, 4th day after operation on gastrointestinal tract (perforating ulcers suturing, resections of the abdomen, small and huge intestines, and so forth.).
Weight loss plan 0b (1а-surgical). Appointed on the 2nd–4th days after food plan 0а. It differs from the 0b with some meals including to the grated and gruel boiled rice, buckwheat, porriage with meat broth or water with 1/4–1/2 milk, mucous groat soup with semolina on vegetable broth, steamed omelettes, nice boiled eggs, steam souffles of low-fat meat and fish (as much as 100 g), oil, mousse from not bitter berries. Meals is given 4–5 occasions a day, not more than 350–400 g.
Weight loss plan 0c (1b-surgical). Serves for extention of the food plan and transition to physiological high-grade meal. The food plan contains cream soup, steamed meals of grated boiled meat, rooster or fish, contemporary cottage cheese grated with milk to the consistence of bitter cream, steamed cheese meals, sour-milk merchandise, baked apples, grated fruit and greens. As much as 100 g of white crackers, grated dairy porridge. Meals is given 6 occasions a day. The temperature of sizzling meals is not more than 50°С, chilly — a minimum of 20°С.
Within the case of organ-saving operations (totally different sorts of vagotomy) the time period of surgical diets within the postoperative interval is stored. The day after the operation, a affected person can have nice parts of meals (drink of cooled boiled water (sipping) as much as 0.5 l a day). The subsequent day, the zero food plan 0 (0а) is appointed for the interval of 1–2 days, on the third–4th day — food plan 0b (1а-surgical) for a interval of two–3 days, then throughout just a few days (3–4) the sufferers obtain food plan 0c (1b-surgical) with the next transition to food plan N1.
Weight loss plan N5а surgical is appointed on the third, 4th, fifth day after the operation on the gallbladder (cholecystectomia). It differs from the food plan 1а and 1b by the restriction of fat, exclusion of broths, roasted cottage cheese and yolk eggs, contemporary milk and its merchandise. Mucous vegetarian soups, steam meals with boiled then cutted very small meat, porridge with rice, buckwheat and oatmeal, compotes, juices of not bitter fruits and berries, and vegetable juices are really useful. Bread and bakery merchandise should not allowed. Water is given in small parts as much as 2 l. The food plan is for 1-2 weeks.
Weight loss plan N5b surgical is appointed on the third, 4th, fifth day after an operation on the pancreas. It differs from food plan N 5а in that it accommodates meals of white-eggs (cocktail) and unboiled juices of greens: pumpkin, carrots, cucumber, which is able to inhibiting trypsin, and in addition it contains calcinating cheese, able to growing the bicarbonate operate of the pancreas. The remainder factors of the food plan 5b are just like food plan 5а. It’s appointed for 1–2 weeks.
Weight loss plan N1. Indications:
Gastric and duodenal ulcer throughout the interval of restoration after or throughout exacerbations.
Exacerbation of gastritis with preserved or elevated acidity.
Exacerbation of gastritis throughout restoration.
Objective: reasonable chemical, mechanical and thermal sparing of the gastrointestinal tract.
The ready meals is especially grated, boiled in water or steamed. Sure dishes are baked and not using a crust. Fish and never tough types of meat are ready as a chunk. Restricted salt. Cold and warm dishes should not allowed. White bread of yesterday baking or dried, dry biscuit are really useful. Forbidden: rye and contemporary bread, merchandise from fancy pastry. Grated vegetable soups or well-boiled groats, vermicelli, boiled rooster and meat are additionally really useful. Soups are crammed with butter and cream. Meat and fish broths, mushrooms and powerful vegetable soups, cabbage soup, borshch, okroshka should not allowed. Low-fat meat, with out tendons, meat of birds — with out pores and skin. Steamed cutlets, meatballs, boiled meat baked within the oven are ready. Fats and difficult types of meat, hen meat — goose, duck, canned meals, smoked meat should not allowed. Fish ought to be low-fat. Dairy merchandise with excessive acidity, sizzling and salty cheese should not allowed. Eggs — 2–3 per day, steam omelette. As for groats, millet, corn, bean and macaroni should not allowed. Regarding greens — white cabbage, radish, sorrel, spinach, onions, cucumbers, salty and salted greens, mushrooms should not allowed. Fruits ought to be candy, grated, cooked. Forbidden: bitter, unripe, wealthy in cellulose fruit and berries, chocolate, ice-cream, carbonated drinks, kvass, and black espresso. Amongst fat — unsalted butter and purified oil are really useful.
