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You are here: صفحه اصلي آموزش بیماران مراقبتهای ویژه (ICU) مراقبت های پس از ترخیص تغذیه بیمار 2

قطب علمی آموزش الکترونیکی دانشگاه علوم پزشکی شیراز

تغذیه بیمار 2

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   لوله های تغذیه ای که به طور مستقیم در دیواره معده کار گذاشته می‌شوند انواع مختلفی دارند اما روش استفاده و مراقبت از آن‌ها مشابه می‌باشد از انواع آن می‌توان گاستروستومی –ژئوژنستومی،... نام برد. کار گذاری این لوله‌های تغذیه ای از طریق یک روش ساده جراحی انجام می‌گردد به این صورت که لوله مخصوص تغذیه در دیواره معده تعبیه می‌شود. این روش برای بیمارانی استفاده می‌گردد که به علت بیماری خاص امکان تغذیه از راه دهان را ندارند.

 

 

 

 

 

در این مبحث به این سؤالات شما پاسخ داده می‌شود:

  1. چگونه لوله های تغذیه ای به طور مستقیم در دیواره معده کار گذاشته می‌شوند؟
  2. تغذیه با لوله های که مستقیم در دیواره معده کار گذاشته می‌شوند چگونه انجام می‌شود؟
  3. مراقبت‌های لازم برای بیماران با لوله‌های مستقیم در معده چیست؟
  4. اقدامات لازم در صورت بروز تهوع و استفراغ چیست؟
  5. در صورت بروز اسهال چه اقداماتی انجام شود؟
  6. اقدامات لازم در هنگام بروز بی اشتهایی چیست؟

     

     1.چگونه لوله های تغذیه ای به طور مستقیم در دیواره معده کار گذاشته می‌شوند؟

این نوع لوله ها انواع مختلفی دارند اما روش استفاده و مراقبت از آن‌ها مشابه می‌باشد از انواع آن می‌توان به گاستروستومی –ژئوژنستومی،... نام برد.

تصویر 1: لوله مستقیماً در دیواره معده یا روده قرار می‌گیرد

کار گذاری این لوله‌های تغذیه ای از طریق یک روش ساده جراحی انجام می‌گردد به این صورت که لوله مخصوص تغذیه در دیواره معده تعبیه می‌شود. این روش برای بیمارانی استفاده می‌گردد که به علت بیماری خاص امکان تغذیه از راه دهان را ندارند.

 

    

2.    تغذیه با لوله های که مستقیم در دیواره معده کار گذاشته می‌شوند چگونه انجام می‌شود؟

وسایل لازم: آب، سرنگ مخصوص غذا، غذای آماده شده

بیمار را در وضعیت نشسته یا روی پهلوی راست قرار دهید.

ابتدا دست‌ها را بشویید سپس با سرنگ غذا محتویات داخل معده را بکشید اگر بیشتر از 100 سی سی بود غذا دهی را به 1 تا 2 ساعت بعد موکول کنید. در غیر این صورت غذایی که قبلاً آماده کرده و از صافی گذرانده‌اید (درجه حرارت مطلوب برای غذا و آب مورد استفاده درجه حرارت اتاق است) را نزدیک بیمار بگذارید پیستون سرنگ غذا را خارج کنید و بعد سرنگ را به سر لوله ای که در دیواره معده کار گذاشته شده است وصل کنید دست خود را بالا نگه دارید بعد حدود 30 تا 50 سی سی به بیمار آب بدهید تا مسیر شسته شود بعد غذا را در سرنگ بریزید و بگذارید آرام آرام وارد معده شود. سعی کنید همیشه سرنگ پر از غذا باشد تا هوا وارد معده نشود و بیمار دچار نفخ شکم نشود. بعد از اتمام تغذیه حدود 30 تا 50 سی سی مجدداً آب وارد معده کنید تا مسیر کاملاً شسته و باز شود بعد از اتمام کار تغذیه سرنگ و وسایل مورد استفاده را با آب و مایع ظرف‌شویی بشویید دقت داشته باشید در هر وعده غذایی بیش از 300 تا 500 سی سی غذا نباید به بیمار داده شود بعد گیره لوله را بسته و لوله را در جای خود ثابت کنید در صورت لزوم می توانید از پانسمان نیز استفاده کنید.

   

  3.  مراقبت‌های لازم برای بیماران با لوله‌های مستقیم در معده چیست؟

1. هر روز اطراف لوله را با آب و صابون بشویید و به آرامی آن‌را خشک نمایید. گاز یا دستمال کاغذی را روی پوست بیمار نکشید بلکه آهسته با گذاشتن و برداشتن دستمال پوست اطراف لوله را خشک نمایید.

2. اطراف لوله را از نظر زخم، رنگ، ترشحات و خونریزی بررسی کنید و در صورت مشکل به پزشک مراجعه نمایید.

3. قبل از غذا دادن حتماً مقدار غذای باقی مانده در معده را اندازه گیری کنید.

4. لوله را تا جایی که وارد معده شده است علامت‌گذاری کنید تا در صورت کوتاه یا بلند شدن لوله متوجه شوید و سریعاً به پزشک اطلاع دهید.

5. در صورتی که بیمار دوست داشت می‌تواند غذا را بو کند، بچشد یا بجود و دور بریزد این کار از لحاظ روحی و جسمی به بیمار بسیار کمک می‌کند.

6. مقدار غذایی که در هر وعده به بیمار می‌دهید را به دقت ثبت کنید.

