COMMON CARE FOR PATIENTS

Regimen is an appropriate order established in the patient care institutions of out-patient or in-patient type with the purpose of creating the best conditions for the recovery of patients. The regimen is equally obligatory for patients and personnel, but personnel actively make and support it, but patients submit to it.

The regimen of the patient care institutions consists of:

Internal regulations.

Sanitary-hygienic regimen of the patient care institution.

Personal hygiene of the patient and personnel.

Temperature, illumination and ventilation regimen.

Balanced diet regimen.

Treatment of patients.

The regimen at the departments and hospitals of different structures has its own peculiarities. The regimen of the infectious hospital differs from the regimen of the surgical hospital, the regimen of the maternity hospital and gynaecology unit differs from the regimen of the children’s and therapeutic department. Inside the hospital, the regimen of departments and even wards also can have its own features. Each patient, depending on the disease, is arrenged an individual regimen concerning movement, meal, etc. A prescribed regimen is entered into the prescription list and medical card: “bed rest”, “active”, etc. Walks, period of activity, massage, diet and additional meals for patients are indicated.

The greatest importance for successful treatment of patients is the condition of the nerve system, belief in recovery, confidence in his hospital doctor and medical personnel.

Organization and conducting of therapeutic-protective regimen in hospitals have great value in creating conditions, which have a good influence on the patient’s nervous system. The basis of this regimen consist of measures which protect the patient from harmful environmental factors which can negatively affect him, complicating the disease course, as well as the measures, creating conditions which favorably influence an organism, support spiritual vivacity, psychological tone of the patient, help him actively take part in the process of therapy.

Basic elements of therapeutic-protective regimen:

Whenever possible, painful sensations shoud be eliminated. Itis, in particular, actual at the surgical departments of hospitals where almost all patients feel pain, from time to time rather intensive, which deprives them of sleep and rest.

Try to avoid negative emotions, caused by aftervision, acoustical and olfactory sensations.

Combine the regimen of rest with physical activity and increasethe patient’s general psychological tone.

Organize such surrounding conditions which favorably influence the patient.

Even a simple list of basic elements of a therapeutic-protective regimen proves that its influence involves all the patient’s stay at the hospital beginning with the moment of reception till discharge from the hospital.

The word of the doctor and medical personnel, which can become for the patient both the reason of iatrogenic diseases, and a source of cheerfulness, is of great importance. For example, accidentally read and misinterpreted case history as well as lab analyses results can influence the mentality of a patient and the treatment result.

It is strictly forbidden for medical personnel to discuss a patient’s condition and have a talk on medical themes in wards. Case reports are kept in special rooms, where patients are prohibited to enter. It is forbidden to talk to other patients about the health of their neighbors and the possible outcome of their disease. The doctor is obliged to give confidence to patients in good results of treatment and favourable outcome of operation.

At the surgical hospital it is necessary to avoid of negative emotions, connected with the look of medical subjects (blood-stained pieces of gauze, napkins, syringes and scalpels, clips with traces of blood, basins filled with used dressings, drenched with pus and blood). The doctor’s appearance, in particular the surgeon’s, is extremely important. In the operating room, he should not appear in the patient’s presence in a blood-stained gown. Smoking is forbidden at the hospital territory too. A doctor and smoking are incompatible. The doctor’s face should be clean and shaved. It is not necessary to “hold an actor’s smile”, but nevertheless, the doctor’s face should look like well-wishing.

Rest, prolongation of physiological night sleep and obligatory day rest have great importance for the patient. Personnel change, wards cleaning and taking the body temperature are conducted after the patients get up, not earlier than 7 o’clock.

For reducing noise, it is necessary to install a soundproof door in the operating and dressing rooms, and equip with silent signal system. Patients should not groan, especially scream during an operation or dressing the wounds. Because of achievements in anesthesiology screaming at the operating and dressing-room is not permissible. While patients are sleeping and having rest, it is expedient to bring medical procedures to minimum, and emergency help should be provided with silent performance of manipulations, using local light sources.

The regimen of rest should be combined with possible physical activity of the patient — hygienic morning and curative gymnastics, walking in fresh air, the organization of cultural entertainments.