Weight loss plan N5. Indication: acute hepatitis and cholecystitis, persistent hepatitis, cirrhosis of the liver with out its insufficiency, cholelithic illness with out exacerbation, if there are not any accompanying illnesses of the abdomen and intestines.
Objective: chemical safety of the liver underneath the situations of high-grade vitamin, selling to the normalization of liver operate and biliary tracts exercise, enchancment of bile secretion.
Boiled, baked, sometimes stewed meals are ready. Forbidden: chilly meals, spinach, sorrel, backyard radish, inexperienced onions, garlic, mushrooms, pickled and salty greens, chocolate, cream merchandise, black espresso, cocoa, chilly drinks, horse-radish, pepper, mustard, meat and fish broths, okroshka, inexperienced soups.
Low-fat meat, baked after boiling and milk sausages are appointed. Fish — low-fat boiled, milk, kefir, bitter milk, bitter cream — as seasoning, semi-fat and low-fat cottage cheese and its merchandise, nonspicy cheese. Eggs, baked egg-white omelette. No multiple yolk per day, with cholelithic illness — as much as 1/2 yolks; any porriage. Greens — uncooked, boiled and stewed.
Weight loss plan N7. Indication: acute nephritis throughout restoration (from third– 4th weeks of therapy), persistent nephritis with out exacerbation and kidney failure.
Objective: reasonable kidney safety, discount of hypertensia and swelling, enchancment of excretion of nitric and different merchandise of metabolism from the organism. Proteins are restricted. Meals is ready with out salt. The quantity of salt is managed by the physician (not more than 3–6 g a day). The meals is salted on the desk. Bread — with out salt. Soups — with greens and groats. Using milk is restricted. Meat and fish broths should not allowed. Fowl — low-fat, boiled, baked after boiling is really useful. Fish — solely boiled, low-fat. Cheese shouldn’t be excluded from dairy merchandise.
Weight loss plan N9. Indication: diabetes of delicate and reasonable severity. Variants of food plan N9 consider the course of insulin remedy, accompanying illness and different components.
Objective: to offer the normalization of carbohydrate alternate and to forestall violation of fats alternate.
Rye bread, protein bread, on the common 300 g, soups from totally different greens, borshch, mild, low-fat meat, fish, mushroom broths with greens and decreased groats. Groats are restricted based on carbohydrates norms. Gruel with buckwheat, millet, oatmeal, leguminous. Beneficial: cabbage, vegetable marrows, pumpkin, salad, cucumbers, tomatoes, eggplants. Drinks — tea, espresso with milk, vegetable juices with not candy fruits and berries, broth of dogrose. Butter, melted butter, oil. Sugar and sweets excluded, restricted quantity of salt, rice, semolina, poppy merchandise, potatos, salty and pickled greens, contemporary fruit, grapes, raisins, bananas, figs, dates, sweets and ice-cream. Animal and culinary fat should not allowed.
Weight loss plan N15. Indications: numerous illnesses, which don’t demand a particular food plan, with out violation of digestion. A transitive food plan to normal meals throughout restoration and after medical diets.
Objective: to offer full-value vitamin underneath the situations of a hospital. Vitality worth and chemical accord to the traditional vitamin of wholesome folks, who should not occupied with bodily work. Nutritional vitamins are given in elevated quantities. All types of culinary processing of meals are allowed. Spicy merchandise and people that are hardly to digest are taken out of the food plan. Vitality worth: 2,800–2,900 kcal, protein — 90–95 g, fat — 100–105 g, carbohydrates — 400 g, salts — as much as 15 g Regime — 4 occasions a day. Bitter-milk merchandise are included. Margarine, fatty meat, goose, and mustard are restricted.
