Nutrition of patients in the surgical department. Nutrition in surgery. Nutrition before surgery

Nutrition of surgical patients

Satisfaction of the energy and plastic needs of the body of a surgical patient is provided by a balanced diet. This is understood as the intake of a sufficient amount of nutrients in accordance with energy costs, which increase in a pathological condition due to an increase in basal metabolism. The optimal ratio of these substances is the daily intake of proteins - 13-17%, fats - 30-35%, carbohydrates - 50-55%. In a surgical patient, protein serves as the most important plastic material in wound regeneration, enzymes and other biologically active substances are formed from protein structures, proteins form the basis of immune complexes that are vital for fighting infection. During illness, catabolism processes predominate in the body, the greatest expression of which is manifested in the loss, first of all, of proteins with a short half-life (liver proteins and enzymes of the gastrointestinal tract). The resulting amino acid imbalance often leads to toxic manifestations. Lipids have a high energy value. They can be replaced in terms of calories with other nutrients, such as carbohydrates. However, some fatty acids are essential. They are involved in the formation of phospholipids - the most important component of all cellular structures. Therefore, the inclusion of fats in the diet also becomes life-defining. Carbohydrates serve as one of the main sources of energy. The lack of these nutrients leads to the rapid utilization of fats and proteins to obtain the necessary energy material. This situation is fraught with irreversible changes in the metabolism in the body, which can lead to the death of the patient. In addition to proteins, fats and carbohydrates, vitamins, trace elements and water must be included in the diet. Their number is taken into account when drawing up the appropriate diets. Depending on the disease, the necessary diet and the route of intake of nutrients into the body are chosen. There are two methods of food delivery - natural and artificial. With natural nutrition, the attending physician prescribes an appropriate diet or table. In our country, there is a single numbered system of dietary nutrition according to N.I. Pevzner, which includes 15 basic diets. Each of them contains indications for use, the purpose of the appointment, a general description of the main features of the chemical composition, a set of products and their culinary processing, the chemical composition and energy value, diet, a list of acceptable and contraindicated dishes and products, as well as some ways of preparing them. The number of diets that are used in a health care facility depends on local conditions and mainly on the profile of the population served. In the general surgical department, the most commonly used diets are N0-a, N0-b, N0-c, N1-a, N1, N5-a, N9, N11, N13, N15, tubular table and parenteral nutrition. A zero diet is indicated after operations on the organs of the gastrointestinal tract, with a semi-conscious state (traumatic brain injury). This diet provides maximum sparing of the digestive organs, prevents flatulence and provides nutrition when it is difficult or impossible to take ordinary food. Sometimes diets N0-b and N0-c are called N1-a and N1-b - surgical. The N0-a diet is prescribed for 2-3 days. It includes jelly-like and liquid dishes, free liquid 1.8-2.2 liters with food temperature not higher than 45°C. Food is consumed 7-8 times a day with a volume of not more than 200-300 g at a time. Fat-free meat broth, rice broth with butter, berry jelly, strained compote, rosehip infusion with sugar, freshly prepared fruit and berry juices, tea with lemon are allowed. After 2-3 days, when the condition improves, add a soft-boiled egg, 50 ml of cream. Prohibit dense and mashed dishes, carbonated drinks, whole milk. Diet N0-b is prescribed for 2-4 days after N0-a. It additionally includes liquid pureed cereals from oatmeal, buckwheat and rice, boiled in meat broth or water, slimy cereal soups on vegetable broth, steam protein omelet, steam soufflé or mashed potatoes from low-fat fish or meat. Food is given no more than 350-400 g per reception 6 times a day. The N0-B diet is a continuation of the previous diet and serves to smoothly transition to a physiologically complete food intake. This diet includes cream soups and puree soups, steamed dishes from mashed boiled meat, chicken or fish, fresh cottage cheese, sour milk drinks, mashed vegetable and fruit purees, 50-75 g of white crackers. Milk can be added to porridge. Food is given 6 times a day. N1-a diet is prescribed 6-7 days after stomach surgery. It is designed for maximum mechanical, chemical and thermal sparing of the gastrointestinal tract in conditions of bed rest. According to this diet, food is prepared in liquid and semi-liquid form and taken in uniform portions every 2-3 hours. For cooking dishes (steam soufflé or mashed potatoes) of low-fat types of fish or meats of medium fatness. Soufflé made from freshly prepared cottage cheese is limited. They use whole milk, cream, unsalted butter, liquid milk porridges from pureed cereals or baby food, homogenized vegetables, milk soup, mucous decoctions in milk, jelly, jelly from non-acidic berries, weak tea, rosehip broth. Exclude substances that stimulate gastric secretion, hot and cold dishes, including cheese, sour cream, ordinary cottage cheese, bread, flour and confectionery, raw fruits and berries, sauces, spices, coffee, cocoa, carbonated drinks. The N1 diet is indicated after gastric surgery as a transitional diet from the N1-a diet to physiologically complete food. It is designed to reduce the inflammatory response and heal the mucosa by limiting thermal, chemical and mechanical stimuli. According to the chemical composition and energy value, this diet is physiological. Dishes are prepared mainly in pure form, boiled in water or steamed. For cooking use low-fat meats and types of fish. It is allowed to use steam cutlets, meatballs, soufflé, mashed potatoes, zrazy, beef stroganoff, aspic on vegetable broth. From dairy products, non-acid mashed cottage cheese, sour cream, mild cheese, dumplings, cheesecakes, semi-viscous porridge with milk, pudding, steamed scrambled eggs or scrambled eggs are recommended. Allowed dried wheat bread or yesterday's baking, boiled potatoes, carrots, beets, pureed vegetable soups, sugar, honey, fresh ripe berries and fruits, weak cocoa, coffee with milk, juices from fruits and berries. You can not use hot and cold dishes, almost all sausages, spicy and salty foods, strong broths, smoked meats, sour and unripe berries and fruits, chocolate, ice cream, kvass, black coffee. The N5-a diet is used in acute cholecystitis 3-7 days after the onset of the disease, 5-6 days after operations on the biliary tract and in acute pancreatitis. Mechanically and chemically sparing food used maintains the functional rest of all digestive organs. Dishes are cooked boiled or pureed, served warm. Food is taken 5-6 times a day. For cooking, lean meat and fish are used in the form of cutlet mass products, low-fat cottage cheese, non-acidic sour cream and cheese. It is permissible to use a steam omelette, porridge with milk in half with water, boiled vermicelli, wheat bread, unbread cookies, mashed potatoes, milk jelly, mashed dried fruits, honey, sugar, tea with milk, lemon, sweet fruit and berry juices, tomato juice, broth wild rose. Foods rich in extractives, coarse fiber, fatty and fried foods, smoked meats, fresh and rye bread, rich and puff pastry, mushrooms, cold snacks, chocolate, ice cream, spices, cocoa, black coffee, carbonated and cold drinks are excluded from food. The N9 diet is indicated for diabetes mellitus. It contributes to the normalization of carbohydrate metabolism.

With this diet, the energy value is moderately reduced due to the reduced content of carbohydrates and fats in food. Sugar and sweets are excluded from the diet, substitutes are used instead, table salt is moderately limited. Among the excluded foods are fatty meats and fish, salted cheeses, rice, semolina and pasta, pastry and puff pastry, salted and pickled vegetables, grapes, raisins, bananas, sugar, honey, jam, sweets, ice cream, sweet juices. The N11 diet is prescribed when the body is depleted after surgery or injury in the absence of diseases of the digestive system.

It aims to increase the body's defenses and improve nutritional status. The products used in this case contain an increased amount of proteins, vitamins, and minerals. Cooking and food temperature is normal. Meals are carried out 5 times a day with the use of free liquid up to 1.5 liters. The recommended list of products is very diverse, ranging from meat and fish dishes to various flour products. The exception is very fatty meat and poultry, lamb, beef and cooking fats, spicy and fatty sauces, cakes and pastries with a lot of cream. The N15 diet is used for various diseases that do not require a special therapeutic diet, and also as a transition to normal nutrition after using other diets. Its goal is to provide physiologically complete nutrition. Proteins, fats and carbohydrates are contained in the amount necessary for a healthy person who is not engaged in physical labor, and vitamins are in an increased amount. Food temperature and cooking are normal.

Free liquid is not limited. Food is consumed 4-5 times a day. Recommended daily use of fermented milk products, fresh vegetables and fruits, juices, rosehip broth. Limit spices, and exclude fatty meats, beef, lamb, pork and cooking fats. After some surgical interventions and in many diseases, natural eating is not possible. In these cases, artificial nutrition is used: enteral (through a tube or stoma), parenteral and combined. Enteral (tube) nutrition is carried out through a tube inserted into the stomach or small intestine.