The therapeutic-protective regimen needs strict observance of an appropriate day regimen. At the majority of hospitals of our country the regimen is approximately alike. Here is an approximate day regimen of the surgical department and a list of the nurse’s functional duties.

The sanitary-hygienic regimen is a number of laws, which determine the sanitary condition of the territory and wards in the hospital.

The territory of the hospital should be protected, entrances and roads between constructions — paved or asphalted. Water supply and sewerage are necessary. For dry garbage it is necessary to have boxes with closing lids, the place under the boxes and around them should be concreted. It is necessary, in due time, to evacuate boxes and periodically disinfect them. The territory of the hospital should be regularly tidied up. Doing up hospital rooms should be damp and done no less than 3–4 times per day with specially marked stock. These intervals should be individual for wards, operating and dressing rooms, buffet, bath and lavatory rooms. Panels are washed in medical establishments with a damp duster 1 time every three days. Once a month the window, plafonds, ceiling, doors should be cleaned of dust. The surfaces of radiators and pipes of the central heating should be wiped with a damp duster every day.

Sanitary-Hygienic Regimen in the Admission Office

The doctor examines everyone who enters the admission office, so that in due time patients with pyo-septic wounds can be revealed and isolated. The patient’s skin and temperature are checked. Wooden spatulas are destroyed after use; metal ones are disinfected (immersed in a 2% formalin solution by 30 min or boiled for 30 min). Thermometers are kept for disinfection in a 0.5% solution of chloramine (30 min) or a 3% solution of hydrogen peroxide (80 min), or a 0.1% solution of desoxyne-1 (15 min). Inspection of a patient is conducted on a couch covered with oilcloth: after every patient’s examination the oilcloth is wiped with a duster moistened in chloramine solution with a 0.5% solution of washing liquid, or a 3% solution of hydrogen peroxide with a 0.5% solution of washing liquid (desoxyne-1). After the patient is examined, a wound inspected and bandages changed the personnel disinfects the hands — washes them in warm running water with soap for 2 min. For this purpose, bars of laundry or toilet soap in small packing (for one use) are used. After the patient’s inspection for pyo-septic diseases, purulent wounds are cleaned, the personnel disinfect the hands with bactericidal preparations (80% ethyl spirit, solution of chlorhexidine bigluconate in 70% ethyl spirit, 0.5% solution of chloramine). The working solutions for the mentioned above preparations are prepared at the drugstore of the treatment-prophylactic establishment. The container with the solution is placed near the washstand, in the dressing-room, for disinfecting hands with ethyl spirit or chlorhexidine preparations; it is put on the palmar surface of the hands by 5–8 ml and rubbed into the skin for 2 min. Such a solution is applied 10 times. Brushes for hands processing are washed and boiled in 2% soda solution for 15 min. Clean brushes are kept in sterile drums. They are taken out with sterile forcepts.

Each employee of the admission office has an individual towel. Towels are changed once a day. Inspection of wounds and changing of bandages are carried out only in dressing gowns, slippers, hats, masks, gloves. When cleaning purulent wounds, abscesses, phlegmons, etc., additionally oil-cloth apron are put on, which are disinfected after each use, as well as oilcloths on couches (solution chloramine or 3% solution of hydrogen peroxide with 0.5% solution of washing liquid).

The patient in the admission office passes full sanitary cleaning — takes a shower or bath, cats the nails. For washing, a patient receives a clean wash cloth. After sanitary cleaning, he puts on clean hospital linen, dressing gown or pajamas, slippers.

The admission room is tidied up no less than two times a day in a damp way with disinfect solutions: 1% solution of chloramine, 0.2% solution of desoxyne-1, 0.5% solution of chlordesine, etc. Cleaning material (buckets, basins, etc.) are marked and strictly used according to the purpose. Dusters are strictly kept according to cleaning purpose. After use, cleaning material is disinfected (soaked in 1% solution of chloramine for 60 min, 0.2% solution of sulphochlorantine — 60 min, 2% solution of dichloride-1 — 60 min, 1% solution chlordesine — 60 min).

