Download Preparation for additional studies of the genitourinary system

Ministry of Health of Republic of Belarus
Education establishment
«The Gomel State medical university»
Chair of Internal Disease №1 with Endocrinology Course
It is discussed at the meeting of chair 30.08.2016
Protocol № ___________
METHODICAL REVIEW
for practical training of foreign students of the 1st course
«Supervision and hygienic care of patients with function break of
genitourinary system»
Theme 10 (Lesson 16; 17)
6h.
1. Training and educational goals, motivation for theme learning,
requirements of initial level of knowledge
1.1 Aim of training: Learn the basic principles of care of patients with kidney
disease and urinary tract.
1.2 Requirements to initial level of knowledge: during the training the student
should
To know:
1. The basic principles of care of patients with kidney disease and urinary tract.
2. The procedure of preparation of patients for instrumental studies of the urinary
system.
To be able to:
1. Caring of patients with kidney disease and urinary tract.
2. Prepare the patient for instrumental examination of the urinary system.
2. Checklist from related subjects
1. Anatomy of the kidney and urinary tract.
2. Physiology of the kidneys and urinary tract.
3. Questions on an occupation subject:
Lesson № 16:
1. Methods of monitoring and care of patients with diseases of the genitourinary
system.
2. Diuresis, method of registration.
3. Care of patients with urination disturbance.
4. Indications and technique of bladder catheterization for men and women.
Lesson № 17:
5. Methods of collecting urine for the general analysis, Nechiporenko analysis,
Zimnitsky analysis, urine sugar analysis, glycosuric profile.
6. Preparation for additional studies of the genitourinary system.
7. Feeding features of patients with kidney and urinary tract diseases.
4. Materials for self-preparation:
Lesson № 16:
1. Methods of monitoring and care of patients with diseases of the
genitourinary system.
Nephrology (Greek «nephros» -Kidney, «logos» - teaching) is called a section
of internal medicine which studies the etiology, pathogenesis and clinical course of
kidney disease, which develops methods of diagnosis, treatment and prevention.
Observation and care of patients with kidney disease and urinary tract should
be carried out in two directions.
1. General measures - measures to monitor and care needed by patients with
diseases of various organs and systems: monitoring of the general state of the patient,
a thermometer, monitor the pulse and blood pressure, the filling temperature of the
sheet, providing personal care of the patient, vessel supply, and others.
2. Special events - event monitoring and care designed to help patients with
symptoms characteristic of diseases of the urinary - pain in the lumbar region, edema,
urination disorders, arterial hypertension and others.
A patient with renal disease and urinary tract requires careful monitoring and
careful maintenance. When it appears (or gain) in the patient edema, urinary
disturbances, change in urine color, increased blood pressure, dyspepsia, deterioration
of the general condition of the patient nurse must immediately inform the doctor.
2. Diuresis, method of registration.
Every 5-10 minutes through the kidneys passes the entire mass of the body's
blood; per day kidneys "chased" up to 1000 liters of blood. Urine formed in the
kidneys continuously, gradually standing out via ureters into the bladder. In a broad
sense, the term "diuresis" refers to the process of formation and excretion of urine,
but it is most often used to describe the amount of urine (Greek diureo - Secrete
urine). The total amount of urine a person during the day, called circadian diuresis.
The average urine output for 1 minute call minute diuresis (this value is used in the
calculation of quantitative indicators of kidney function).
The daily amount of urine secreted by adult normal ranges from 1000 to 2000
ml, with an average of 50-80% of an oral liquid. The rest of the volume of fluid is
released through the lungs (300-400 ml, during exercise up to 500 ml / day), and skin
(300-400 ml / day); about 100 ml is excreted in the feces decorated. Urine output
increases when receiving large amounts of fluid and food that increases urine output
and, on the contrary, decreases during exercise and in hot weather when sweating,
vomiting, diarrhea.
Violation of urine output is the most common symptom of kidney and urinary
tract diseases. There are the following changes in urine output.
Polyuria (from the Greek «polys» -Many, «uron» - urine) is an increase in the
daily amount of urine of more than 2000 ml. Polyuria is often associated with
increased thirst and increased fluid intake.