In surgical patients, it is indicated for:

* impaired consciousness due to traumatic brain injury or severe intoxication;

* the presence of mechanical obstacles in the oral cavity, pharynx and esophagus (tumors and strictures);

* a condition accompanied by increased catabolism (sepsis, burn disease, polytrauma);

* anorexia of any origin. Tube feeding is contraindicated in:

* disorders of digestion and absorption of the small intestine;

* acute bleeding from the upper gastrointestinal tract;

* intractable vomiting and diarrhea;

* dynamic intestinal obstruction;

* intestinal paresis after surgical interventions; * Anomalies in the development of the gastrointestinal tract. For probe nutrition, mixtures prepared just from liquid products (cream, milk, broths, eggs, juices) in combination with easily soluble (milk powder, sugar, starch) or crushed (meat, fish, cottage cheese) components are used. High-calorie and convenient mixtures from baby food, ENPIT (protein, fat-free), homogenized canned mixtures from natural products, as well as industrially prepared instant mixtures from proteins, fats and carbohydrates of vegetable origin. With tube feeding, to get used to the new conditions of food intake, 50% of the daily calorie intake is introduced on the first day. Further, the dose is increased, and from the fourth day they give the entire estimated volume.

Uniform intake of food during the day is achieved with the help of special pumps, thereby preventing nausea, vomiting, dumping syndrome and diarrhea. In cases where it is impossible to pass the probe into the stomach, for example, with a tumor of the esophagus, a gastrostomy operation is performed. A tube is inserted into the artificially created fistulous passage through which the patient is fed.

To do this, use a liquid nutrient mixture (tubular table). Nutrition through the gastrostomy is started on the second day after the operation. 100-150 ml of the mixture is injected into the stomach at the same time using a Janet syringe or by gravity through a funnel connected to a tube, every 2-3 hours. After each feeding, the tube is washed with water and a clamp is placed on it. After 5-7 days, it is allowed to use mushy food 400-500 ml 4-5 times a day.

For the preparation of the mixture, the same food substrates are recommended that are used for feeding through a tube. Due to the fact that there is a gap between the tube and the wall of the fistula, which is almost impossible to completely seal, leakage of gastric contents along the tube is observed, and the skin around the gastrostomy is subjected to maceration. Accession of an infection is fraught with development in this place of a purulent inflammation. For its prevention, careful care of the gastrostomy is necessary. After each feeding in the stoma area, the skin toilet is performed, wiping it with a cotton or gauze swab moistened with 0.1-0.5% potassium permanganate solution. After thoroughly drying the skin, a layer of Lassar paste is applied to its surface and an aseptic dressing is applied. In some diseases of the stomach (total tumor damage, chemical burns), for the purpose of feeding, a jejunostomy is imposed - a small intestinal fistula.

Nutrient mixtures are introduced into the intestine through a tube, the chemical composition of which approaches the chyme of a healthy person. Initially, a saline solution is used with the addition of glucose, which stimulates the absorption of these substances. After 3-4 days, protein solutions (hydrolysin, aminopeptide) are added to enteral nutrition. And, finally, the last stage of the adaptive nutrition program is the addition of fat emulsions (lipozin). Enterostomy care is carried out in the same way as with a gastrostomy. The greatest danger is the failure of the sutures that fix the wall of the stomach or intestines to the parietal peritoneum.

In this case, they move away from the anterior abdominal wall and the gastric or intestinal contents flow into the abdominal cavity with the development of peritonitis. Such a complication is treated only surgically. In cases where it is not possible to feed naturally or through a tube, parenteral nutrition is used as the most simplified way to supply the body with nutrients. For this, well-tolerated solutions are made up of individual nutrients. They include proteins, fats, carbohydrates, water and electrolytes, providing full satisfaction of the energy and plastic needs of the body. Such a complete high-calorie diet (up to 3000 kcal per day) can be used if necessary for a long (years) time. For the introduction of nutrients by the parenteral route, the main (jugular, subclavian) vein is catheterized. The duration of operation of the catheter depends on the quality of its care.

Types of surgical operations

In accordance with the classification according to the urgency of execution, emergency, planned and urgent operations are distinguished. Emergency operations Emergency operations are called operations that are performed almost immediately after the diagnosis is made.

Types of surgical operations

Hernias and herniotomy with intravaginal hernias

Sterilization of surgical instruments. There are many ways to sterilize, but one of the most common and effective is boiling. Pour tap water into the sterilizer and add sodium hydroxide (2.5 g per 1000 ml) ...

Kinesiotherapy in surgical intervention for congenital heart defects

Preoperative period. Tasks of exercise therapy: moderate mobilization of the reserves of the cardiorespiratory system; facilitating the work of the heart by mobilizing extracardiac circulatory factors; struggle with the manifestation of neurosis, anxiety ...

Features of the recovery process in the postoperative period in patients with different types of perception of their illness

A disease is a process that occurs as a result of exposure to an organism of a harmful (extraordinary) irritant of the external or internal environment ...

Features of infusion therapy in the clinic in cardiovascular surgery

In the sense of the cause of embolism, it is necessary to keep in mind mainly fresh endocarditis or acquired heart defects. After anti-shock therapy and surgical intervention on the vessels, the doctor must again deal with the underlying disease ...

Spatial limitations of the cranial cavity The volume of the cranial cavity, surrounded by bones, is approximately constant ...

Features of infusion therapy in neurosurgical practice in traumatic brain injury

Loss of consciousness, danger of aspiration, high energy and nutrient intake in severe traumatic brain injury are often indications for artificial nutrition (parenteral, tube feeding)...

Features of medical deontology

Surgery belongs to the field of medicine where the importance of the practical skills of medical personnel is extremely high. All thoughts and attention of surgeons, operating rooms and ward nurses are concentrated on the operating room...

The role of a nurse in the organization of nutrition for children in health facilities

For children older than 1 year, as a rule, a group nutrition system is used, in which the child, depending on the pathology, is assigned one or another type of nutrition. Each type of medical nutrition is indicated by a special diet number ...

Vascular surgery at the present stage

With operational access to the vessels, they are guided by the corresponding projection lines. When opening the vagina of the vessel, the artery is isolated from the accompanying veins ...

Physical rehabilitation of women of working age with rheumatoid arthritis

One of the important components of successful rehabilitation of patients with RA is an adequate nutritional structure, which makes it possible to increase the effectiveness of complex therapy. The nature of nutrition affects the immune system ...

Surgical instruments

All surgical instruments can be assembled into kits that allow you to perform typical surgical operations. On the instrumental table of the operating sister there should be “connecting instruments” - i.e. those...

Surgical instruments

Endoscopy is a method of diagnosing and treating human diseases, performed through natural physiological openings or pinpoint punctures of the integument using optical instruments. A distinction is made between diagnostic and therapeutic endoscopy.

Ethics of behavior of medical workers

Surgery refers to the area of ​​medicine where the practical skills of a nurse are extremely important. All thoughts and attention of surgeons, operating rooms and ward nurses are concentrated on the operating room...

1. The amount of water in the body is normal in relation to body weight up to ...

more than 70%

2. A threat to human life is the loss of water by the body in an amount up to ...

over 25%

3. The average daily human need for water is ...

1.5–2 liters

ü 2.5 liters

3-4 liters

4 - 5 liters

4. Pronounced clinical manifestations are accompanied by the loss of water in the body in the amount ...

ü 10% or more

5. With an increase in body temperature by one degree C, the loss of water by the body per day increases by ...

6. The main energy source for the human body are ...

ü carbohydrates

vitamins

· minerals

7. The daily requirement for carbohydrates is ...

8. The motor function of the intestines is mainly supported by ...

Dietary carbohydrates

ü non-edible carbohydrates

vitamins

9. The main source of reparative processes...

· carbohydrates

vitamins

mineral salts

10. A person's daily protein requirement is (in grams) ...

11. Essential amino acids are found in proteins ...

ü animal origin

vegetable origin

12. Source of proteins for the body...

the proteins of food

· carbohydrates

vitamins

microelements

13. The daily requirement for fats is ...

14. The main source of energy during prolonged fasting ...

ü stored fats

tissue proteins

storage of glycogen in the liver

15. The optimal ratio of proteins, fats and carbohydrates in food for a person should be ...

16. For edema and inflammation, rich food is prescribed ...

sodium

Phosphorus

ü calcium

iron

17. Calcium salts provide...

the normal condition of the bones

o blood clotting

vasodilating effect

ü anti-inflammatory action

oncotic pressure in blood vessels

18. Trace element involved in the formation of hemoglobin ...

19. Trace element that maintains osmotic pressure in the blood...

20. Trace element actively involved in the work of the thyroid gland ...

21. Malnutrition in surgical patients occurs in diseases leading to ...

ü increased protein breakdown, exceeding their intake

ü insufficient intake of nutrients

increased loss of nutrients

ü Decreased absorption of nutrients

a combination of several of the above reasons

22. Ways of feeding surgical patients ...

ü through the mouth

ü enterally

ü parenterally

intraosseous

23. Artificial nutrition of the patient with the introduction of food directly into the gastrointestinal tract is called ...

parenteral

ü enteral

mixed

24. During the examination period, in the absence of diseases of the digestive system, the patient is prescribed a table ...