Sanitary-Hygienic Regimen in the Surgical Department

After the patients’ discharge, the bed, bedside-table, support for urine vessel, wiped with a moistened duster with disinfectant solution (1% solution chloramine B or 0.75% solution chloramine B, 0.5% solution of detergent, 0.2% solution of desaxon-1, 0.5% solution of chlordesine, etc.).

It is not allowed to accept to the surgical department soft toys which could not be disinfected.

Patients with pyo-septic diseases and postoperative purulent complications are isolated in separate wards or departments. In these wards, ultra-violet bactericidal irradiators of the close type should be established.

The personnel who work in purulent units and wards, after work, change surgical coats, masks and hats.

Hands are disinfected with 70% spirit or chlorhexidine for 2 min.

The department is kept in order. Cleaning is carried out not less than twice per day by a damp way with a soap-soda solution. Disinfectants are used after linen is changed and in the case of occurrence of hospital infections. In wards for patients with pyo-septic diseases and postoperative purulent complications, daily cleaning is carried out with necessary application of disinfectant solutions (1% solution of chloramine, 3% solution of hydrogen peroxide with 0.5% solution of detergent, 0.2% solution of desaxone-1, chlordesine).

Sanitary-Hygienic Regimen at the Operating Block, Wards and Resuscitation Departments

The operating block is separated from other rooms of the surgical department by a tambour, equipped with a source of bactericidal ultra-violet irradiators. The door to the operating room is constantly held shut. The operating block is equipped with stationary bactericidal irradiators and ventilating devices with prevailing of air inflow over drawing out. In the air inflow system bacterial filters are set. In the operating, dressing-rooms, wards and departments of intensive therapy for decreasing microbic fertilization, the following air-filters are recommended — AFMR-0.9, AFMR-1.5 (air filters mobile recirculatory).

The operating rooms are strictly divided for clean and purulent operations. If there are no conditions for these requirements observance, operations concerning purulent processes are carried out on specially alloted days with the following disinfection of the operational block and all equipment. Surgeons, scrub nurses and all the personnel taking part in the operation take a hygienic shower before the operation, put on operational linen (pajamas, slippers, cap and surgical coat). Before entering the operational room, the surgical coat is put off, a mask, shoe covers are put on, and then they go into the preoperating room, where hands are cleaned and a sterile surgical coat, mask and gloves are put on. The “rule of the red strip” is strictly kept. Everyone who enters the operating room (over the red strip) should have sterile linen on. Students and all other persons before entering the operating room put on a 4-layered mask and diligently hide their hair under the medical cap, then they put on shoe covers. For utilized shoe covers, a bucket with a lid is put. It is prohibited to be in the operating room in street shoes and for those who do not participate in the operation.

Patients are brought to the operating room in the surgical transport, which belongs to the department. In front of the operating block, he is put in to the surgical transport of the operating block and delivered to the operational table. The operating room’s barrow is in the preoperating room at the same place. Every day the barrows are cleaned with a duster moistened in disinfectant solution (1% solution of chloramine, etc.). Everything that is brought in the operating room (devices, apparatus and other objects) is disinfected (1% solution chloramine, etc.). A table for sterile instruments is covered with a sterile cloth directly before the operation, sterile instruments are placed on it and it’s covered with a sterile cover from above. A dressing material and instruments used during the operation, are collected in special bowls. It is strictly forbidden to keep in the operational room the objects which are not used during operation.

At the surgical department pure and purulent dressing rooms are strictly distinguished. If there is only one dressing room, the cleaning of purulent wounds is carried out after pure manipulations are done with the following cleansing of the room and all the equipment with disinfectant solutions (1% solution chloramine B, 3% hydrogen peroxide and 0.5% washing solution, etc.). Employees of the dressing rooms, resuscitation and intensive therapy departments have to change surgical coats, caps and masks every day. Nurses, while dressing the patient’s purulent wound must put on an oilcloth apron, which is disinfected after every dressing (wiped with a duster moistened in a 1% solution of chloramine B), and their hands are cleaned with 70% spirit or 1% solution of chlorhexidine.

