春暉居家護理所

如何使管灌病人維持良好的營養狀態

How to make tube feeding to maintain a good nutritional status of patients?

為何需要鼻胃管灌食?

Why nasogastric tube feeding?

1. 吞嚥障礙

Dysphagia

1. 由口進食不足以供應日常營養需求.

Insufficient supply of food from the mouth of the daily nutritional requirements.

1. 意識不清病人.

Unconscious patients.

二.  鼻胃管留置的護理

Nasogastric tube nursing retention

1. 每日至少做一次口腔及鼻腔清潔.

At least once a day oral and nasal cavity clean.

1. 每日更換膠帶時,需將皮膚擦乾淨再黏貼新膠布,並需更換黏貼部位.

The daily replacement of tape, the need to clean the skin and then a new adhesive tape and adhesive parts to be replaced.

1. 更換膠帶時,需將鼻胃管旋轉1/4圈.

Replace tape when the nasogastric tube to be rotated 1 / 4 turn.

1. 每日注意鼻胃管刻度,脫出超過10公分,要通知護理人員處理.

Nasogastric tube daily attention to scale, prolapse of more than 10 cm, to inform the nursing staff processing.

1. 意識不清病人,必要時做適當的約束.

For the unonscious patient, if necessary, make the appropriate constraints.

三.  何謂『低血鈉症』?

What is “hyponatremia?”

四.  甚麼是『鈉離子』?它是人體必需的’礦物質之一,存在於人體細胞.胃黏膜.膽汁.胰液.骨骼中,主要由小腸吸收,並由腎臟排泄.

What is “sodium?” It is an essential 'one of the minerals present in human cells. Mucosa. Bile. Juice. Bones, mainly by intestinal absorption, excretion by the kidneys.

『鈉離子的功能』:可幫助調節細胞內的滲透壓,協助神經傳導及維持骨骼肌與心肌的功能..

“Function of sodium ion:” to help regulate the intracellular osmotic pressure, to help maintain muscle and nerve conduction and cardiac function.

正常值:135~145meq/L                                       P.1

Normal: 135 ~ 145meq / L

『低血鈉症』:抽血血清濃度低於135 meq/L稱之,常見於攝取水份過多.流失增加或管灌食物內食鹽攝取過少.

Hyponatremia: blood serum concentrations of less than 135 meq / L commonly known, is common in water intake too much. Loss or tube feeding to increase intake of too little salt in food.

   會導致:嘔吐.呼吸困難.嗜睡.厭食等.

Causing: vomiting. Breathing. Sleepiness. Anorexia and so on.

『高鈉血症』?抽血血清濃度高於145meq/L稱之.會導致心輸出量降低呼吸喘.不安.昏迷等.

“Hypernatremia?” Blood serum concentrations higher than 145meq / L call it. It will lead to reduction in cardiac output short of breath, disturbing, coma and so on.

一.  管灌飲食的一般原則(一)

The general principles of tube feeding (a)

1.依病患的營養狀態.疾病.消化吸收能力來決定灌食方法及食物內容.

.配方濃度以1大卡/1cc為宜,但若營養不良或需限水病人最高可至2大卡/1cc.

According to nutritional status of patients. Disease. Digestion and absorption capacity to determine the feeding methods and food content.
Formulation concentration of 1 kcal / 1cc is appropriate, if patients are malnourished or need to limit the maximum water to 2 kcal / 1cc.

3.一日以1200-2000大卡為宜,分5-6次灌食.

1200-2000 kcal per day is appropriate, dividing 5-6 times for a feeding.

4.每次灌食量以350cc以下為宜.

Every time feeding capacity to 350cc or less.

5.灌食前應洗手.

Wash your hands before feeding.

二.  管灌飲食的一般原則(二)

The general principles of tube feeding (b)

1. 灌食前應將病患頭部抬高45~60度,灌食後1小時才能平躺,以免造成吸入性肺炎.

Feeding the former patients should be 45 to 60 degrees head elevation. 1 hour after feeding is the time for lying in order to avoid aspiration pneumonia.

2. 灌食速度要平均,不宜過快,避免嘔吐.

Feeding speed of the average, not too fast, to avoid vomiting

1. 每次灌食前要回抽以評估消化情形,會抽量大於50-100CC應延後灌食(30分鐘後再評估).

Withdrawing before each feeding to assess the digest, it might be drawn should be greater than 50-100CC delayed feeding (30 minutes after the assessment).

2. 灌食後以溫開水30-50CC沖淨,並揉捏胃管管壁.

After feeding 30-50CC warm water rinse, and kneading the tube wall.

一.  管灌飲食要加鹽巴嗎?

Add tube feeding salt?

食鹽的化學成份為『NaCl』,健康成年人一日食鹽攝取量為8~10公克,內含的鈉為3200~4000毫克(Mg),慢性病患者建議在5~6公克的鹽(日),內含鈉:2000~2400毫克.

Chemical composition of salt is “NaCl.” Salt intake in healthy adults day 8 to 10 grams, containing the 3200 to 4000 mg of sodium (Mg), chronic diseases suggested that 5 to 6 grams of salt (per day), the sodium: 2000 ~ 2400 mg.

   一般商業配方牛奶:每250CC泡好的牛奶含鈉:190~215mg(舒體康:214.5mg)

General commercial formula milk: milk soaked sodium per 250CC: 190 ~ 215mg (Shutikang: 214.5mg)

   一日1500CC管灌牛奶可攝取1287 毫克.

Daily 1500CC tube feeding milk can result in the intake of 1287 mg.

二.  鹽巴怎麼加?

How to increase salt?

1. 至少於管灌牛奶內再加3-5公克的鹽巴.

At least within the tube feeding of milk plus 3-5 grams of salt.

1. 怎麼加:單獨添加於每位管灌病人每次的管灌量內,可於最後一管牛奶內倒入鹽巴,再倒水沖淨管壁.

How to increase: a single added to each tube feeding tube feeding patients the amounts of each can of milk in the last one into the salt, rinse and then pour the wall.

三.  管灌配方乃沖泡方法:

Tube feeding formula method:

1. 以適量溫水,加入廠商建議之每次沖泡量調勻(以舒體康為例:為55公克).

The amount of warm water, add the manufacturer's suggested

amount of each brew and mix thoroughly (Take Shutikang as an example: 55 grams.)

1. 加入溫水至250CC即可提供250大卡的熱量.

You can add warm water to the 250CC that offers 250 calories.

1. 盡快管灌完畢.
2. Complete as soon as possible the tube feeding.
3. 不要將所有病人之鹽巴加在一起調,建議單獨給予.
4. Do not all patients with the transfer of salt. It is recommended given alone.
   
   

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