ü No. 15 /general/

25. During the examination period, patients with liver and gallbladder disease are prescribed a table ...

26. Patients with diabetes during the examination period receive a table ...

27. Patients with cardiovascular diseases during the examination period receive a table ...

28. In case of kidney stone disease, a table is prescribed during the examination ...

29. Methods of administering nutrients in enteral nutrition ...

through a probe

through a gastrostomy

through jejunostomy

intravenously

through the mouth

30. Indications for tube feeding...

ü lack of appetite /anorexia/ with burn disease or an extensive purulent-inflammatory process

obstruction of the esophagus

Decompensated stenosis of the outlet of the stomach

a prolonged state of unconsciousness

ü violation of the act of swallowing in traumatic brain injury

31. The probe made of ...

red rubber

ü silicone

PVC

fluoroplast

32. Probes made of ...

red rubber

ü silicone

fluoroplast

PVC

33. Ways of introducing a probe into the stomach for enteral nutrition ...

ü swallowing

ü with mandrin "blindly"

ü endoscopically

under x-ray control

ü intraoperatively

34. Endoscopic methods of inserting a probe into the stomach for enteral nutrition...

ü according to the guide previously passed through the biopsy channel of the endoscope

with mandrin

parallel to the endoscope

through the biopsy channel of the endoscope

35. With the fractional method, nutritional cocktails are administered through a tube ...

continuously for 12 hours

continuous for 24 hours

ü with an interval of 2-3 hours

36. Fractionally, nutrients can be introduced into the gastrointestinal tract through a probe ...

ü Syringe Janet

Syringe for injection

ü roller pump

37. Continuous introduction of nutrients into the gastrointestinal tract through a probe is carried out ...

ü roller pump

ü using systems for transfusion

Janet's syringe

cooking syringe

Syringe for injection

38. With fractional tube feeding, a nutrient cocktail can be injected into the lumen of the jejunum once...

up to 500 ml

39. In the lumen of the stomach with fractional tube feeding, a nutritious cocktail can be injected once...

40. Nutrients that can be used to make tube feeding cocktails...

ü broths

o Butter

ü infant formula

ü sour cream

41. A tube inserted for feeding through the mouth into the stomach is called ...

ü orogastric

nasogastric

gastrostomy

jejunostomy

nasojejunal

42. Regurgitation most often occurs when feeding through ...

ü orogastric tube

a nasogastric tube

gastrostomy

jejunostomy

43. Complications with prolonged feeding through a nasogastric tube...

ü pharyngitis

ü laryngitis

ü esophagitis

insufficiency of the closing function of the cardia

stomatitis

44. When feeding through a jejunostomy, for better assimilation of the nutrient mixture, it is advisable to add ...

antibiotics

hormones

ü enzymes

Enzyme inhibitors

45. Introduced food is not processed by bile and pancreatic secretions during feeding ...

probe

through a gastrostomy

through jejunostomy

46. ​​Basic requirements for nutrients for enteral administration ...

ü high biological value

ü good digestibility

Ease of preparation and dosage

Balance of essential and non-essential nutritional factors

solubility in water

47. A probe passed into the stomach through the nose is called ...

nasoduodenal

ü nasogastric

orogastric

· oroduodenal

48. Indications for prescribing nutritional enemas...

ü dehydration

- stimulation of diuresis

hypoproteinemia

replenishment of energy costs

replenishment of NaCl deficiency

49. In the lower segment of the large intestine,...

amino acids

50. For rectal administration, mainly ...

ü 5% glucose solution

ü 0.9% saline solution

protein hydrolysates

mixtures of amino acids

fat emulsions

51. Liquids can be administered rectally as a single drip up to ...

· not limited

52. The volume of nutrient enemas should not exceed ...

53. The barmaid-distributor is engaged in ...

Feeding the seriously ill

delivery of food from the kitchen to the department

portioning food

giving food to the sick

office cleaning

54. A bedridden patient is fed ...

nurse

o postal nurse

barmaid

55. It is allowed to distribute food ...

ü barmaid

nurse

ü nurse

56. When feeding patients, the head nurse must control ...

ü Food conformity to prescribed diets

ü Observance of sanitary rules

ü work of distributors

the work of nurses

patients' appetite

57. Elements of daily cleaning of rooms for feeding patients ...

ü Wet floor cleaning

ü wiping furnishings with 0.25% calcium hyrochlorite

ü ventilation

cleaning of walls and ceilings

58. Frequency of general cleaning of rooms for feeding patients ...

o Once a week

· 2 times per week

1 time in 3 months

· 1 time per month

59. The shelf life of food from the moment it is prepared in a hospital kitchen is no more ...

60. Quality control of products stored in patients is carried out by a nurse ...

ü daily

1 time in 3 days

1 time per week

61. Patients are allowed to store food in ...

ü polyethylene bags

ü glass jars

metal containers

62. To collect food waste use ...

ü metal buckets

ü tanks with lids

FOOD BEFORE AND AFTER OPERATIONS

FOOD AT INJURIES

NUTRITION FOR BURN DISEASE

NUTRITION IN POST-RESECTION SYNDROME

Diet option with mechanical sparing

Approximate one-day menu of the wiped option

Diet option without mechanical ironing Approximate one-day menu of the unwashed option

Approximate menu of an unpurified diet option after

resection of the stomach

Diet options for patients undergoing total

resection of the stomach

Sample one day menu

CORRECTIVE POSTOPERATIVE DIET

NUTRITION FOR ULCER DISEASE

Recipes for some dishes

NUTRITION BEFORE AND AFTER THE OPERATION

Proper diet therapy before and after surgery significantly reduces the possibility of complications and contributes to the rapid recovery of the patient. In the absence of contraindications to food intake, nutrition in the preoperative period should create reserves of nutrients in the body. The diet contains 100-120 g protein, 100 g fat, 400 g carbohydrates (100- 120 g easily digestible); 12,6 MJ (3000 kcal), an increased amount of vitamins compared to the physiological norm, in particular C and P, due to fruits, vegetables, their juices, rosehip broth. In the absence of edema, it is necessary to saturate the body with fluid (up to 2.5 liters per day). 3-5 days before surgery, fiber-rich foods that cause flatulence (legumes, white cabbage, wholemeal bread, millet, nuts, whole milk, etc.) are excluded from the diet. Patients should not eat for 8 hours before surgery. Longer fasting is not indicated, as it weakens the patient.

One of the reasons for urgent hospitalizations and possible operations are acute diseases of the abdominal organs, united under the name "acute abdomen" (acute appendicitis, pancreatitis, cholecystitis, perforated stomach ulcer, intestinal obstruction, etc.). Patients with an "acute abdomen" are prohibited from eating.

A surgical operation causes not only local, but also a general reaction of the body, including changes in metabolism. Nutrition in the postoperative period should: 1) ensure the sparing of the affected organs, especially during operations on the digestive organs; 2) enable normalization of metabolism and restore the overall strength of the body; 3) increase the body's resistance to inflammation and intoxication; 4) promote the healing of the surgical wound.

After abdominal surgery, a starvation diet is often recommended. The liquid is administered intravenously, and the mouth is only rinsed. In the future, the most sparing food (liquid, semi-liquid, pureed), containing a sufficient amount of liquid, the most easily digestible sources of nutrients, is gradually prescribed. To prevent flatulence, whole milk, concentrated sugar solutions and fiber are excluded from the diet. The most important task of therapeutic nutrition is to overcome protein and vitamin deficiency within 10-15 days after surgery, which develops in many patients due to malnutrition in the first days after surgery, blood loss, tissue protein breakdown, and fever. Therefore, perhaps an earlier transfer to a full-fledged diet with a wide food set is necessary, but taking into account the patient's condition, the abilities of his body in relation to the intake and digestion of food. It is necessary to reduce the phenomena of metabolic acidosis by including dairy products, fruits and vegetables in the diet. After surgery, patients often have a large loss of fluid. The approximate daily requirement for fluid during this period is: 2-3 liters - in uncomplicated course, 3-4 liters - in complicated (sepsis, fever, intoxication), 4-4.5 liters - in severe patients with drainage. If it is impossible to provide nutrition to operated patients in the usual way, parenteral (intravenous) and tube nutrition are prescribed. Enpits are especially indicated for feeding through a tube or drinking bowl - highly soluble concentrates everywhere.

Below is a diet plan in the postoperative period, compiled taking into account the recommendations of the Kiev Research Institute of Clinical and Experimental Surgery and the Kiev Research Institute of Food Hygiene. This scheme can be changed taking into account the patient's condition, concomitant diseases and other factors.

Operations gynecological, urological, on soft tissues, bones. There is no need for special diets. Assign diet number 15 with a sufficient content of high-grade proteins, fresh fruits, vegetables, juices. If the operation was traumatic, was performed under general anesthesia, then diet No. 1a or 16 is used for 1-3 days.