Oliguria (from the Greek «olygos» - Small, «uron» - urine) is a decrease in the
number of allocated urine per day to 500 ml or less.
Anuria (from the Greek «an» - absence, «uron» - Urine) is failure to urine in
the bladder, which may be a consequence of the termination of its isolation (100 ml /
day or less up to the complete absence of urine).
Ischuria (from the Greek «ischo» -To delay, hinder, «uron» - urine) is the
inability to empty the bladder, in spite of the overflow of his urine (urinary retention).
Nicturia for normal renal function characterized by a significant prevalence of
daily urine output over the night (the ratio of day to night diuresis in a healthy person
is about 4: 1). Nocturia (from the Greek «nyktos» -. Night, «uron» - urine) is change
in this ratio in favor of nocturnal diuresis (urine when most stands out day and night).
Enuresis. Often in patients with elderly nocturia combined with incontinence enuresis (from the Greek "enireo." - Urinate).
Pollakiuria. The frequency of urination is normal 3 to 4 times a day.
Pollakiuria (from the Greek «pollakis» -. Many times, often, «uron» - urine) is
frequent urination (more than 6-7 times a day).
Dysuria (from the Greek «dys» -Prefix denoting difficulty dysfunction, «uron»
-mocha) is the common name of urination disorders in the form of pain, palpitations
and / or difficulty of urine excretion of urinary bladder. Dysuria appears common
symptom for various inflammatory diseases of the genitourinary system (cystitis,
urethritis, pyelonephritis, renal tuberculosis, etc.), Passing for ureteral stones.
Strangury (from the Greek «strangos» -. Something squeezed out, drop, «uron»
- urine) - urinating small amounts (drops) because of its steep difficulty.
Methods of determining the water balance and control set out in the
methodological development of the theme "Caring for the sick and monitoring
diseases of the cardiovascular system."
3. Care of patients with urination disturbance.
Patients with impaired urination require a lot of attention. The patient with
enuresis mattress should be covered with oilcloth, spread a sheet on top of it. If you
frequently need to give the patient diuresis diapers to lay their crotch; currently
special diapers for adults used for this purpose. the patient's skin should be carefully
washed baby soap; skin of the hands, feet and physiological folds should be
lubricated with baby cream daily. When incontinence each time of departure should
undermine the patient for the prevention of pressure ulcers and prevention of skin
infection.
If seriously ill, feel the need to empty the bladder, is in the general ward, it is
desirable to isolate the sick from other with screen.
When submitting the urinal vessel should be borne in mind that not all patients
are free to urinate while lying in bed. Therefore, the urinal vessel should always be
warm. Where necessary (unless contraindicated), sometimes it is advisable to put a
warm heating pad on the suprapubic area. After voiding the bag is emptied and
washed well. Once a day is necessary to rinse the urinal vessel with a weak solution
of potassium permanganate or hydrochloric acid to remove its walls formed on a
dense precipitate ammonia odor.
Emergency aid to the patient with urinary retention is an early excretion of
urine from the bladder. Independently urinate may contribute noise flowing from the
tap water, irrigation genitals with warm water, if not contraindicated attachment
warmers on the suprapubic area. If these measures proved ineffective, recourse to
bladder catheterization, or the imposition of cystostomy.
4. Indications and technique of bladder catheterization for men and
women.
Catheterization of the bladder is the introduction of a catheter into the bladder
is held to derive from it the urine, bladder irrigation, the introduction of drugs or
extraction of urine for testing. It requires special precautions so as not to add to the
urinary bladder infections. Therefore catheterization should be performed only when
necessary. Catheterization is carried out with the help of soft and hard catheters. Soft
catheter is a flexible rubber or polymer tube to 25-30 cm in length and with a
diameter up to 10 mm (№1-30). The upper end of the catheter curved, side blind with
small oval holes. The outer funnel end of the catheter is extended in order to make it
easier to insert the tip of the syringe for administration of drug solutions and rinsing
the bladder. Currently used disposable sterile catheters, and often include the bag
(see. Fig.). Very easy to work disposable catheters with a hydrophilic lubricant. It
(Example EasiCath) made of polyvinyl chloride and over the entire surface covered
with a hydrophilic lubricant, which is activated by contact with water and increases in
volume, creating a completely smooth and slippery film on the entire surface of the
catheter. Catheterization using such a catheter does not require special oils or gels for
administration to the bladder. They are widely used for catheterization carried out by
the patient himself.
