Tube feeding after stroke. Tube feeding: algorithm

Throughout life, a person may encounter certain diseases and various health problems, some of them so serious that they can disrupt certain functions of the body. One of these problems is a violation of swallowing function, in which a person loses the ability to feed independently in the traditional way.

There is a way out of such situations - the installation of a nasogastric tube, that is, a special device that eliminates the need for chewing and swallowing functions.

This type of nutrition can be used for a long time; it is applicable both in hospital and at home, allowing the patient to be provided with all the necessary nutrients.

Transporting a patient after a stroke

Transporting a patient after a stroke is not an easy task. It is necessary to create comfortable conditions for a person, otherwise his health can be undermined.

There are a large number of companies providing services for moving bedridden patients. If necessary, you can transfer the patient from one city to another.

Relatives of the patient should pay attention to the following things:

• The condition of the vehicle in which the patient is transported.
• Duration of the company's operation.
• Competence of service personnel accompanying the patient.
• The company has the appropriate certificates.

It is recommended to read reviews about the company on the World Wide Web. The cost of a service such as transporting a patient after a stroke directly depends on the factors listed above.

In most cases, the patient is transferred from the bed to the vehicle on a stretcher. It is not recommended to plan to transport a patient if their condition is considered unstable.

The patient's relatives should not treat him like a wax doll. It is important that the patient knows about the upcoming transportation and takes it calmly.

Prohibited Products

All fatty meats (pork, lamb, ducks and geese) should be completely excluded from the diet; any by-products, semi-finished products, industrially produced pates and sauces, smoked and sausage products, ready-made minced meat, lard, and lard are also not recommended. Products from the following list are also prohibited:

• salted, dried or dried, marinated fish, sushi;
• fats from meat, mushrooms and fish;
• full-fat cottage cheese, sour cream and cream, processed or spicy cheese;
• baked goods, cakes and pastries, puff pastry products, sweets, ice cream;
• alcohol, carbonated sweet drinks, coffee, strong tea.

To prevent bloating, you do not need to use fresh bread, milk, cabbage, especially raw cabbage, radishes, grapes, peas, and beans in the early post-stroke period.

Tube feeding

Many patients have impaired swallowing. In addition, serious brain damage can lead to severe mental disorders. The patient loses interest in life and refuses food offered. In both the first and second cases, the patient is fed through a tube after a stroke. It must take place in a medical facility, under the supervision of medical personnel.

If the patient has mental disorders, feeding is carried out forcibly, so in this case the consent of the relatives is necessary.

The necessary medications are also given by probe. After the patient's condition improves, he is allowed to be spoon-fed.

How should a patient eat after a stroke?

The patient's diet should be balanced. His diet must include fruits, vegetables and meat dishes. These products are enriched with useful substances that are necessary to restore damaged brain structure. It is recommended to steam the dishes. The consistency of the food should be liquid. Spices are not allowed when preparing dishes.

People caring for the patient need to be caring. If necessary, you need to support the cutlery, because the patient’s weak hands do not obey it well.

The table below shows the benefits of individual foods for stroke.

The right diet for patients

After the first month of illness, new products and dishes are gradually introduced into the menu. In this case, the basis of nutrition is vegetables, cereals, fish, less often meat, and dairy products. If there are no problems with intestinal function, then add cabbage and legumes.

Cooking methods may also be closer to normal, but fried and spicy foods will need to be avoided for a period of at least a year. This also applies to animal fats, confectionery products, alcoholic beverages, as well as any food with preservatives and flavorings.

The most beneficial foods for stroke patients include:

• fish of moderate fat content (pollock, cod, pike perch, catfish, salmon), seafood, seaweed;
• rabbit, chicken and turkey meat;
• vegetables - everything except radish, radish, daikon;
• fresh fruits and berries and juices from them;
• cereals – buckwheat, oatmeal, pearl barley, brown, red or black rice, quinoa, bulgur;
• legumes - beans, chickpeas, mung beans, lentils, green peas and green beans;
• raw nuts and seeds (if chewing is difficult, grind them and add to porridge or sauce);
• fermented milk drinks and cottage cheese of low or medium fat content (not higher than 9%), sour cream and cream can be added to first courses or sauce, no more than 15 g per day;
• vegetable oils - olive, walnut, sesame, virgin sunflower;
• parsley, dill, cilantro, basil;
• lemon juice to add taste;
• drinks - juices and fruit drinks, compotes, rosehip decoction, herbal or weak green tea;
• bread is best dark and with bran;
• for desserts you can use mousses made from berries, dried fruits, fruit jelly; marshmallows, honey, marshmallows, meringues, chocolate (20 g) are acceptable in small quantities; you can only use whole grain flour or add bran to baked goods.