Operations on the thyroid gland. 1st day - hunger, in the evening - warm tea with lemon, if there is no danger of bleeding, on the 2nd-4th day, diet No. 1a is prescribed; on the 4-5th day - diet No. 16 with the transition to the 6-7th day on a diet No. 15.

Operations on the lungs, mediastinum, heart. 1-2 day - diet No. 0a; on the 3rd-5th day - surgical diet No. 1; on the 5-6th day - diet number 15, and with a tendency to edema or hypertension - diet number 10.

Operations on the esophagus with opening of its lumen (resection, etc.). Eating through the mouth is allowed no earlier than 5-6 days later. Prior to this, tube and parenteral nutrition is carried out. On the 7-8th day - the first feeding through the mouth, in small sips of 100 ml of sweet warm tea and 50 ml of rosehip infusion; on the 8-9th day - two meals: 1st - 200 ml of warm sweet tea with lemon, 2nd - 160 ml of meat broth and 50 ml of rosehip infusion, on the 10-11th day use broth, liquid kissel , tea, cream - 50 ml, soft-boiled egg, 20 g butter, the amount of liquid is not limited; on the 12-15th day, 6 meals are prescribed, the volume of servings is 100-200 ml; give tea, broth, puree soup from mashed cereals, cream, kefir, sour cream, soft-boiled egg, mashed fresh fruits, juices; on the 16th-22nd day, diet No. About is used; on the 23-27th day - No. Ov: from the 28th day - surgical diet No. 1.

Operations on the stomach (resection, etc.). 1st day - hunger; on the 2nd day - 1 cup of warm sweet tea and 50 ml of rosehip infusion in a teaspoon in 15-20 minutes; on the 3rd day - from a spoon 4 cups of warm sweet tea and 50 ml of rosehip infusion; on the 4-5th day, with normal peristalsis, no bloating, gas discharge, diet No. 0a is prescribed (an additional 2 soft-boiled eggs); on the 6-8th day - diet No. About; on the 9-11th day - diet No. Ov; on the 12th day - diet No. 1 or 1 surgical.

Operations on the biliary tract (cholecystectomy, etc.) - 1st day - hunger; on the 2nd-4th day - diet No. 0a; on the 5th-7th day - diet No. Ob and Ov. In these diets, meat broths are replaced with slimy soups, eggs with steamed protein omelettes; on the 8th-10th day, diet No. 5a is prescribed; on the 15-16th day - diet number 5. Within 10-14 days after the operation, fat in the diet is limited (no more than 40 g per day). In addition, limit cholesterol-rich foods. It is advisable to use a sparing diet No. 5 (No. 5sch) instead of a diet No. 5a.

Resection of the small intestine. 1st day - hunger; on the 2nd-4th day - diet No. 0a; on the 5th-10th day - diet No. About; on the 11th-14th day - diet No. Ov. From the 15th day after the operation, diet No. 1 is prescribed surgical. In the future, diet No. 46 and 4c are used.

Appendectomy. 1-2 day - diet No. 0a; on the 3rd-4th day - diet No. Ob or Ov; from the 5th day, a surgical diet No. 1 is prescribed, and then a diet No. 2 or 15.

Operations on the rectum (resection, with polyps). 1-2 day - hunger; on the 2-3rd day - liquid and jelly-like dishes: 200 ml of fat-free meat or chicken broth with 10 g of butter, tea with lemon and 15 g of sugar, fruit jelly, rosehip infusion; on the 3rd-4th day, add a soft-boiled egg, protein steam omelette, cream; on the 4-5th day - meat and curd steam soufflé; from the 6-7th day, the diet includes milk semolina and mashed buckwheat porridge, mashed potatoes, rice soup with mashed vegetables, cream soup from vegetables, meat and rice, meat dumplings, cottage cheese diluted with cream, sour cream, curdled milk, mashed potatoes from baked apples, blueberry jelly. Such a diet creates maximum rest for the rectum, does not cause flatulence, and forms a small amount of feces.

Eating - 7 times a day in small portions. Next, appoint a diet No. About (8-9th day); on the 10-15th day - diet No. Ov; on the 16th day - surgical diet No. 1. For less complex operations (cracks, hemorrhoids, fistulas), diet No. 1 is prescribed on the 8th day

surgical with transfer to diet No. 15. In the absence of stools from the 7th day, the diet includes a decoction and puree of dried apricots, prunes, boiled beets, kefir and other mildly laxative foods.

Tonsillectomy. After the operation to remove the tonsils in the evening, give 200 ml of warm meat broth, 50 ml of cream, 150 ml of apple jelly; on the 2-3rd day, a diet No. About is prescribed; on the 3rd-5th day - diet No. Ov; on the 5th - 6th day - surgical diet No. 1.

NUTRITION FOR INJURIES

Therapeutic nutrition for injuries is determined by the location and nature of the traumatic injury. In all cases, nutrition should provide not only the body's needs for nutrients and energy, but also increase its defenses in conditions of wound inflammation and possible infection, as well as accelerate the healing of damaged tissues.

In maxillofacial injuries with impaired chewing and swallowing, liquid or semi-liquid food (zero diets) is indicated, and then pureed, pureed, mushy - diets No. 1a and 16. With moderate damage to the masticatory apparatus, diets of group No. 1 can be used with the first days, and with extensive injuries, tube feeding is necessary. The so-called jaw diet recommended for patients with impaired chewing, but maintaining the function of sucking and swallowing. Patients take food through a drinking bowl and a rubber tube.

Food is prepared on the basis of diet No. 2 or 1 (for peptic ulcer, gastritis), but is passed through a meat grinder, diluted with broth (if there are no contraindications), milk, tea, boiled water, compote decoction and brought to the consistency of liquid sour cream. Bread is given in the form of well-ground crackers, diluted with the liquids indicated above.

The chemical composition and energy value of the jaw diet correspond to diet No. 1 or 2.

With maxillofacial injuries, taste perversions are observed (food may seem sour or bitter) and a drop in appetite, therefore, in the absence of contraindications, foods that improve the individual tastes of the patient can be added to food. With a prolonged sluggish course of the wound process, a complication of infection in the diet, the protein content is increased to 120 g (60-65% - of animal origin) and vitamins. In case of maxillofacial injuries, it is desirable to use en-pits, especially if it is necessary to feed through a tube or drinking bowl. During the recovery period, diet No. 2 or 1 is used in the form of regular meals.

In case of damage to the larynx and nasopharynx, pureed, pureed and semi-liquid food is prescribed. Jelly-like dishes are especially indicated, which, in case of violation of the act of swallowing, are swallowed better than liquid food. Exclude hot and cold dishes, spicy, salty, sour foods. The diet is based on diets No. 1a, 16 or 1, and in the initial period, in severe cases, on the basis of zero diets. The diets include steamed meat and fish soufflés and purees, mashed cottage cheese, soft-boiled eggs, steam scrambled eggs, strained meat jelly, fish jelly, sour cream, cream, slimy soups, mashed milk, semi-liquid cereals, jelly, jelly, mousses, fruit and vegetable puree, juices, a decoction of compote, etc. In case of injuries of the esophagus, in particular its burns with alkali and acids, in the first 2-3 days only liquid food is given to spare the affected mucous membranes, then 2-4 days - mushy, pureed , in the form of jelly, and from the 5-8th day they gradually switch to food with moderate mechanical sparing. Therefore, diets of the type of zero diets are used, then diets No. 1a, 16, 1, and then No. 2.

In case of injuries of the abdominal organs, nutrition should ensure sparing of the affected organs. Basically, the diet is built in the same way as in the postoperative period.

In case of bone fractures, especially large tubular ones, nutrition should help accelerate the process of bone fusion. With extensive skeletal injuries in the body, protein breakdown increases by 60-75%, especially at the expense of muscle proteins, and the basal metabolism increases. In this regard, a diet high in protein is indicated. (110 -130 g, 60% - animals), as well as calcium (1-1.5 g), phosphorus (1.5-2.2 g) and vitamin D. Dairy products, in particular cottage cheese and cheese, are of particular importance in nutrition. as well as eggs, meat, fish. To improve metabolism and balance the diet, a simultaneous increase in diets of vitamins C, A and group B is necessary. Diet No. 11 meets these requirements. For small fractures, diet No. 15 is prescribed with a moderate increase in protein content (110 d) and calcium.

The amount of water in the body is normal in relation to body weight up to ...

more than 70%

A threat to human life is the loss of water in the body in an amount up to ...

The daily requirement of a person for water on average is ...

1.5–2 liters

ü 2.5 liters

3-4 liters

4 - 5 liters

Pronounced clinical manifestations are accompanied by the loss of water in the body in the amount of ...

ü 10% or more

With an increase in body temperature by one degree C, the loss of water by the body per day increases by ...