In some cases the catheter may be mounted on a longer term. For this
purpose, use disposable Foley catheter. It is a double-lumen tube, one channel is used
to remove urine from the bladder, and the other communicates with a spout near the
sealed chamber of the catheter. This catheter can be mounted in a bubble in the
required time (a day or more) for the permanent removal of urine. Fixing Foley
catheter in the bladder is carried out through an original cuff, which is formed by
introducing a second catheter lumen in sterile liquid volume of 10-15 ml (see. Fig.).
Administering to a female catheter
Indications.
- Acute urinary retention.
- Washing of the bladder and the insertion of the drugs.
- Collection of Urine for Research.
Contraindications.
- Damage to the bladder, urethral rupture.
- Acute inflammation of the bladder, urethra.
Facilities (sterile):
Bathrobe, cap, mask, waterproof apron, catheters, forceps anatomy - 2 pieces,
forceps, tray, clean and sterile gloves, a sterile cloth (gauze) tissue -. In sufficient
numbers, sterile disposable Foley catheter or other disposable catheter, sterile syringe
20 ml sterile pp chloride and 0.9% sodium furatsillina solution of 1: 5000, for the
collection of urine drainage bag or tray, a container of disinfectant solution, oilcloth
underlayer, an antiseptic solution for cleaning the, tube with a sterile lubricant.
The procedure is performed in a bed (it is possible on the gynecological chair
in the office of manipulation). Assistant Help simplify the procedure.
Preparation for the procedure:
1. Explain to the patient the need for the procedure, its essence, to get her
consent.
2. Carry out hygienic hand antisepsis.
3. Wear clean gloves
4. Place the patient on his back, legs bent at the knees and slightly dissolve in
hand.
5. Support under the patient's buttocks with oil cloth napkin (diaper). On top
of the protruding edge of the diaper to put the boat (you can use sterile disposable
surgical drapes with a slit in the center of the tape down).
6. Prepare the equipment for cleaning the patient.
7. Stand to the right of the patient, in his left hand to take the container
(pitcher) with a solution for cleaning the in the right forceps with a napkin.
Substitution of patient movements from top to bottom, in sequence from the pubis to
the anus.
8. Change napkins, dry skin in the same sequence as the waste dump wipes,
gloves in the package with the used material.
9. Prepare equipment for catheterization
10. Wash hands, perform hygienic antiseptic, put on sterile gloves.
Implementation procedure:
1. Extend the left hand labia, right hand with tweezers to take a gauze soaked
in a solution of furatsilina.
2. Process the urethral opening move downwards between the small labia.
3. Change the gauze.
4. Apply a cotton swab soaked in furatsilina solution to the opening of the
urethra for one minute.
5. Reset the swab into a solution for disinfection, change tweezers. Each swab
is used only once, for cleaning the six used tampons.
6. Take the tweezers beak soft catheter at a distance of 4-6 cm from the end,
as the stylus.
7. Stroke the outer end of the catheter over the brush and clamp between the
fourth and fifth fingers of his right hand.
8. Douse the beak of the catheter with sterile water-soluble lubricant
(abundantly).
9. Extend the left hand labia, gently introduce the catheter right by the length
of 4-6 cm until urine (see fig.).
10. Lower the free end of the catheter into a container to collect the urine.
11. Reset the tweezers on the tray, followed by disinfection.
12. Push the left hand above the pubis, at the same time removing the catheter
after the cessation of self-discharge of urine from the catheter.
13. Remove the catheter and dump it into
a container for subsequent disinfection.
14. Remove gloves and place in a
container for waste materials.
15.
antiseptic.
Wash
hands,
perform
hygienic
Introduction catheter to man
Indications:
- Acute urinary retention.