Watch the video about nutrition recommendations after a stroke:

Prevention of infectious diseases

A patient who has suffered a stroke is especially susceptible to various infectious diseases. After all, he is constantly in a lying position. As a result, stagnation of blood in the body may occur; this circumstance can lead to the appearance of various bronchopulmonary diseases. In order to prevent the development of an infectious disease, you need to:

• Perform chest drainage massage daily. It is a combination of pushing and tapping movements. The massage is done from top to bottom.
• Be careful when ventilating the patient's room: avoid hypothermia or drafts.

If the patient's risk of infection is quite high, the doctor may prescribe antibiotics. Such patients are recommended to be vaccinated during an epidemic of acute respiratory diseases. They are at increased risk.

How to reduce the likelihood of bedsores?

In bedridden patients, bedsores often form. They usually appear on the lower back, in the buttocks area, under the shoulder blades. The inflammatory process begins in the skin area, then it reaches the bone tissue. If there are third and fourth degree bedsores, a person will need surgical intervention, during which the doctor removes dead tissue.

To prevent a person from developing bedsores, which often occur after a stroke, the following rules must be followed:

• It is necessary to wipe the patient's body several times a day.
• Under areas of the body that experience strong pressure, you need to place cushions made of soft materials. They help relieve tension and eliminate the possibility of tissue compression.

It is recommended that the patient purchase a specialized functional bed. Such products are manufactured specifically for bedridden patients.

How to choose a walker?

The main task of the products is to provide the patient with reliable support when moving. Certain types of walkers are presented in the table.

The cost of goods varies from 2 to 8 thousand rubles. But it is not at all necessary to buy expensive walkers after a stroke. Even from the simplest products you can make an effective trainer for performing various exercises.

Recipes for tasty and healthy dishes for sick people

Dietary food must be appetizing; this can be achieved using high-quality products and simple recipes.

Zucchini soup with grain flakes

For 1 serving you will need a young zucchini or zucchini, a small carrot, 2 tablespoons of cereal flakes, a sprig of parsley, dill and celery.

Vegetables are peeled and cut as desired, pour in water so that it covers by 2 cm, cook over low heat for 10 minutes, then add flakes. Once fully prepared, pass through a blender.

Serve with finely chopped herbs and a teaspoon of sour cream. If swallowing is difficult, then the greens are sprinkled with flakes, and then the soup is rubbed through a sieve.

Steamed cod meatballs

Rinse a tablespoon of rice and cook until half cooked. Grind 200 g through a meat grinder, add rice, egg, 2 g salt. With wet hands, form small meatballs and place them on a wire rack over simmering water. Cook for 15 minutes. To serve, prepare a sauce from a quarter glass of milk (boiled and cooled), a teaspoon of flour dried in a dry frying pan and ground dry basil (2g). Boil the sauce until thick, then add 5 g of butter.

Pumpkin dessert

You need to choose a pumpkin from the sweet varieties; in this case, sugar is not required. For dessert you will need 250 g of diced vegetables, peeled and chopped apple, 5 dried apricots. First, the dried apricots are boiled until soft in a small amount of water, then pumpkin, apple and cinnamon are added on the tip of a knife. After complete readiness, pass through a blender or knead to a puree.

The diet in the post-stroke period should cover the need for essential nutrients for faster recovery of patients, as well as prevent the progression of atherosclerosis and hypertension. Impaired swallowing and limited mobility of patients require the preparation of pureed food, which simultaneously activates the intestines.

To properly prepare a diet, you need to know the permitted and prohibited foods, as well as use the recommended cooking methods.

The importance of specific exercises

It is necessary to ensure that the patient regularly does exercises designed to restore impaired motor functions. They are selected by a specialist individually.

The closest attention should be paid to the following exercises:

• Movements that help improve fine motor skills (folding a puzzle, sorting out cereals).
• Patients with damage to the lower extremities are recommended to perform an exercise such as “bicycle”.

After the patient's condition improves, he is recommended to exercise in the pool. The effectiveness of such training is extremely high.

Features of nutrition through a gastrostomy tube

What is a gastrostomy?

Percutaneous gastrostomy is a special system for feeding through the anterior abdominal wall and an artificial entrance to the stomach cavity.

How is percutaneous endoscopic gastrostomy performed?