272. The main energy source for the human body is...

ü carbohydrates

vitamins

· minerals

273. The daily requirement for carbohydrates is...

274. The motor function of the intestine is mainly supported by...

Dietary carbohydrates

ü non-edible carbohydrates

vitamins

275. The main source of reparative processes...

· carbohydrates

vitamins

mineral salts

276. The daily requirement of a person for proteins is (in grams) ...

277. Essential amino acids are found in proteins...

ü animal origin

vegetable origin

278. Source of proteins for the body...

the proteins of food

· carbohydrates

vitamins

microelements

279. The daily requirement for fats is...

280. The main source of energy during prolonged fasting...

ü stored fats

tissue proteins

storage of glycogen in the liver

281. The optimal ratio of proteins, fats and carbohydrates in food for a person should be ...

282. For edema and inflammation, rich food is prescribed...

sodium

Phosphorus

ü calcium

iron

283. Calcium salts provide...

the normal condition of the bones

o blood clotting

vasodilating effect

ü anti-inflammatory action

oncotic pressure in blood vessels

284. Trace element involved in the formation of hemoglobin...

285. A trace element that maintains osmotic pressure in the blood...

286. Trace element actively involved in the functioning of the thyroid gland...

287. Eating disorders in surgical patients occur in diseases leading to ...

ü increased protein breakdown, exceeding their intake

ü insufficient intake of nutrients

increased loss of nutrients

ü Decreased absorption of nutrients

a combination of several of the above reasons

288. Methods of nutrition of surgical patients ...

ü through the mouth

ü enterally

ü parenterally

intraosseous

289. Artificial nutrition of a patient with the introduction of food directly into the gastrointestinal tract is called ...

parenteral

ü enteral

mixed

290. During the period of examination, in the absence of diseases of the digestive system, the patient is prescribed a table ...

ü No. 15 /general/

291. During the period of examination, patients with liver and gallbladder disease are prescribed a table ...

292. Patients with diabetes during the examination period receive a table ...

293. Patients with cardiovascular diseases during the examination receive a table ...

294. In nephrolithiasis, a table is prescribed during the examination ...

295. Ways of introducing nutrients in enteral nutrition ...

through a probe

through a gastrostomy

through jejunostomy

intravenously

through the mouth

296. Indications for tube feeding...

lack of appetite /anorexia/ with burn disease or an extensive purulent-inflammatory process

obstruction of the esophagus

Decompensated stenosis of the outlet of the stomach

a prolonged state of unconsciousness

ü violation of the act of swallowing in traumatic brain injury

297. The probe made of...

red rubber

ü silicone

PVC

fluoroplast

298. Probes made of ...

red rubber

ü silicone

fluoroplast

PVC

299. Ways of introducing a probe into the stomach for enteral nutrition...

ü swallowing

ü with mandrin "blindly"

ü endoscopically

under x-ray control

ü intraoperatively

300. Endoscopic methods of inserting a probe into the stomach for enteral nutrition...

according to the guide previously passed through the biopsy channel of the endoscope

with mandrin

parallel to the endoscope

through the biopsy channel of the endoscope

301. In the fractional method, nutritious cocktails are administered through a probe...

continuously for 12 hours

continuous for 24 hours

ü with an interval of 2-3 hours

302. Fractionally, nutrients can be introduced into the gastrointestinal tract through a probe ...

ü Syringe Janet

Syringe for injection

ü roller pump

303. Continuous introduction of nutrients into the gastrointestinal tract through a probe is carried out ...

ü roller pump

ü using systems for transfusion

Janet's syringe

cooking syringe

Syringe for injection

304. With fractional tube feeding, a nutrient cocktail can be injected into the lumen of the jejunum once...

up to 500 ml

305. A nutritional cocktail can be introduced into the lumen of the stomach during fractional tube feeding...

306. Food substances that can be used to prepare cocktails for tube feeding ...

ü broths

o Butter

ü infant formula

ü sour cream

307. A probe inserted for feeding through the mouth into the stomach is called ...

ü orogastric

nasogastric

gastrostomy

jejunostomy

nasojejunal

308. Regurgitation most often occurs when feeding through ...

ü orogastric tube

a nasogastric tube

gastrostomy

jejunostomy

309. Complications during prolonged feeding through a nasogastric tube...

ü pharyngitis

ü laryngitis

ü esophagitis

insufficiency of the closing function of the cardia

stomatitis

310. When feeding through a jejunostomy, for better assimilation of the nutrient mixture, it is advisable to add ...

antibiotics

hormones

ü enzymes

Enzyme inhibitors

311. Introduced food is not processed by bile and pancreatic secretions during feeding...

probe

through a gastrostomy

through jejunostomy

312. Basic requirements for nutrients for enteral administration ...

ü high biological value

ü good digestibility

Ease of preparation and dosage

Balance of essential and non-essential nutritional factors

solubility in water

313. A probe passed into the stomach through the nose is called...

nasoduodenal

ü nasogastric

orogastric

· oroduodenal

314. Indications for prescribing nutritional enemas...

ü dehydration

- stimulation of diuresis

hypoproteinemia

replenishment of energy costs

replenishment of NaCl deficiency

315. In the lower segment of the large intestine are well absorbed...

amino acids

316. Predominantly used for rectal administration...

ü 5% glucose solution

ü 0.9% saline solution

protein hydrolysates

mixtures of amino acids

fat emulsions

317. Liquids can be administered rectally as a single drip up to...

· not limited

318. The volume of nutrient enemas should not exceed ...

319. The barmaid-distributor is engaged in...

Feeding the seriously ill

delivery of food from the kitchen to the department

portioning food

giving food to the sick

office cleaning

320. Feeds a lying patient...

nurse

o postal nurse

barmaid

321. It is allowed to distribute food...

ü barmaid

nurse

ü nurse

322. When feeding patients, the head nurse must control ...

ü Food conformity to prescribed diets

ü Observance of sanitary rules

ü work of distributors

the work of nurses

patients' appetite

323. Elements of daily cleaning of rooms for feeding patients ...

ü Wet floor cleaning

ü wiping furnishings with 0.25% calcium hyrochlorite

ü ventilation

cleaning of walls and ceilings

324. Frequency of general cleaning of premises for feeding patients ...

o Once a week

· 2 times per week

1 time in 3 months

· 1 time per month

325. The shelf life of food from the moment it is prepared in a hospital kitchen is no more than ...

326. Quality control of products stored in patients is carried out by a nurse ...

ü daily

1 time in 3 days

1 time per week

327. Patients are allowed to store food in ...

ü polyethylene bags

ü glass jars

metal containers

328. To collect food waste, use ...

ü metal buckets

ü tanks with lids

Especially for practicing dietitians, this article brings together all the features of diet therapy at various periods before and after surgical treatment in the form of characteristics and basic principles for the use of specialized diets developed by a candidate of medical sciences, a nutritionist of the highest qualification category E. N. Preobrazhenskaya ( North-Western State Medical University named after I. I. Mechnikov, St. Petersburg). All presented diets have a high level of efficiency and digestibility and are used in the work of surgical departments.

Probe diet for surgical patients

Indications: violation of acts of swallowing, chewing; violation of the patency of the upper gastrointestinal tract; unconscious or sharply weakened state; anorexia and unwillingness to eat; impossibility of natural oral intake of food.

general characteristics

The diet consists of liquid and semi-liquid (cream consistency) foods and dishes that can pass through the tube into the stomach or small intestine. Soups, broths are seasoned with butter or vegetable oil, cream, sour cream, ice cream. Dense foods and dishes (meat, fish, vegetables, etc.) are crushed by rubbing machines (blender) or rubbed through a sieve after grinding through a meat grinder. Separate products are rubbed and diluted with a liquid, taking into account the nature of the mixture (boiled water, broth, tea, vegetable broths, milk, juice, etc.). Avoid cold and hot foods and drinks. The temperature of the dishes should be 45-50 ° C, as when chilled, the food becomes viscous and difficult to pass through the probe.

Specialized food products are widely used as part of the probe diet, including enteral mixtures and dry protein composite mixtures. However, it should be remembered that, unlike enteral mixtures, which are used as independent nutrition, dry composite protein mixtures are used exclusively as part of the dish (introduced at the stage of its preparation as an integral part of the recipe).