- Washing of the bladder and the insertion of the drugs.
- Preparation of urine for testing.
Contraindications:
- Damage to the bladder, urethral rupture.
- Acute inflammation of the bladder, urethra.
Facilities (sterile):
Bathrobe, cap, mask, waterproof apron, catheters, forceps anatomy - 2 pieces,
forceps, tray, clean and sterile gloves, a sterile cloth (gauze) tissue -. In sufficient
numbers, sterile disposable Foley catheter or other disposable catheter, sterile syringe
20 ml sterile pp chloride and 0.9% sodium furatsillina solution of 1: 5000, a tray for
collecting urine or a urine collection bag, a container of disinfectant solution, oilcloth
underlayer, an antiseptic solution for cleaning the, tube with a sterile lubricant (Fig.).
Gel bladder catheterization
Preparation for the procedure:
1. Explain to the patient the need for the procedure, its essence, to obtain
consent.
2. Carry out hygienic hand antisepsis. Put on clean gloves.
3. The patient lay on his back, legs bent at the knees and slightly dissolve in
hand.
4. Put under the patient's buttocks with oil cloth napkin (diaper). On top of
the protruding edge of the diaper to put the ship.
5. Prepare the equipment for cleaning the patient.
6. Stand to the right of the patient to his left hand to take a sterile towel, wrap
it the penis below the head.
7. Take the penis between the 3rd and 4th fingers of his left hand, gently
squeeze the head, 1st and 2nd fingers gently push back the foreskin.
8. Take the forceps in the right hand of gauze, moisten in the solution process
furatsilin and head of the penis from the top to bottom of the urethra to the periphery,
changing tampons.
9. Change tweezers, gloves.
10. Wosh your hands perform hygienic antiseptic, put on sterile gloves.
Implementation of procedures
1. Take a sterile forceps in the right hand of the catheter at a distance of 5-7
cm from the beak (beak of the catheter is pushed down). Stroke end of the catheter
over the brush and clamp between the 4th and 5th fingers. The catheter is positioned
over the brush in an arc.
2. Well moisten the catheter tip is a water-soluble lubricant. Enter 5-10 ml of
sterile water-soluble lubricant or anesthetic gel into the urethra.
3. Enter a forceps catheter 4-5 cm, 1-2 holding his left hand the head of the
penis.
4. Steal forceps catheter for another 3-5 cm from the head and slowly sinking
into the urethra to the length of 19-20 cm until urine from the end of the catheter (see.
Fig.).
5. Dip the remaining end of the catheter
into a container to collect the urine.
6. After the cessation of urine to press the
left hand above the pubis to drive out the
remainder of urine from the bladder.
7. Remove the catheter with forceps in the
reverse order.
8. Remove gloves, place them in a
container for waste materials, tweezers - a container with disinfectant.
9. Wash hands, perform hygienic antiseptic, dry, apply a protective cream.
Important to remember that absolutely must not be used to introduce the
catheter mineral oil (mineral oil, etc). Only need to use urethral gels (Katedzhel with
lidocaine, and others.).
Lesson № 17:
5. Methods of collecting urine for the general analysis, Nechiporenko
analysis, Zimnitsky analysis, urine sugar analysis, glycosuric profile.
Methods of collecting urine for laboratory examination
All patients who are hospitalized as a therapeutic as well as in other branches,
be sure to take a urine for laboratory analysis. The correct technique of taking the
urine, utensils and preparation of the patient depends on the correctness of the result
of research and the accuracy of diagnosis. At different times of the day urine has a
different composition, depending on the reception and the nature of food, the amount
of fluid you drink, exercise, temperature, etc. It depends on the amount of urine
introduced into the body fluid, its loss in sweat, on the nature of the food, etc.
Collecting urine for general studies
In urinalysis include determining the color, transparency, relative density
(specific gravity), its reaction, the presence of protein, glucose, and a microscopic
examination of urine sediment. Urine should be taken on the first morning after the
patient's admission to hospital.