1. The entire procedure is performed under anesthesia. At the first stage, esophagogastroduodenoscopy is performed to exclude pathologies of the upper gastrointestinal tract that prevent the installation of a gastrostomy tube.
2. An endoscopist performing an examination of the stomach determines the most convenient place for installing a gastrostomy (the anterior wall of the lower third of the body of the stomach) and uses the endoscope to “illuminate” the place where the gastrostomy is installed on the skin.
3. The assistant doctor, guided by endoscopic “illumination,” makes a small (about 7-9 mm) incision at the site of the planned installation of the gastrostomy tube and inserts a thin plastic pointed rod into the stomach.
4. The rod inside has a channel through which a conductor is inserted into the lumen of the stomach. The endoscopist grabs the guidewire with forceps and, removing the endoscope, removes the thread from the stomach and esophagus into the patient’s oral cavity. The other end of the thread is held by a medical assistant.
5. A gastrostomy tube is attached to the withdrawn part of the guidewire. The assistant doctor, by pulling the thread from the opposite end, ensures the movement of the gastrostomy tube through the esophagus into the stomach. In this case, the gastrostomy tube is brought to the surface of the skin and fixed to it with a plate, and the flat rubber part (cannula of the gastrostomy tube) is pressed tightly against the wall of the stomach from the inside. Thus, the anterior wall of the stomach is connected to the skin of the anterior abdominal wall, and water and nutritional mixtures can be injected directly into the lumen of the stomach through a plastic tube.
6. This minimally invasive procedure lasts about one hour and is performed under constant endoscopic control in order to avoid complications.
7. During the first 24 hours after the gastrostomy tube is installed, you should not administer nutritional mixtures or any other liquids through it.

How will you feel?

Minor pain is possible, which can be easily relieved with painkillers prescribed by your doctor.

Important: feeding through a gastrostomy tube can only be started after the permission of the attending physician. The amount of food and frequency of administration in the first days are discussed additionally!

How to care for a gastrostomy tube?

• Regularly change the sterile dressing placed around the incision site between the skin and the restraint. During the first week, dressings are performed daily, and then every other day. The area of ​​skin around the stoma and the fixation device should be well dried. Every day, rotate the plastic probe 180 degrees around its axis and move it up and down 1.0-1.5 cm so that it does not stick to the walls of the stoma.
• Make sure that the external fixation disc is at least 5 mm from the surface of the skin. If you have gained or lost weight, it becomes necessary to loosen or tighten the fixation device.
• After each meal, rinse the gastrostomy tube with 20-40 ml of water. The tube must be washed every 8 hours, even if you did not administer nutritional formula through it. Clean with a damp cloth and then dry the skin around the stoma and the retainer to avoid infection. Ask your healthcare provider which skin disinfectant you should use.
• If your gastrostomy tube falls out, contact your doctor immediately.

What food can you eat?

Food can only be taken in liquid form (the consistency of cream) and without lumps, so that the tube does not become clogged. Remember that food should contain a sufficient amount of quality protein and healthy fats (butter and vegetable oil). Daily calorie content should be approximately 2000 kcal. The daily volume is divided into equal portions of 150-200-300 ml, administered every 2-3-4 hours and is approximately 2000 ml. The temperature of the food introduced should be approximately 40-45 degrees (with the exception of specialized mixtures that are consumed at room temperature).

Main courses: blended (carefully chopped) low-fat boiled vegetables, diluted with broth, meat, poultry; liquid mashed porridge with added butter.

You can use baby meat, vegetable and fruit food, diluting them to the appropriate consistency with cream or broth. Also use milk, fermented milk products, sour cream. Boiled eggs can also be crushed and added to food. You can use compotes, fruit drinks, and juices as drinks.

In our medical institution, a probe table will be prepared for you in the kitchen. If necessary, the attending physician will prescribe nutritional support in the form of ready-made specialized mixtures, and part of the daily diet can be replaced with them. You can also use your own blender and prepare the necessary mixtures yourself from the dishes offered for the common table. When taking diluted food, you do not need additional fluid intake if you are not thirsty, especially since after each meal you need to rinse the tube with 50-60 ml of warm water.

If you have a favorite food or drink (tea, coffee), then do not deny yourself the pleasure and add it to your diet.

What to eat?

You will be given two Janet syringes (150 ml), and now they will serve as utensils.

What do you need to prepare for meals?

You will need:

• the finished mixture, its temperature should be approximately 40 degrees;
• drinking water at room temperature or slightly warmer;
• 2 syringes Janet;
• 2 containers with a volume of 200 and 500 ml (glass, mug, glass);
• spoon;
• napkin;
• blender (optional, for advanced users).