Probe feeding modes

Postoperative patients in critical situations or operated on the digestive organs need a consistent expansion of the diet. There are several options for tube feeding:

1. 24-hour nutrition - drip introduction of a nutrient mixture at an increasing or constant rate. On the first day, the volume of the nutrient mixture and the rate of administration increase from 50 ml/h (injection rate 20-30 drops/min) to 75-100 ml/h (injection rate 30-40 drops/min). The maximum feed rate of the mixture should not exceed 125 ml / h. The introduction of the nutrient mixture begins at a rate of 50 ml / h on the first day. Each subsequent day, the rate of administration increases by 25 ml/h. The maximum flow rate of the mixture should not be more than 125 ml/h. The introduction is carried out within 18-20 hours during the day. Dosers for enteral nutrition can be used, which facilitates the control of the rate of introduction of the mixture (IN Leiderman et al., 2004).
2. Periodic (session) nutrition. When using an intermittent drip diet, the first 100 ml of the mixture is administered within 20-30 minutes. The next 100 ml - 2 hours after the start of the first feeding. In the case of good tolerance, the rate of administration increases to 5-10 ml / min. Each portion of 200 to 400 ml is administered over 20-40 minutes with an interval between feedings of 2-3 hours. Nutrition sessions for 4-6 hours are carried out only in the absence of a history of diarrhea, malabsorption syndrome and operations on the gastrointestinal tract ("Dietology. Guide", edited by A. Yu. Baranovsky, 2006).
3. Bolus nutrition. Manual method of active portioned introduction of the nutrient mixture using large-volume syringes into the nasogastric tube or through the gastrostomy (it is impossible through the jejunum). The initial bolus should not exceed 100 ml. With good tolerance, it is increased daily by 50 ml. The rate of injection with a syringe is not more than 250 ml in 30 minutes. Meals are carried out in fractions of 100-200 ml every 2 hours up to 9-10 feedings per day. Note that against the background of bolus feeding, diarrhea develops more often.
4. Cyclic nutrition. It is carried out during a 10-12-hour night period for the purpose of additional alimentation of a patient who does not receive the necessary diet during the day (short bowel syndrome, Crohn's disease, UC, etc.). Regardless of the selected mode, before the introduction of the next portion of the mixture, the residual volume of gastric contents should be determined. If it is more than half of the previously introduced portion, the next feeding should be skipped.

After each meal, the probe should be washed with boiled water (30-50 ml) at room temperature!

Chemical composition and energy content of probe diets

"Probe 1-1 day", "Probe 1 day": proteins - 10-12 g; fats - 10-12 g; carbohydrates - 40-50 g; calorie content - 300-320 kcal, the total energy value of nutrition and the fluid content in the diet in the early postoperative period consists of parenteral and enterally administered solutions and mixtures and is determined by the attending physician.

"Probe 1-2 day", "Probe 2 day": proteins - 23-25 ​​g; fats - 20-22 g; carbohydrates - 100-150 g; calorie content - 600-800 kcal.

"Probe 2-3 day": proteins - 65-70 g; fats - 55-60 g; carbohydrates - 100-150 g; calorie content - 1100-1400 kcal.

"Probe 1-4-5 day", "Probe 4-5 day": proteins - 80-85 g; fats - 75-80 g; carbohydrates - 250 g; calorie content - 2000 kcal.

Every day, the dietary component of nutrition increases, and on the 4th-5th day, in terms of energy value, the content of proteins, fats and carbohydrates, the diet corresponds to physiological norms. The missing amount of fluid is determined by the attending physician and administered according to indications, taking into account the electrolyte balance. Then the transition to natural oral nutrition is carried out with the gradual replacement of nutrient mixtures with natural products. If necessary, the patient can receive food according to the diet of the 4-5th day for a long time.

In addition to natural nutrition, malnourished patients with symptoms of hypoproteinemia are prescribed polymeric or oligomeric balanced enteral mixtures. If necessary, special metabolically directed specialized mixtures and modules are added.

In order to enrich the diet, enhance its biological value, it is recommended to combine the intake of traditional food products and ready-made nutritional mixtures balanced in all nutrients, as well as the inclusion of dry protein composite mixtures in the diet at the stage of preparing a dietary meal. In addition, it facilitates the preparation of tube diets.

The Federal State Budgetary Institution "Research Institute of Nutrition" of the Russian Academy of Medical Sciences recommends the following products for consumption:

• Bread (crushed wheat bread crumbs).
• Soups (based on low-fat meat, fish broths, dairy soups with allowed mashed vegetables and cereals, mashed soups).
• Meat, poultry, fish (lean beef, veal, chicken, rabbit, turkey). Children's and dietary canned meat ("Kroshka", "Chick", "Butuz", etc.).
• Dairy products (milk, cream, dairy products, cottage cheese). Dry milk and acidophilic mixtures ("Baby", "Kid", etc.).
• Eggs (soft-boiled, omelets).
• Cereals (semolina, oatmeal, rice, buckwheat, oatmeal; cereal flour).
• Vegetables (potatoes, carrots, cauliflower, zucchini, pumpkin in the form of canned baby food or homogenized in a blender).
• Fruits, berries (ripe pureed fruits and berries up to 150-200 g per day; decoctions of dried fruits, kissels, juices).
• Drinks (tea, tea with milk, cream, coffee and cocoa with milk; juices from fruits, berries, vegetables; decoctions of rose hips and bran).
• Fats (butter, vegetable).

The following dishes and products are excluded from consumption:

• fresh bread; sweet products.
• Fatty meat soups, fish broths.
• Fatty sinewy meats, skin of birds and fish; offal.
• Raw, fried eggs.
• Pasta.
• White cabbage and other vegetables; canned vegetable snacks; legumes.
• Grape.
• Black coffee; carbonated drinks.
• Meat and cooking fats.

• Rye bread crackers up to 50 g (for the Zond diet).
• Milk soups (if tolerated).
• Liver.
• Milk on average 600 ml per day (with milk intolerance - replacement with fermented milk products); sour cream in dishes.
• Eggs (1-2 pieces per day).
• Green peas, beets; natural canned vegetables homogenized.
• Plum, apricot juices.
• Sugar (30-50 g per day), honey (20 g per day).
• Butter (30 g per day), vegetable (30 g per day).

Currently, there is a fairly large number of various enteral mixtures: standard, polysubstrate, balanced, semi-elemental balanced, modular, specialized, monomeric. In addition, other specialized products are used in tube feeding - dry composite protein mixtures.

Required specialized food items:

• enteral mixtures: the most commonly used are full-fledged polysubstrate balanced mixtures that allow you to meet the physiological needs of the body, or semi-elemental balanced mixtures containing partially hydrolyzed and easily digestible macronutrients;

Surgical specialized preoperative diet

Indications for appointment— preparation of planned surgical patients:

• uncontrolled weight loss - more than 10% of the usual within 6 months;
• loss of more than 5% of the usual body weight in the last month;
• moderate and severe malnutrition;
• serum albumin concentration below 30 g/l.

Purpose of appointment: improve the nutritional status of the body, increase its resistance to infection, promote immunity.

general characteristics

A diet with a high calorie content with a predominant increase in the content of proteins, vitamins and minerals is 1.5-2 times higher than the physiological norm.

Culinary processing

Dishes of varying degrees of grinding are allowed, providing moderate mechanical and chemical sparing. Products are boiled in water or steamed, baked without a rough crust, cooked mainly in a pureed form. Wipe dishes from foods rich in connective tissue or fiber.

Exclude: foods and dishes that linger in the stomach for a long time, are difficult to digest, irritate the mucous membrane of the gastrointestinal tract. Food temperature: hot dishes from 57 to 62 ° C, cold ones not lower than 15 ° C.

Diet: fractional - 5-6 times a day.

Chemical composition and calorie content: proteins - 110-120 g (60% animals); fats - 85-95 g (20-25% vegetable), carbohydrates - 400-450 g (100-120 g easily digestible), energy value - 2800-3100 kcal. Sodium chloride - 6 g (in the absence of edema), free fluid - 2-2.5 l (in the absence of edema).

The following foods are allowed for consumption:

• Soups (based on weak low-fat meat and fish broth, on decoctions of vegetables with boiled or grated cereals, with the addition of allowed pureed vegetables, noodles or homemade noodles, with meatballs, with profiteroles).
• Lean or fat-free meat (beef, meat pork, veal, chicken, turkey, rabbit). Low-fat varieties can be in pieces, poultry without skin, minced beef (cutlets, freak-delki, dumplings, soufflés, rolls, etc.). Boiled tongue, liver (if there are no contraindications) in the form of pate.
• Fish (lean types of fish without skin) in a piece or chopped.
• Dairy products (fresh non-acidic cottage cheese in its natural form or in dishes, sour-milk drinks, milk in dishes).
• Eggs (soft-boiled, omelets) up to 2 pcs. in a day.
• Cereals (viscous or mashed cereals, boiled in water with the addition of milk or meat broth, vermicelli).
• Vegetables (potatoes, carrots, beets, cauliflower, zucchini, pumpkin, green peas, ripe tomatoes).
• Appetizers (salad of boiled vegetables, fresh tomatoes, meat, fish; boiled tongue, liver pate, mild cheese, low-fat non-wiry ham, doctor's sausage, dairy, black caviar).
• Fruits, berries, sweets (ripe fruits and berries of sweet varieties - baked or in the form of mashed potatoes, mousses, jelly, compotes; sambuki; meringues; snowballs; marshmallows, marshmallows, sugar, honey, jam, jam from sweet berries and fruits).
• Sauces (milk with the addition of a small amount of sour cream without sautéing flour, fruit). Spices (bay leaf, dill, parsley leaves, cinnamon, cloves).
• Fats. Butter unsalted butter, ghee, vegetable oil. Give 5 to 15 g per dose, depending on tolerance.
• Drinks (weak tea, tea with lemon, milk [if tolerated], cream, weak cocoa and coffee substitute with milk; sweet juices from fruits and berries diluted with water 1:1 or 1:2; decoctions of rose hips and bran).