Basic rules for the collection of urine for general studies:
1. For a general analysis is desirable to use the entire first morning portion of
urine, which is collected during the night in the bladder. Often, however, in practical
public health recommend to explore send midstream urine volume of at least 100 ml.
2. The urine is collected in a one-off, clean and dry the dishes with a tight
screw cap, after careful toilet of external genitals (regardless of the sex of the
patient).
3. Using pharmacy gum attach an accompanying document (specify the type
of study, the patient's name and initials, department).
Taking urine for analysis is not recommended during menstruation; if there is
a need to then take the urine through a catheter pretreated female external genitalia
disinfectant (Frc solution 1: 5000, or the like.).
Prolonged storage of urine leads to a change in its physical properties, the
growth of bacteria and destruction of elements precipitate. Therefore, if you can not
quickly bring the urine to the laboratory, it is necessary to put in a cool place. The
analysis should be carried out no later than 2 hours after the receipt of the material.
Analysis of urine using test strips
Test strips for use in screening prophylactic examinations, the patient bed in
urgent conditions. Determine the presence of urinary glucose and ketone bodies,
microalbuminuria. There are test strips with a set of reagent zones, which allows you
to use one strip to determine the changes in carbohydrate metabolism, infections of
the urinary tract, liver disease and biliary tract and hemolytic condition. When using
this method it is necessary to carefully follow the instructions for use (for example, at
too short immersion time strips, the result will be incorrect).
The methodology of the test:
1. Take a clean container for urine sample. Use neottsentrifugirovannuyu
thoroughly mixed, freshly portion of urine. Perform the test within an hour urine
collection, or may be distorted results, particularly blood counts, nitrite and
leukocytes.
2. Take the required number of strips from the container and immediately
tightly close the lid.
3. Completely dip the strip into the urine portion Stir for 2 seconds.
4. Carefully remove the traces of urine on the edge of the container with a
urine sample or place the strip on a napkin.
5. Keep the strip in a horizontal position to prevent the connection or other
reagents urine contamination.
6. Observe the reaction time in each reagent area and perform a visual
interpretation of the results, comparing them with a color scale, located on the
container.
7. In interpreting the results with the help of a urine analyzer, use a suitable
test strip and follow the instructions in the relevant operating manual.
Urine on S. Zimnitsky (for Zimnitsky sample)
This test allows you to determine urination and concentration ability of the
kidneys. For the samples previously prepared 8 clean half-liter cans. Each bank is
written portion of the room (№1 to №8) and the time during which each piece is
going. For 3 days for hours, the patient urinates into another bank. Home study at 6
o'clock in the morning when the patient gets up and relieve his bladder into the toilet.
Later in the interval from 600 to 900 hours, he collects the urine in the first bank,
regardless of the frequency of urination, from 900 to 1200 - in the second, etc. The
end of the sample to 600 hours of the next day. At night, the patient awake at 0 hours,
300 hours, and if necessary - and 600 hours. Patients should be warned that it is
necessary to collect all urine without residue. If one of the 3-hour periods of the
patient has not urinated, the bank is left empty. On the contrary, if any 3-hour period
was abundant diuresis, then, if necessary, labeled with the same number of additional
jar and hand over to the lab. Throughout the study the patient is on a normal waterfood mode. In assessing samples taken into account: the total urine output per day;
the ratio of daytime and nocturnal urine; the relative density of urine in all portions
and its fluctuations during the day; fluctuation in urine volume portions.
Urine for Nechiporenko A.
The method used to determine the amount of formed elements in 1 mL of
urine. It is convenient, easy and available for use in any laboratory or hospital clinic.
After careful toilet collect midstream urine of the morning and sent to the laboratory,
where the counting chamber, the number of leukocytes, erythrocytes and hyaline
casts in 1 ml of urine. To collect midstream urine the patient explained that the initial
portion of urine on account of "time" - "two", he sends in the toilet, then a short delay
urination. Further, in a clean, dry jar collects 20-30 ml of urine. It is this portion is
sent to the laboratory, the patient produces the end of urination in the toilet.
Taking urine diastase. Take a few milliliters of warm fresh urine and
immediately sent to the laboratory. This analysis is performed for suspected acute
pancreatitis.
