Nursing Experience of Early Application of Nasoenteric Tube for Enteral Nutrition in Critically Ill ICU Patients

Objective:To investigate the effective nursing measures of early application of nasoenteric tube for enteral nutrition in critically ill patients in ICU,and to summarize the nursing experience.Methods:The study was carried out in June 2023–November 2023.62 samples of ICU critically ill patients were selected,all of whom used enteral nutrition by mesenteric tube and were grouped into an observation group(n=31)and a control group(n=31)by using the numerical table randomization method.The patients in the control group were basic nursing interventions,and the patients in the observation group were comprehensive quality care,comparing the nutritional indexes,complication rates,and nursing satisfaction between the two groups.Results:All nutritional indicators of the observation group were higher than those of the control group after nursing intervention(P<0.05);the complication rate of the observation group was lower than that of the control group(P<0.05);the nursing satisfaction of the observation group was higher than that of the control group(P<0.05).Conclusion:Comprehensive quality nursing care during the early application of a gastroenteric tube for enteral nutrition in critically ill patients in the ICU can improve nutritional indexes,reduce the incidence of complications and improve nursing satisfaction.

Application of early enteral nutrition nursing based on enhanced recovery after surgery theory in patients with digestive surgery

BACKGROUND Postoperative nursing can improve the restlessness and gastrointestinal function of patients with tracheal intubation under general anesthesia in digestive surgery.Wide application of various nursing methods and routine nursing in periop-erative nursing of patients with general anesthesia in digestive surgery.AIM To investigate the impact of early postoperative enteral nutrition nursing based on the enhanced recovery after surgery(ERAS)theory on postoperative agitation and gastrointestinal recovery in patients undergoing general anesthesia that experienced tracheal intubation.METHODS The data of 126 patients with digestive surgery from May 2019 to February 2022 were retrospectively analyzed.According to different nursing methods,they were divided into control group and observation group,with 63 cases in observation group and 63 cases in control group.The patients in the control group had standard perioperative nursing care,whereas those in the observation group got enteral nourishment as soon as possible after surgery in accordance with ERAS theory.Both the rate and quality of gastrointestinal function recovery were compared between the two groups after treatment ended.Postoperative anes-thesia-related adverse events were tallied,patients'nutritional statuses were monitored,and the Riker sedation and agitation score(SAS)was used to measure the incidence of agitation.RESULTS When compared to the control group,the awake duration,spontaneous breathing recovery time,extubation time and postoperative eye-opening time were all considerably shorter(P<0.05).There was no significant difference in the recovery time of orientation force between the two groups(P>0.05);however,the observation group had a lower SAS score than the control group(P<0.05).The recovery time for normal intestinal sounds,the time it took to have the first postoperative exhaust,the time it took to have the first postoperative defecation,and the time it took to have the first postoperative half-fluid feeding were all faster in the observation group than in the control group(P<0.05);Fasting blood glucose was lower in the observation group compared to the control group(P<0.05),while the albumin and hemoglobin levels were higher on the first and third postoperative days;however,there was no statistically significant difference in the incidence of anesthesia-related adverse reactions between the two groups(P>0.05).CONCLUSION The extremely early postoperative enteral nutrition nursing based on ERAS theory can reduce the degree of agitation,improve the quality of recovery,promote the recovery of gastrointestinal function,and improve the nutritional status of patients in the recovery period after tracheal intubation under general anesthesia.

Nutritional Screening Tools in Institutionalized People: A Case Study of Using Nutritional Risk Screening (NRS 2002) and Mini Nutritional Assessment (MNA)

Nutritional status expresses the physiological and nutritional needs to maintain the composition and adequate functioning of the organism. NRS 2002 and MNA protocols were applied to short-term institutionalized patients in Rio Verde (Brazil). Older adults and people with special needs of all ages, both sexes, regardless of possible pathology they may have, except if it causes contagion, were included, patients duly authorized by the person responsible for the institution and who were able to undergo evaluation. Thirty-eight patients from the institution were evaluated, of which ten were excluded from the research according to pre-established criteria. More than 50% of participants were male, with an overall average age of 63.43 years. The characteristics related to nutritional status by NRS 2002 and MNA showed that the risk of malnutrition and its absence are associated with a wide age range. The MNA presents a more nuanced nutritional risk classification, showing that even 61% of the 96% of participants who would be out of nutrition risk, according to the NRS 2002, are “at risk of malnutrition”. Applying the MNA can demonstrate more conservative results than the NRS 2002.