 

4.      اقدامات لازم در صورت بروز تهوع و استفراغ چیست؟

اگر بیمارتان دچار تهوع و استفراغ می‌باشد ابتدا باید سعی کنید علت اصلی آنرا پیدا کنید ممکن است از عوارض جانبی داروها باشد یا غذای تهیه شده آلوده باشد.

زمانی که بیمار تهوع دارد بهتر است حجم کمی غذا را با فاصله های مکرر به بیمار بدهید. مراقب باشید بیمار به علت تهوع و استفراغ دچار کم آبی نشود.

تذکر: از خوراندن حجم زیادی غذا دریک وعده غذایی به بیمار خودداری نمایید.

اگر بیمار استفراغ می‌کند سر بیمار را بالا بیاورید و به یک سمت خم کنید و ظرفی در اختیار وی قرار دهید تا محتویات دهان را در آن بریزد.

در این بیماران سعی کنید مرتب دهان بیمار را بشویید اگر بیمار نمی‌تواند مسواک را تحمل کند از محلول آب نمک یا آب ساده و یا دهان‌شویه برای شستن دهان استفاده کنید.

در صورت ادامه تهوع و استفراغ حتماً با پزشک مشاوره کنید ممکن است بیمار نیاز به استفاده از داروهای ضد تهوع داشته باشد؛ و بیمار دچار کم آبی شود پس در این مورد دقت لازم را داشته باشید و از پزشک یا پرستار کمک بخواهید.

   

5.       در صورت بروز اسهال چه اقداماتی انجام شود؟    

اگر بیمار مبتلا به اسهال شده است. اول سعی کنید علت آنرا پیدا کنید ممکن است غذای بیمار آلوده بوده باشد.                                                        

برنامه رژیم غذایی بیمار را از موادی ساده مانند پنیر – موز – ماست – برنج کته ای تهیه کنید. از دادن میوه و سبزی – مایعات داغ – قهوه و غذای چرب به بیمار خودداری کنید.       

بعد از هر بار اجابت مزاج ناحیه تناسلی را از مدفوع پاک کنید و ناحیه تناسلی را با آب و صابون بچه بشویید و خشک نمایید. در صورت ملتهب شدن ناحیه تناسلی با مشورت پزشک می‌توانید از پماد زینک اکساید و پودر بچه استفاده نمایید.

نکته مهم: جهت ایمنی خود حتماً از دستکش یک‌بار مصرف استفاده کنید.

در صورت تکرار اسهال با پزشک و پرستار مشاوره کنید. زیرا در اثر ادامه اسهال بیمار دچار کم آبی می‌شود.

   

6.  اقدامات لازم در هنگام بروز بی اشتهایی چیست؟

افراد بیمار ممکن است به علت مسائل روحی یا جسمی دچار بی اشتهایی شوند. در این افراد سعی کنید غذای بیمار را تزیین کرده و شکل زیبایی به غذا بدهید تا اشتهای بیمار تحریک شود.

دهان‌شویه دادن بیمار می‌تواند اشتهای او را تحریک کند.

این بیماران باید از موادی استفاده کنند که معده سریع خالی شود مانند غذاهایی که شیرین هستند یا انواع ژله، بستنی و ...

مکمل‌های غذایی مانند پروتئین‌ها، ویتامین‌ها و شیر خشک به مواد غذایی بیمار اضافه کنید تا بیمار مقدار انرژی لازم را دریافت کند.

 

خلاصه

 

لوله‌هایی که به طور مستقیم در دیواره معده کار گذاشته می‌شوند، انواع مختلفی دارند. اما روش استفاده و مراقبت از آن‌ها مشابه می باشد از انواع آن می‌توان به گاستروستومی –ژئوژنستومی، ... نام برد. البته در ارتباط با این لوله‌ها می‌بایست مراقبت‌های زیر انجام شود:

1. هر روز اطراف لوله را با آب و صابون بشویید و به آرامی آنرا خشک نمایید. گاز یا دستمال کاغذی را روی پوست بیمار نکشید بلکه آهسته با گذاشتن و برداشتن دستمال پوست اطراف لوله را خشک نمایید.

2. اطراف لوله را از نظر زخم، رنگ، ترشحات و خونریزی بررسی کنید و در صورت مشکل به پزشک مراجعه نمایید.

3. قبل از غذا دادن حتماً مقدار غذای باقی مانده در معده را اندازه گیری کنید.

4. لوله را تا جایی که وارد معده شده است علامت‌گذاری کنید تا در صورت کوتاه یا بلند شدن لوله متوجه شوید و سریعاً به پزشک اطلاع دهید.

5. در صورتی که بیمار دوست داشت می‌تواند غذا را بو کند، بچشد یا بجود و دور بریزد این کار از لحاظ روحی و جسمی به بیمار بسیار کمک می‌کند.

6. مقدار غذایی که در هر وعده به بیمار می‌دهید را به دقت ثبت کنید.


 

 



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شناسه

تهیه کننده: نجمه نادری

متخصص علمی محتوا: دکتر عباس خسروی، دکتر گلنار ثابتیان و دکترشهرام پایدار

Refernces:

1.درسنامه پرستاری داخلی جراحی برونرسودارث، اس‍م‍ت‍ن‍ر (1385)، س‍وزان‌ اوک‍ان‍ل‌

2.      www.mdconsult.com/public/patient/view

3.       www.critcaremd.com

4.       www.myicucare.org/Critical_Care_Team

5.      www.ncbi.nlm.nih.gov/pubmed/11863143

6.      www.tju.edu/jmc 

7.      www.mc.vanderbilt.edu/root/vumc.php?site=neurocritical

8.      www.stonybrooksurgery.org

9.      libraries.umdnj.edu/camlbweb/hrc/critical

10.   www.uhn.ca

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