Determination of glucose in urine. For the quantitative determination of
glucose in the urine (glycosuria) urine is collected daily, determines its quantity
stirred urine take a small portion (10-20 ml) and sent to a laboratory where it is
determined the percentage of glucose and calculate daily diuresis given daily
glucosuria.
Note that the currently considered determination of glucose in the daily urine
volume is inefficient because glucose is rapidly destroyed, and to set the exact
concentration impossible.
To assess the severity of glycosuria necessary to calculate the loss of glucose
in the urine per day when determined in each portion of urine.
Collecting urine glyukosurick profile
In the treatment of diabetes with insulin conduct research glycosuria at certain
intervals during the day (glyukozurichesky profile). To this day urine was collected
for separate portions. Such portions may be 3, 5 or 8. Trehportsionnaya urine usually
going from 700 to 1400 hours (morning urine), from 1400 to 1900 hours (daily urine)
and from 1900 up to 700 hours (night urine). At each portion defined by the amount
of urine glucose and the percentage of it is calculated and glycosuria.
Collecting urine for microbiological examination (urine culture)
Morning urine sample is collected in a sterile laboratory container with a lid
(using midstream urine). The urine is delivered to the laboratory within 2 hours after
collection (urine storage allowed in the refrigerator, but no more than 3-4 hours).
Collection of urine is performed prior to drug treatment.
6. Preparation for additional studies of the genitourinary system.
Preparing to X-ray examination of the kidneys and urinary tract.
Survey urography is a type of x-ray, which is a simple x-ray of the kidneys,
ureters and bladder and is used for the diagnosis of diseases of these organs as stones
and foreign bodies, in rare cases, tumors and parasitic diseases (echinococcus),
accompanied by the deposition of an X-ray contrast calcium salts.
IVP is a kind of x-ray contrast which is used for the diagnosis of kidney and
ureter diseases and bladder
Contrast radiography. Depending on the mode of administration, the
radiopaque material (material that does not pass X-rays, whereby the X-ray image is
formed on a shadow) are two types of X-ray contrast kidneys and urinary tract.
• Retrograde urography (urography - X-ray examination method that allows to
obtain images of the urinary tract) - a method of research, when radiopaque substance
injected through a urinary catheter into the ureter. Special training of the patient is not
required.
• When excretion (excretion) urography radiopaque substance injected. This
method allows the study reveal the presence of kidney and urinary tract stones,
abnormalities of cicatricial constrictions, tumor formation (see. Fig.). The rate of
radiopaque substance characterizes the functional ability of the kidneys.
Fig. Excretory urography.
Stages of preparation of the patient to X-ray
examination of the kidneys and urinary tract
following.
1. Purpose of the 2-3 days prior to the study
diet that excludes foods rich in plant fiber and
containing other substances that contribute to
increased formation of gas. Should be excluded from
the food fresh rye bread, potatoes, beans, fresh milk,
fresh fruit and vegetables, fruit juices. If flatulence
prescribed by a doctor patient give activated charcoal.
2. Carrying out tests on individual tolerability of a radiopaque material for 1224 hours prior to the study.
3. Limitation of patients receiving the liquid for 12-18 hours prior to the
study.
4. Statement of enema (to obtain "clean" rinsing water) the night before and
the morning of 2 hours prior to the study. The study was conducted strictly on an
empty stomach.
Radiopaque substance administered to the patient directly to the X-ray room.
Stages of preparation of the patient to X-ray examination of the kidneys and
urinary tract following.
1. Purpose of the 2-3 days prior to the study diet that excludes foods rich in
plant fiber and containing other substances that contribute to increased formation of
gas. Should be excluded from the food fresh rye bread, potatoes, beans, fresh milk,
fresh fruit and vegetables, fruit juices. If flatulence prescribed by a doctor patient give
activated charcoal.
2. Carrying out tests on individual tolerability of a radiopaque material for 1224 hours prior to the study.
3. Limitation of patients receiving the liquid for 12-18 hours prior to the
study.