After dressings, the dressing material is put in special containers, and damp cleansing with the application of disinfectant solutions is conducted (1% solution chloramine, 6% solution of hydrogen peroxide and 0.5% solution of detergent, etc.). Infected dressing material is burned. The personnel who do not work in the dressing room, wards and departments of intensive therapy is forbidden to enter the postoperative ward. Before a patient is moved from the operating room to the intensive therapy ward, the bed and bedside-table are processed with disinfectant solutions (1% solution of chloramine or 0.2% solution of desoxine-1). The bed must be made with bed linen, which has undergone processing.

Cleansing of the operational block, dressing rooms and intensive therapy, and resuscitation departments is done in a damp way no less than twice a day with disinfectants (chloramine, desoxine, chlordesine, etc.). General cleansing in the operational block and dressing room is conducted once a week. The operational block and dressing room are first cleared of things and equipment, ventilators, medicines, etc. As a disinfectant, a complex, which consists of a 6% solution of hydrogen peroxide and 0.5% solution of detergent, is used. After disinfection, the operating room and dressing-room are irradiated with ultra-violet light (direct or reflected), hanging or ceiling bactericidal lamps are switched on.

For utilization of dressing and waste products after operations, muffle furnaces are established.

Personal Hygiene of Patients and Personnel

The personnel should have working clothes and correctly use them: outer and working clothes should be kept separately, in different wardrobes; they should not leave the hospital territory in working clothes and wear it over the working time. The linen should be kept in a dry, light, ventilated room and clean separately from dirty ones. The dirty linen should be disinfected. At admission the patients are carried out cleansing and later on should follow the rules of personal hygiene. It is necessary to make the bed and to change bed-clothes and underwear once a week. Each patient should have an individual towel, a glass for medicines, a mug. Objects of care for patients should be washed after every use and keep in a closed dresser. While walking, patients should not leave the hospital territory.

The doctors, nurses and aid women’ cloths should be of different colors.

Sanitary-Hygienic Regimen of Patients Feeding

In the organization of nutrition, it is necessary to consider not only the quantity and quality of a diet but also a properly serving table, pleasant appearance of dishes, temperature of food, fast service. We shall notice that the centralized system of nutrition, which exists in hospitals, presents real difficulties as for preservation of ready food quality while delivering it from the kitchen to the patients’ wards. The food temperature falls, flavoring qualities deteriorate, calories number reduces.

Organization of patients’ nutrition is an important thing in the complex of medical measures. Equipment of public catering organization and the buffet departments of treatment-prophylactic establishment are under doctor’s responsibility. The doctor-dietician provides the control over sanitary requirements performing by public catering organization’s workers handing out of food to the wards is done by the barmaid and duty nurses of the department from dishes marked “for food handing out”. The technicians who are occupied with wards and other rooms cleansing are not allowed to hand out food. Patients (except the seriously ill patients) take food in a special room — a dining room. Personal food products (house-made) are kept in the bedside-table (dry products which do not spoil) and in special alloted refrigerators (products which quickly spoil). The range and amount should be approved by the doctor.

After each food handing out, the cafeteria and dining room are diligently cleansed with disinfectants (1% chloramine solution, etc.). Wisps of bast for tableware and wiping tables, after the end of cleaning, are boiled or disinfected, and then dried and kept in special clean containers with a cover. The personnel of the public catering organization and cafeteria should keep the rules of personal hygiene: before visiting the toilet surgical coats are to be removed, after visiting the toilet hands are to be washed and disinfected with 0.5% chloramine solution or 0.5% chlorhexine solution or other preparations.

The majority of surgical diseases are accompanied by deterioration in nutrition. The condition of protein balance before an operation, in many respects, depends on the character and phase of the basic pathological process (inflammation, trauma, etc.) and peculiarities of nutrition.

During acute surgical diseases, in particular intestinal obstraction a patient within some hours, and sometimes minutes, can lose a huge amount of protein, salt and water. In the case of acute traumas the big loss of liquid is specially dangerous. During chronic diseases the most dangerous is protein loss.