Enhanced recovery after surgery-based nursing in older patients with postoperative intestinal obstruction after gastric cancer surgery:A retrospective study

BACKGROUND Gastric cancer-related morbidity and mortality rates are high in China.Patients who have undergone gastric cancer surgery should receive six cycles of chemotherapy according to their condition.During this period,intestinal obstruction is likely to occur.Electrolyte balance disorders,peritonitis,intestinal necrosis,and even hypovolemic shock and septic shock can seriously affect the physical and mental recovery of patients and threaten their health and quality of life(QoL).AIM To quantitatively explore the effects of enhanced recovery after surgery(ERAS)-based nursing on anxiety,depression,and QoL of elderly patients with postoperative intestinal obstruction after gastric cancer.METHODS The clinical data of 129 older patients with intestinal obstruction after gastric cancer surgery who were treated and cared for in our hospital between January 2019 and December 2021 were examined retrospectively.Nine patients dropped out because of transfer,relocation,or death.According to the order of admissions,the patients were categorized into either a comparison group or an observation group according to the random number table,with 60 cases in each group.RESULTS After nursing care,the observation group required significantly less time to eat for the first time,recover bowel sounds,pass gas,and defecate than the comparison group(P<0.05).No significant difference was noted in nutrition-related indicators between the two groups before care.Before care,the Symptom Check List-90 scores between the two groups were comparable,whereas anxiety,depression,paranoia,fear,hostility,obsession,somatization,interpersonal sensitivity,and psychotic scores were significantly lower in the observation group after care(P<0.05).The QoL scores between the two groups before care did not differ significantly.After care,the physical,social,physiological,and emotional function scores;mental health score;vitality score;and general health score were significantly higher in the observation group,whereas the somatic pain score was significantly lower in the observation group(P<0.05).CONCLUSION ERAS-based nursing combined with conventional nursing interventions can effectively improve patient’s QoL,negative emotions,and nutritional status;accelerate the time to first ventilation;and promote intestinal function recovery in elderly patients with postoperative intestinal obstruction after gastric cancer surgery.

The Effect and Nursing of Indwelling Nasal Jejunal Feeding Tube for Enteral Nutrition in Acute Severe Pancreatitis

Objective:To analyze the effect of enteral nutrition and nursing intervention in patients with indwelling nasojejunal tube in acute severe pancreatitis.Methods:Sixty cases of patients with indwelt nasojejunal tubes treated in our hospital from August 2019 to August 2020 were divided into routine group and observation group as research subjects.Patients in both groups received enteral nutrition,patients in the routine group received routine care,and patients in the observation group received quality care.The recovery time of gastrointestinal function,length of hospital stay,hospitalization cost,nutritional indicators and incidence of complications in the two groups were compared.Results:The recovery time of gastrointestinal function in observation group was lower than that in routine group,P<0.05;The length and cost of hospitalization in observation group were lower than those in routine group,P<0.05;The nutritional indexes in observation group were higher than those in routine group,P<0.05;The incidence of complications in observation group was lower than that in routine group,P<0.05.Conclusion:Quality nursing service improve the effect of enteral nutrition,so as to ensure that patients get sufficient nutritional support.Its effect is remarkable and it is worthy of widespread clinical application.

Nursing Diagnostics of Nutrition Domain of NANDA International in Hemodialysis Patients

Introduction: The dialysis causes the loss of the nutrients and the elevation of catabolism, thus, patients in dialysis have at high risk for the loss of body reserves of protein and energy. Objective: To identify nursing diagnoses of nutrition domain of NANDA International in hemodialysis patients and to correlate them to the socioeconomic and clinical data. Design: Cross-sectional study. Setting: Performed in a large university hospital in northeastern Brazil. Participants: The first stage was carried out with 50 patients, selected with the following inclusion criteria: Being hospitalized and undergoing hemodialysis in that hospital;aged 18 years old or over;being conscious and oriented. Exclusion criteria were patients undergoing hemodialysis in that hospital with external service, pregnant women and patients being treated by plasmapheresis. In the second stage, participants were three nursing specialists in nephrology and nursing diagnoses. Methods: The defining characteristics of the nursing diagnoses inserted in the nutrition domain were observed in patients and then these data were judged by nurses, in order to identify diagnoses present in each patient. The Chi-square, Fisher’s exact and Mann-Whitney tests were used in the analysis of the relationship of socioeconomic and clinical data, with an adopted p value of p = 0.001), origin (p = 0.014), religion (p = 0.046) and income (p = 0.039), respectively. Conclusion: The variables that showed significant association were risk of impaired liver function and gender;imbalanced nutrition: More than body requirements and origin requirements;risk for deficient fluid volume and religion;and deficient fluid volume and income.