• Rye and any fresh bread; pastry or puff pastry.
• Strong meat, as well as fish and mushroom broths, dairy, pea, bean, millet soup; okroshka.
• Fatty and sinewy varieties of meat and poultry (ducks, geese).
• Fatty fish, salted, smoked; canned food.
• Whole milk; dairy products with high acidity, spicy cheeses.
• Eggs (hard boiled, fried).
• Millet, pearl barley, barley, corn, legumes, whole pasta.
• Raw uncooked vegetables. White cabbage, garlic, turnip, swede, radish, sorrel, spinach, onion, radish, cucumbers, sweet peppers, pickled and pickled vegetables, mushrooms.
• Spicy, salty snacks, canned food, smoked meats.
• Sour, underripe, fiber-rich fruits and berries, chocolate, ice cream, cream products.
• Fatty and spicy sauces, horseradish, mustard, pepper.
• All other fats.
• Carbonated drinks, kvass, black coffee, grape juice, fruit drink.

The consumption of such foods is limited:

• If tolerated - soups with finely chopped vegetables. Soups from mashed sweet berries with semolina. Vegetables are not sautéed.
• Weak jelly in bone broth with the addition of gelatin. Milk sausages.
• Cream, sour cream in dishes 10-15 g. Mild grated cheese or slices.
• Add green peas, finely chopped greens to dishes.
• Mashed dried fruits.

• Composite protein dry mixes as a component of preparing ready-made dietary meals.

Zero (surgical) diets

Since order No. 330 (as amended by the orders of the Ministry of Health and Social Development of the Russian Federation of October 7, 2005 No. 624, of January 10, 2006 No. 2, of April 26, 2006 No. 316), along with the main standard diets, various surgical diets are preserved in medical institutions of the corresponding profile, we adhere to the traditional systems of surgical diets: 0a; 0b; 0v etc.

Due to the proper organization of nutrition for patients in the postoperative period, it is possible:

• ensure sparing of the affected organs, especially during operations on the digestive organs;
• contribute to the normalization of metabolism and the restoration of the general forces of the body;
• increase the body's resistance to inflammation and intoxication;
• promote wound healing.

Surgical Specialized Diet 0a

Indications for appointment

It is prescribed after operations on the digestive organs, when the intake of ordinary food is impossible, difficult or contraindicated.

Purpose of appointment: the diet provides maximum unloading and sparing of the digestive organs, prevents bloating.

general characteristics

Culinary processing: food consists of liquid and jelly-like dishes. The amount of sodium chloride is sharply limited. Ordinary foods and dishes can be replaced with solutions of nutrient mixtures that are adequate in chemical composition and calorie content. Diet: 6-8 times a day; for 1 reception no more than 100-300 ml. Food temperature: not higher than 45 °C and not lower than 20 °C.

Chemical composition and calorie content: proteins - 5 g; fats - 15-20 g; carbohydrates - 150 g; caloric content - 750-800 kcal; table salt - 1 g; free liquid - up to 2 liters.

• The meat broth is weak.
• Rice broth with cream or compote broth.
• Kissel berry liquid.
• Rosehip decoction with sugar.
• Fruit jelly.
• Tea with lemon and sugar.

The following dishes and products are excluded from consumption:

• Any dense and puree-like dishes.
• Whole milk and cream.
• Sour cream.
• Grape and vegetable juices.
• Carbonated drinks.

The following foods are limited:

• Fresh fruit and berry juices, diluted 2-3 times with sweet water - up to 50 ml per dose.
• When the condition improves on the 3rd day, add a soft-boiled egg, butter 10 g, cream 50 ml.

It is necessary to use specialized food:

• Composite protein dry mixes as a component of preparing ready-made dietary meals.

Table 1. Scheme of parenteral and enteral tube feeding in the early postoperative period (days 1-7)

Note. Diet therapy + protein correction with dry composite protein mixtures - when digestion function is restored.

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Surgical Specialized Diet 0b

Indications for appointment

The diet is indicated when the patient feels well.

Purpose of appointment: to expand the diet in the postoperative period, usually after the surgical specialized diet 0a. Assign for 2-4 days.

general characteristics

Nutrition is built on the principle of a gradual increase in the load on the gastrointestinal tract and the inclusion of a sufficient amount of protein for a faster and more complete restoration of the functions of the digestive organs. It is recommended to include free liquid up to 2 liters in the diet. Sodium chloride 4-5 g. Food must be taken 6 times no more than 350-400 g per reception. For the whole day - 50 g of sugar and 20 g of butter. For the first 4-5 days, 5-6 meals are recommended in the amount of 70-100 ml per 1 meal. It is prescribed after the surgical specialized diet 0a. The diet is applied to further expand the diet.

Culinary processing: food is cooked in pureed form, boiled in water or steamed. Tendons, fascia, fat are removed from meat, and skin is removed from chickens. Products wiped, limitedly - from cutlet mass, 3-4 times turned through a meat grinder with a fine grate. The amount of table salt is limited. Diet: 6 times a day. Food temperature: hot dishes - no higher than 50 ° C, cold - no lower than 20 ° C.

: 40-50 g protein, 40-50 g fat, 250 g carbohydrates, 1550-1650 kcal. Free liquid up to 2 liters. Sodium chloride 4-5 g.

The following foods and dishes are allowed for consumption:

• Eggs (soft-boiled, omelets).
• Fruits, berries, sweets (well-mashed fruit and berry purees, baked apples; jellies, mousses from non-acidic berries and fruits).

The following dishes and products are excluded from consumption:

• Sour cream, ice cream.
• Millet.
• Meat and cooking fats.

The following foods are limited in consumption:

• Crackers (100 g for the whole day).
• Slimy soups.
• Turkey mashed, chopped.
• Piece of boiled fish.
• Eggs (2-3 per day).
• Shredded cauliflower.
• Sugar (60 g for the whole day).

It is necessary to use specialized food:

• Composite protein dry mixes as a component of preparing ready-made dietary meals.

In the future, it is required to expand the diet and move on to physiologically nutritious nutrition. The recommended chemical composition of the diet: 80-90 g of protein, 65-70 g of fat, 320-350 g of carbohydrates, 2200-2300 kcal, 6-7 g (!) sodium chloride. Bread in the form of white crackers up to 100 g is recommended on the 8th day. Food is taken from 6 to 7 times a day in the amount of 200-400 ml. For the whole day sugar - 60 g, butter 20 g.

Surgical Specialized Diet 0v

Indications for appointment

It is prescribed after diet 0b.

Purpose of appointment: serves to further expand the diet and transition to a physiologically complete diet.

general characteristics

Nutrition is built on the principle of a gradual increase in the load on the gastrointestinal tract and the inclusion of a sufficient amount of protein for a faster and more complete restoration of the functions of the digestive organs.

Culinary processing: food is cooked in pureed form, boiled in water or steamed. Tendons, fascia, fat are removed from meat, and skin is removed from chickens. Products wiped, limitedly - from the cutlet mass, turned 3-4 times through a meat grinder with a fine grate. The amount of table salt is limited. Diet: 6 times a day. Food temperature: hot dishes - no higher than 50 ° C, cold - no lower than 20 ° C.

Chemical composition and calorie content: proteins - 80-90 g; fats - 65-70 g; carbohydrates - 320-350 g; caloric content - 2200-2300 kcal; table salt - 6-7 g; free liquid - 2 liters.

The following foods and dishes are allowed for consumption:

• Bread (crackers from wheat bread of the highest grade).
• Soups (mashed soups and soups-creams from vegetables, mashed from cereals, meat, poultry, liver, fish).
• Meat, poultry (lean non-stringy beef, veal, rabbit, skinless chicken).
• Fish (low-fat varieties: cod, ice, pike perch, carp, pike, carp, saffron cod, bream).
• Dairy products (freshly prepared grated cottage cheese with milk or cream, steam dishes from cottage cheese, sour-milk drinks).
• Eggs (soft-boiled, omelets).
• Cereals (milk semolina, mashed rice, oatmeal, buckwheat).
• Vegetables (potatoes, carrots, zucchini, pureed pumpkin).
• Fruits, berries, sweets (well-mashed fruit and berry purees, baked apples; jellies, mousses from non-acidic berries and fruits).
• Drinks (rosehip broth; fruit, berry, vegetable juices; compote broth, jelly, weak tea, coffee with and without milk).
• Fats (butter and vegetable oil).