Malnutrition is very dangerous. It can lead to a severe course of the hospital infection, violation in wounds healing, development of protein-free oedemas. Malnutrition increases a possibility of shock development, colloid-osmotic pressure fall, immunobiological protective reactions of an organism are disturbed, repairing processes in tissue and the blood cells regeneration slow down, the synthesis of hormones and enzymes increases, tendency to infectious complications rises. Valuable food and effective metabolism, tolerance to operational trauma increases, postoperating complications incidence decreases, patients manage the infection better.

There are two ways nutrients delivery to an organism — natural and artificial. A great number of diseases and postoperating conditions make the normal process of natural nutrition is impossible. In these cases artificial nutrition applied. Different forms of artificial nutrition are distinguished: parenteral, enteral (through a probe or ostomy) and combined. The enteral form is the closest to natural nutrition. It is always applied if there are no direct contradictions to its usage.

The patient’s diet during the preoperative period should be enriched with vitamins, due to foods and vitamins. The products which may cause meteorism (leguminous, cabbage, whole milk, etc.) are excluded 3–5 days before the operation.

In order to avoid aspiration of food remains from stomach to lungs, the last meal should be not less than 8 h before the operation.

During the postoperative period it is necessary to compensate the increased expenses of an organism both during the operation and first days after it. It is necessary to replace the waisted liquid, protein, mineral substances, vitamins, in particular vitamins C, A, K. If necessary parenteral nutrition is provided. Depending on the extent and type of operative intervention, pathogenetically grounded “surgical” diets are distinguished.

Surgical Diets

Zero surgical diets. The purpose is mechanically and chemically preserving nutrition. It is fluid, semifluid, jelly-like grated food in three consecutive diets: 0 (0а), 0b (1a-surgical), 0c (1b-surgical).

Diet 0 (0а) is appointed on the 2nd, 3rd, 4th day after operation on gastrointestinal tract (perforating ulcers suturing, resections of the stomach, small and large intestines, etc.).

Diet 0b (1а-surgical). Appointed on the 2nd–4th days after diet 0а. It differs from the 0b with some meals adding 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, fine boiled eggs, steam souffles of low-fat meat and fish (up to 100 g), oil, mousse from not sour berries. Food is given 4–5 times a day, no more than 350–400 g.

Diet 0c (1b-surgical). Serves for extention of the diet and transition to physiological high-grade meal. The diet includes cream soup, steamed foods of grated boiled meat, chicken or fish, fresh cottage cheese grated with milk to the consistence of sour cream, steamed cheese food, sour-milk products, baked apples, grated fruit and vegetables. Up to 100 g of white crackers, grated dairy porridge. Food is given 6 times a day. The temperature of hot foods is no more than 50°С, cold — no less than 20°С.

In the case of organ-saving operations (different kinds of vagotomy) the term of surgical diets in the postoperative period is kept. The day after the operation, a patient can have fine portions of food (drink of cooled boiled water (sipping) up to 0.5 l a day). The next day, the zero diet 0 (0а) is appointed for the period of 1–2 days, on the 3rd–4th day — diet 0b (1а-surgical) for a period of 2–3 days, then during a few days (3–4) the patients receive diet 0c (1b-surgical) with the following transition to diet N1.

Diet N5а surgical is appointed on the 3rd, 4th, 5th day after the operation on the gallbladder (cholecystectomia). It differs from the diet 1а and 1b by the restriction of fats, exclusion of broths, roasted cottage cheese and yolk eggs, fresh milk and its products. Mucous vegetarian soups, steam foods with boiled then cutted very small meat, porridge with rice, buckwheat and oatmeal, compotes, juices of not sour fruits and berries, and vegetable juices are recommended. Bread and bakery products are not allowed. Water is given in small portions up to 2 l. The diet is for 1-2 weeks.

Diet N5b surgical is appointed on the 3rd, 4th, 5th day after an operation on the pancreas. It differs from diet N 5а in that it contains foods of white-eggs (cocktail) and unboiled juices of vegetables: pumpkin, carrots, cucumber, which is capable of inhibiting trypsin, and also it includes calcinating cheese, capable of increasing the bicarbonate function of the pancreas. The rest points of the diet 5b are similar to diet 5а. It is appointed for 1–2 weeks.