4. Statement of enema (to obtain "clean" rinsing water) the night before and
the morning of 2 hours prior to the study. The study was conducted strictly on an
empty stomach.
Radiopaque substance administered to the patient directly to the X-ray room.
Ultrasonic research methods (ultrasound or sonography)
Sonography (Greek: the echo -. Echo, echo, grapho - write, paint) is a
diagnostic method based on the principle of reflection of ultrasonic waves transmitted
by tissue from the source sensor ultrasound that is reflected from various structures
(organs, tissues), form an image.
Preparation for ultrasound of the bladder, the prostate gland in men.
A study carried out with the full bladder, so for 4 hours prior to the study
must be unable to urinate. Before transrectal prostate examination performed enema.
7. Feeding features of patients with kidney and urinary tract diseases.
Key therapeutic diets used in patients with diseases of the urinary system
Currently, the base diet used in the course of uncomplicated disease (diet B).
If nephrotic syndrome without violating azotovydelitelnoy function used high-protein
diet M.
A diet with high protein content - Diet N
(High-protein)
It is a diet with a high protein content, the normal amount of fats, complex
carbohydrates and carbohydrate restriction. Limited salt (6-8 g / day), chemical and
mechanical stimuli, stomach, biliary tract. Meals are prepared in boiled, stewed,
baked, mashed and neprotertye form a couple. The temperature of food - from 15 to
60-65 ° C. Free fluid - 1.5-2 l. Rhythm Power fractional, 4-6 times a day.
Indications for: diseases and conditions, requiring the introduction of an
increased amount of protein (malabsorption, kidney disease with nephrotic syndrome
without violating nitrogendeleted function, type 1 diabetes, sepsis and other serious
bacterial disease, severe anemia). Protein content - 110-120 g (including animals 45-60 g), fat - 80-90 g (including plant - 30 g), carbohydrates - 250-350 g, including
mono- and disaccharides ( 30-40 g); refined carbohydrates excluded patients with
diabetes mellitus. Energy value - 2080-2650 kcal. Vitamin C - 70 mg. A close
analogue numbering system: diet 5, 7, 7a, b, 10.
In case of violation of renal function nitrogendeleted used diet low in protein diet N.
A diet with a reduced protein content - N diet
(Low protein)
This protein restricted diet to 0.8, or 0.6, or 0.3 g / kg of ideal body weight
(60, 40 or 20 g / day), a sharp limitation of salt (2-3 g / day) and fluid (0.8-1 l / day).
Excluded nitrogenous extractives, cocoa, chocolate, coffee, salty snacks. The proteinfree diet administered white bread, mashed potatoes, mousses of swellable starch.
The dishes are prepared without salt, boiled, neprotertye. A diet enriched with
vitamins and minerals. Rhythm Power fractional, 4-6 times a day.
Indications for chronic glomerulonephritis with rapidly and moderately severe
violation azotovydelitelnoy kidney function and severe and moderate azotemia.
Cirrhosis of the liver with hepatic encephalopathy.
Protein content - 20-60 g (including animals - 15-30 g), fat - 80-90 g
(including plant - 20-30 g) of carbohydrate - 350-400 g, including mono- and
disaccharides (50-100 g). Energy value - 2120-2650 kcal. Vitamin C - 70 mg. A close
analogue numbering system: diet 5, 7 g.
5. LITERATURE
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Elaida, 2012. - 200 p.
2. Oslopov, VN General nursing care in a therapeutic clinic: Tutorial / VN
Oslopov, OV Epiphany. - M .: GEOTAR - Media 2008.
3. Comb, AL .. Bases of general nursing: Textbook. / AL Comb, AA
Sheptulin. - M .: Medicine, 1991. - 256 p.
4. Murashko VV .. General nursing: Textbook. / VV Murashko, EG
Shuganov, AV Panchenko- M .: Medicine, 1998. - 224 p.
5. Mukhina, SA General nursing. / SA Mukhina, II Tarnovskaya. - M .:
Medicine, 1989. - 326 p.
Head of the department of Internal Diseases No.1
with Endocrinology Course,
PhD, assist. of Professor
E.G. Malaeva