The following dishes and products are excluded from consumption:

• Other types of bread and flour products.
• Not pureed cereal, vegetable soups.
• Other types of meat and poultry. Uncleaned dishes.
• Fatty fish species, salted, smoked, canned.
• Sour cream, ice cream.
• Eggs (hard boiled, fried, raw).
• Millet.
• Not pureed permitted vegetables and other types of vegetables.
• Grape. Not pureed fruits and berries.
• Grape juice, cold and carbonated drinks.
• Meat and cooking fats.

The following foods are restricted in consumption:

• Crackers (100 g for the whole day).
• Slimy soups.
• Turkey mashed, chopped.
• Piece of boiled fish.
• Milk is mainly in dishes, if tolerated - whole. Cream (up to 100 g per day).
• Eggs (2-3 per day).
• Pureed barley, barley porridge.
• Shredded cauliflower.
• Sugar (60 g for the whole day).
• Plum, apricot, peach juices.
• Butter (20 g for the whole day).

It is necessary to use specialized food:

• Composite protein dry mixes as a component of preparing ready-made dietary meals.

Surgical Specialized Diet #1

general characteristics

The diet is moderately mechanically and chemically sparing, physiologically complete, high in protein, fat content at the lower limit of the norm, restriction of easily digestible carbohydrates. Surgical specialized diet No. 1 is distinguished by the inclusion of weak meat and fish broths and vegetable broths and the restriction of whole milk. It can be considered as a variant of the diet with mechanical sparing, it is prescribed to patients who have undergone gastric resection on the 10-14th day for 2-4 months; from the 14-15th day after operations on the intestines in the case when there are no complications and the recovery processes of the digestive system proceed favorably. The diet is physiologically complete with moderate chemical, mechanical and thermal sparing of the gastrointestinal tract. Strong causative agents of the secretion of the stomach and intestines, irritants of the gastrointestinal mucosa that linger in the stomach for a long time and hard-to-digest foods and dishes are limited.

Culinary processing: dishes are cooked in a boiled form, steamed, individual dishes are baked without a crust; the food is mostly pureed. Fish and coarse meats are allowed in pieces. Table salt is limited moderately. Diet: 5-6 times a day. Temperature of dishes: very cold and hot dishes are excluded.

Chemical composition and calorie content: proteins 110 g (of which 60% are animals), fats 100 g (20% vegetable), carbohydrates 400-450 g; calorie content 2950-3150 kcal, table salt - 6 g; free liquid - 1.5 l. The mass of the daily ration is 3 kg.

The following dishes and products are allowed to be eaten:

• Bread (yesterday's wheat bread; dry biscuit, dry biscuits).
• Soups (on weak meat, fish, vegetable broths; mashed cereals with the addition of allowed mashed vegetables; with vermicelli or homemade noodles; soups-mashed vegetables, boiled chicken or meat).
• Meat, poultry (lean beef, lamb, veal, rabbit, chicken, turkey. Tongue, liver).
• Fish (low-fat types of fish without skin in the first six months of rehabilitation: pollock, pollack, cod, haddock, perch, pike perch, hake, pike).
• Dairy products (milk, cream 10% [diluted], non-acidic cottage cheese, sour cream, non-acidic kefir, fermented baked milk, yogurt, bifidok, narine, etc.).
• Eggs (soft-boiled, omelets).
• Cereals (semolina, rice, buckwheat, oatmeal), porridge from them, mashed, semi-viscous, boiled in milk or water. Vermicelli boiled in milk or water.
• Vegetables (potatoes, carrots, beets, cauliflower, steamed or in water and mashed; zucchini, pumpkin - not mashed; dill - finely chopped into soup).
• Appetizers (salad of boiled vegetables, meat, fish; boiled tongue, liver pate, mild cheese, low-fat, non-stringy, unsalted ham, doctor's sausage, dairy, diabetic, dietary).
• Fruits, berries, sweets (ripe fruits and berries of sweet varieties - boiled, baked, in the form of mashed potatoes, mousses, jelly, compotes, sambuca; meringues, snowballs, marshmallows, marshmallows, sugar, honey, jam, jam from sweet berries and fruits) .
• Sauces, spices (sour cream; fruit, milk-fruit - without sautéing flour, with the addition of butter).
• Fats (unsalted butter, ghee, vegetable oil).
• Drinks (weak tea, tea with milk, cream, weak cocoa and surrogate coffee with milk; sweet juices from fruits and berries [strawberry, raspberry, etc.]; rosehip broth).

The following dishes and products are excluded from consumption:

• Rye and any fresh bread, pastry or puff pastry products.
• Strong meat and fish broths, mushroom and strong vegetable broths, cabbage soup, borscht, okroshka; milk soups.
• Fatty and sinewy varieties of meat and poultry, ducks, geese, canned food, smoked meats.
• Fatty fish (salmon, nelma, notothenia, sturgeon, black halibut, oily herring, mackerel, white salmon, eel, etc. salted, canned food).
• Dairy products with high acidity, spicy cheeses.
• Eggs (hard boiled, fried).
• Millet, corn, pearl barley, legumes, whole pasta.
• White cabbage, turnip, swede, radish, sorrel, spinach, onion, cucumbers, pickled, pickled and pickled vegetables, mushrooms.
• Spicy, salty snacks, smoked meats.
• Sour, insufficiently ripe, fiber-rich fruits, dried fruits and berries, chocolate, ice cream.
• Sauces, spices (meat, fish, mushroom, tomato, horseradish, mustard, pepper).
• All other fats.
• Carbonated drinks, kvass, black coffee.

The following dishes and foods are limited in eating:

• 1-2 times a week are not rich buns, baked pies with apples, jam, boiled meat, fish, eggs, cheesecakes.
• Soups from mashed sweet berries with semolina. Flour for soups is dried (not sautéed).
• Weak jelly in bone broth with the addition of gelatin.
• Baked fish, jellied fish.
• Sour cream. Fresh factory-made cottage cheese (preferably in dishes), mild cheese.
• Eggs (2-3 per day).
• Porridge crumbly, pasta finely chopped.
• Green peas, non-acidic tomatoes - up to 100 g.
• Sea fish on vegetable broth, sturgeon caviar, soaked low-fat herring and mincemeat.
• Pureed dried fruits, butter cream.
• Dill, parsley, vanilla, cinnamon.
• Tomato sauce, milk - if tolerated.
• Dilute raw vegetable (carrot, beet) juices with water.

It is necessary to use specialized food:

• Composite protein dry mixes as a component of preparing ready-made dietary meals.

Features of the diet of a surgical patient

The diet of the surgical patient also depends on the volume and nature of the surgical intervention.

After operations on the gastrointestinal tract in the first days, the patient can receive only enteral nutrition, then it is necessary to start expanding the diet: sequentially appoint specialized surgical diets depending on the patient's condition.

After operations on the upper gastrointestinal tract (esophagus, stomach), the patient should not receive anything through the mouth for the first two days. Conducted parenteral nutrition. Starting from the 2-3rd day, complete enteral nutrition, sipping and switching to surgical specialized diets 0a, 0b, 0c are prescribed, from the 10-12th day, in the absence of complications, the patient is transferred to a specialized surgical diet No. 1.

After operations on the abdominal organs, but without compromising the integrity of the digestive tract (gall bladder, pancreas, spleen), specialized surgical diets can be prescribed in the first days after surgery.

After operations on the colon, it is necessary to create conditions so that the patient does not have a stool for 4-5 days. The patient should receive food with a small amount of fiber.

After operations in the oral cavity, a probe is inserted through the nose, and through it the patient receives liquid food. On the first day after surgery, it is preferable to prescribe enteral mixtures.

After surgical interventions not related to the gastrointestinal tract, in the first 1-2 days, the patient can receive specialized surgical diets and quite quickly (within a week) switch to a mechanically and chemically sparing high-protein diet.

Conclusions for nutritionists

Thus, nutrition in the postoperative period is based on the fact that many patients develop a deficiency of protein, vitamins, trace elements, a tendency to acidosis, and dehydration. Diet therapy is aimed at correcting metabolic disorders, providing the physiological needs of the body for nutrients and energy, sparing the affected organs, increasing the body's resistance and stimulating the healing of the surgical wound.

We reviewed the general principles of diet therapy for surgical patients, the use of which is necessary to improve effective treatment and reduce the risk of complications and the formation of chronic diseases. By applying these principles, you will be able to provide the patient with:

• a balanced diet for the main food nutrients with control of the constant intake of essential food components into the body;
• adequate protein intake depending on the patient's condition, the degree of development of protein-energy deficiency;
• the optimal condition of the patient by the choice of therapeutic nutrition.

In the following articles, we will present information and recommendations on diet therapy depending on the clinical and statistical groups of surgical patients, specific types of surgical interventions, while defining the main features of clinical nutrition, with specific examples of diet therapy for surgical patients.