Diet N1. Indications:

Gastric and duodenal ulcer during the period of recovery after or during exacerbations.

Exacerbation of gastritis with preserved or elevated acidity.

Exacerbation of gastritis during recovery.

Purpose: moderate chemical, mechanical and thermal sparing of the gastrointestinal tract.

The prepared food is mainly grated, boiled in water or steamed. Certain dishes are baked without a crust. Fish and not rough sorts of meat are prepared as a piece. Limited salt. Cold and hot dishes are not allowed. White bread of the previous day baking or dried, dry biscuit are recommended. Forbidden: rye and fresh bread, products from fancy pastry. Grated vegetable soups or well-boiled groats, vermicelli, boiled chicken and meat are also recommended. Soups are filled with butter and cream. Meat and fish broths, mushrooms and strong vegetable soups, cabbage soup, borshch, okroshka are not allowed. Low-fat meat, without tendons, meat of birds — without skin. Steamed cutlets, meatballs, boiled meat baked in the oven are prepared. Fat and tough sorts of meat, bird meat — goose, duck, canned food, smoked meat are not allowed. Fish should be low-fat. Dairy products with high acidity, hot and salty cheese are not allowed. Eggs — 2–3 per day, steam omelette. As for groats, millet, corn, bean and macaroni are not allowed. Concerning vegetables — white cabbage, radish, sorrel, spinach, onions, cucumbers, salty and salted vegetables, mushrooms are not allowed. Fruits should be sweet, grated, cooked. Forbidden: sour, unripe, rich in cellulose fruit and berries, chocolate, ice-cream, carbonated drinks, kvass, and black coffee. Among fats — unsalted butter and purified oil are recommended.

Diet N5. Indication: acute hepatitis and cholecystitis, chronic hepatitis, cirrhosis of the liver without its insufficiency, cholelithic disease without exacerbation, if there are no accompanying diseases of the stomach and intestines.

Purpose: chemical protection of the liver under the conditions of high-grade nutrition, promoting to the normalization of liver function and biliary tracts activity, improvement of bile secretion.

Boiled, baked, occasionally stewed foods are prepared. Forbidden: cold foods, spinach, sorrel, garden radish, green onions, garlic, mushrooms, pickled and salty vegetables, chocolate, cream products, black coffee, cocoa, cold drinks, horse-radish, pepper, mustard, meat and fish broths, okroshka, green soups.

Low-fat meat, baked after boiling and milk sausages are appointed. Fish — low-fat boiled, milk, kefir, sour milk, sour cream — as seasoning, semi-fat and low-fat cottage cheese and its products, nonspicy cheese. Eggs, baked egg-white omelette. No more than one yolk per day, with cholelithic disease — up to 1/2 yolks; any porriage. Vegetables — raw, boiled and stewed.

Diet N7. Indication: acute nephritis during recovery (from 3rd– 4th weeks of treatment), chronic nephritis without exacerbation and kidney failure.

Purpose: moderate kidney protection, reduction of hypertensia and swelling, improvement of excretion of nitric and other products of metabolism from the organism. Proteins are limited. Food is prepared without salt. The amount of salt is controlled by the doctor (no more than 3–6 g a day). The food is salted at the table. Bread — without salt. Soups — with vegetables and groats. The use of milk is limited. Meat and fish broths are not allowed. Fowl — low-fat, boiled, baked after boiling is recommended. Fish — only boiled, low-fat. Cheese is not excluded from dairy products.

Diet N9. Indication: diabetes of mild and moderate severity. Variants of diet N9 take into account the course of insulin therapy, accompanying disease and other factors.

Purpose: to provide the normalization of carbohydrate exchange and to prevent violation of fat exchange.

Rye bread, protein bread, on the average 300 g, soups from different vegetables, borshch, light, low-fat meat, fish, mushroom broths with vegetables and reduced groats. Groats are limited according to carbohydrates norms. Gruel with buckwheat, millet, oatmeal, leguminous. Recommended: cabbage, vegetable marrows, pumpkin, salad, cucumbers, tomatoes, eggplants. Drinks — tea, coffee with milk, vegetable juices with not sweet fruits and berries, broth of dogrose. Butter, melted butter, oil. Sugar and sweets excluded, limited amount of salt, rice, semolina, poppy products, potatos, salty and pickled vegetables, fresh fruit, grapes, raisins, bananas, figs, dates, sweets and ice-cream. Animal and culinary fats are not allowed.