Parenteral Diet within the Surgical Clinic
Parenteral vitamin is extensively utilized in instances when enteral or probe feeding is unattainable. It is without doubt one of the types of diethotherapy, throughout which vitamin help is carried out by blood circulation. Parenteral vitamin is really useful throughout pronounced violations of protein alternate, brought on by poor enteral vitamin and elevated protein metabolism. Dysfunction of protein alternate is considered one of most vivid shows of metabolic reactions to trauma, bleeding, operation, acute illnesses, and so forth. Additionally it is mandatory to think about that elevated disintegration and lack of protein, as a rule, happens concurrently with the lower in oral earnings of vitamins.
Within the surgical clinic parenteral vitamin is really useful:
Throughout extreme traumas with damage to the osteo-articulate equipment, inside organs, and burns.
Throughout surgical interventions on organs of the gastrointestinaltract if the affected person can not take meals enterally (tumors, burns, abdomen and esophageal strictures, impassability of the intestines, penetrating wounds of stomach with damage to the gastrointestinal tract, and so forth.), in addition to throughout postoperative problems (peritonitis, retroperitoneal and belly abscesses), gastric and intestinal fistulas and different surgical illnesses.
In reanimational apply: throughout intensive operations on thechest organs.
Throughout acute pyo-septic processes.
The next preparations are utilized for parenteral diethotherapy:
Casein hydrolysate is an answer of amino acids and peptides obtained by means of hydrolysis of full-value protein (casein) with the preservation of all irreplaceable amino acids in it. It’s disadvantaged of antigenic qualities and toxicity, sterile, apyrogenic; hydrolysate-103; aminopeptide; fibrinosolum; aminosolum (Sweden); aminonum (Finland); alvedosin (Germany); travamin (USA); proteolizate (Czech); pasedrolum (Japan).
Polyamine is developed by the Central Hematology and Haemotransfusion Analysis Institute.
Combination of 13 amino acids (8 are irreplaceable). 1 l of preparation accommodates 80 g of amino acids and 50 g of sorbite. This preparation is entered slowly i/v (10–20 drops per min.), 400–800 ml per day for five days and extra.
Amikin. Recommended by the Kiev Analysis Institute for Hematology of haemotransfusion along with the Ukrainian Analysis Institute for Meat-and-Milk Business. Mild-yellow clear liquid accommodates 4.55–5.5 g of protein in 100 ml.
Hydrolysine. Acidic hydrolysate of the blood. Recommended by the St-Perersburg Analysis Institute for Hematology and haemotransfusion. Comprises 8 g/l of normal nitrogen, 40% of amino nitrogen, 0.58 g/l of ammonia.
Aminocrovine. Incomplete hydrolysate of homogeneous protein of utilized blood. It accommodates 44–56 g of protein. All irreplaceable amino acids are preserved within the preparation.
Blood, plasma, albumin, protein should not utilized for parenteral vitamin. Plasma protein is utilized by the organism for plastic functions solely on the tenth–twenty fifth day after introduction, as a result of they need to be cut up as much as the stage of amino acids earlier than they are often utilized.
Essentially the most widespread and dependable sort of energetic materials is glucose. It is suggested to enter a ten–40% resolution of glucose. On the similar time with glucose, insulin ought to be given with the ratio of 1 U for each 5 g of glucose.
Fatty emulsions are additionally utilized for parenteral vitamin. It’s introlipid (Sweden), lipofundinum (Germany).
Throughout parenteral vitamin, it is rather necessary to enter potassium salts, as a result of the introduction of concentrated options of glucose in a fancy with amino acids generates hypokalemia. Subsequently, even for the dearth of deficiency it’s essential to enter 3 g of potassium chloride for each 150 g of infused glucose. The management over potassium stage and different electrolytes in blood serum is compulsory.