Diet N15. Indications: various diseases, which do not demand a special diet, without violation of digestion. A transitive diet to general food during recovery and after medical diets.

Purpose: to provide full-value nutrition under the conditions of a hospital. Energy value and chemical accord to the normal nutrition of healthy people, who are not occupied with physical work. Vitamins are given in increased amounts. All kinds of culinary processing of food are allowed. Spicy products and those which are hardly to digest are taken out of the diet. Energy value: 2,800–2,900 kcal, protein — 90–95 g, fats — 100–105 g, carbohydrates — 400 g, salts — up to 15 g Regime — 4 times a day. Sour-milk products are included. Margarine, fatty meat, goose, and mustard are limited.

Parenteral Nutrition in the Surgical Clinic

Parenteral nutrition is widely applied in cases when enteral or probe feeding is impossible. It is one of the forms of diethotherapy, during which nutrition support is carried out through blood circulation. Parenteral nutrition is recommended during pronounced violations of protein exchange, caused by poor enteral nutrition and increased protein metabolism. Disorder of protein exchange is one of most vivid displays of metabolic reactions to trauma, bleeding, operation, acute diseases, etc. It is also necessary to consider that elevated disintegration and loss of protein, as a rule, occurs simultaneously with the decrease in oral income of nutrients.

In the surgical clinic parenteral nutrition is recommended:

During severe traumas with injury to the osteo-articulate apparatus, internal organs, and burns.

During surgical interventions on organs of the gastrointestinaltract if the patient cannot take food enterally (tumors, burns, stomach and esophageal strictures, impassability of the intestines, penetrating wounds of abdomen with injury to the gastrointestinal tract, etc.), as well as during postoperative complications (peritonitis, retroperitoneal and abdominal abscesses), gastric and intestinal fistulas and other surgical diseases.

In reanimational practice: during extensive operations on thechest organs.

During acute pyo-septic processes.

The following preparations are applied for parenteral diethotherapy:

Casein hydrolysate is a solution of amino acids and peptides received by way of hydrolysis of full-value protein (casein) with the preservation of all irreplaceable amino acids in it. It is deprived 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 Research Institute.

Mixture of 13 amino acids (8 are irreplaceable). 1 l of preparation contains 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 5 days and more.

Amikin. Suggested by the Kiev Research Institute for Hematology of haemotransfusion together with the Ukrainian Research Institute for Meat-and-Milk Industry. Light-yellow transparent liquid contains 4.55–5.5 g of protein in 100 ml.

Hydrolysine. Acidic hydrolysate of the blood. Suggested by the St-Perersburg Research Institute for Hematology and haemotransfusion. Contains 8 g/l of general nitrogen, 40% of amino nitrogen, 0.58 g/l of ammonia.

Aminocrovine. Incomplete hydrolysate of homogeneous protein of utilized blood. It contains 44–56 g of protein. All irreplaceable amino acids are preserved in the preparation.

Blood, plasma, albumin, protein are not applied for parenteral nutrition. Plasma protein is used by the organism for plastic purposes only on the 10th–25th day after introduction, because they should be split up to the stage of amino acids before they can be applied.

The most widespread and reliable kind of energetic material is glucose. It is recommended to enter a 10–40% solution of glucose. At the same time with glucose, insulin should be given with the ratio of 1 U for every 5 g of glucose.

Fatty emulsions are also applied for parenteral nutrition. It is introlipid (Sweden), lipofundinum (Germany).

During parenteral nutrition, it is very important to enter potassium salts, because the introduction of concentrated solutions of glucose in a complex with amino acids generates hypokalemia. Therefore, even for the lack of deficiency it is necessary to enter 3 g of potassium chloride for every 150 g of infused glucose. The control over potassium level and other electrolytes in blood serum is obligatory.