Nutritional Evaluation by Nurses and Physical Recovery of Malnourished Patients after Esophagectomy

Following an esophagectomy, nurses’ patient nutrition observations are important for physical recovery and quality of life. The study proposed to identify the factors associated with physical recovery among esophageal cancer patients after surgery based on nurses’ observations and nutritional evaluations. Data were collected from the nursing records of 21 esophagectomy patients. The data included patients’ rate of weight loss, body mass index (BMI), energy intake, and postoperative complications. Patients were divided into two groups according to their weight loss rate: <8% and ≥8%. Patient outcomes were compared between the two groups. There was no difference in average BMI before or after surgery between the two groups. There was no difference in albumin levels during hospitalization;however, after esophagectomy, energy intake at discharge was insufficient in both groups. The ≥8% weight loss may be facilitated, or at least confounded, by the presence of recurrent nerve paralysis and aspiration pneumonia. Thus, the nursing records typically identified the need to check for recurrent laryngeal nerve palsy and aspiration pneumonia in conjunction with nutritional assessment to enhance patients’ physical recovery. When weight loss was significant, nurses provided oral intake support with the NST, and patients maintained oral intake levels similar to the group with weight loss under 8%. In order to better support physical recovery among malnourished, post esophagectomy patients, nurses need to monitor for signs of recurrent nerve palsy and aspiration pneumonia in addition to nutritional intake.

Construction and Evaluation of a Nutrition Nurse Specialist Training Center Impact Statement

Background: To construct and evaluate the new Clinical Nutrition Nurse Practice Training Center in Guangdong Province. Methods: Seventy-four specialized nutrition nurses were trained from 2019-2020. Their core abilities and performance of duties were evaluated using the Clinical Nutrition Specialty Nurses Core Competence Self-evaluation Scale. This study adhered to the Revised Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) guidelines. This study was approved by the Ethics Committee of “The Third Affiliated Hospital of Sun Yat-sen University”. Results: The nurses obtained higher results one year after graduation compared with before training. Except for the areas of writing and participation, all training dimension differences were statistically significant (p Conclusions: The results indicate that the training provided in the Clinical Nutrition Nurse Practice Training Center is effective in improving the quality of specialist nursing as a whole.

Elderly Persons Aged 80 Years and Older and Their Nutritional Status

A challenge for health care providers is that there will be a distinct rise globally in the number of elderly people aged 80 years and over. Malnutrition is a well-known problem among elderly people;few studies have focused on the nutritional status of those aged over 80, irrespective of whether they live in nursing homes (NHs) or in ordinary housing. The aim of the study was to examine the nutritional status of elderly people aged 80 or older. The study was cross-sectional with 64 elderly persons (80 - 100 years old) living in NHs (n = 35) or in ordinary housing (n = 29). Their nutritional status was assessed with the Mini Nutritional Assessment. Among the elderly people living in NHs, half were at risk and one fourth were suffering from malnutrition. Ten percent of the elderly persons in ordinary housing were found to be at risk;none were malnourished. Thirty-one percent had BMI values <23. The majority of the participants ate 2 - 3 meals per day and were prescribed more than three medications daily. Although not statistically significant, well-nourished participants were more likely to be married, and to rate their psychological and physical health very good/good compared to participants who were at risk of becoming malnourished or were malnourished. In conclusion, the results indicate that special attention regarding nutritional intake is required for those aged 80 years and older irrespective of type of accommodation. The RNs have a responsibility to identify the problems and needs and to implement and evaluate nutritional care in this age group. There is a further need for knowledge regarding the effects of both nutritional interventions and of their optimum timing.

Nursing Diagnosis in Patients with Liver Cirrhosis in Use of Feeding Tube

The objective was to identify the most frequent nursing diagnoses labels in patients with liver cirrhosis in use of feeding tube. A descriptive research was carried out in a Brazilian Hospital with 20 adult patients. Systematic data collection utilized the Conceptual Model of Wanda Horta, the first nurse to introduce the concept of Nursing Process in Brazil. The six phases of the nursing diagnostic reasoning proposed by Risner were used;nursing diagnoses were described according to NANDA-I taxonomy II. Patients were mainly male;half of them were middle age adults;they had an average of 12.8 nursing diagnoses labels;and the most frequent were: risk for aspiration and risk for infection. Nurses needed to develop effective skills to properly diagnose in order to provide safe care and improve patient outcomes.

The relation between pregnant adolescents’attitude about nutrition and weight gain during pregnancy and hemoglobin level

Purpose: This study is carried out to analyze the relation of weight raise and hemoglobin level during pregnancy of pregnant adolescents to their nutriational attitudes. Methods: This study is a cross-sectional study carried out to examine the relationship between nutrition habits vs weight and level of hemoglobin in the 49 pregnant adolescents participants (≤18 years of age) who had applied to pregnant and emergency services in Sammas Vehbi Ekecik Gynecology and Children’s Hospital in the city of Aksaray, Turkey, between February 15 and March 25 2004, and accepted to participate in this study. General information regarding the pregnant adolescents, their knowledge on nutrition and nutritional habits were filled in during face-to-face interviews. These pregnant adolescents were monitored during the months of April, May, June and July and their measurements were taken. Data of the study were analyzed in a computer. Results: When the nutritional knowledge scores of the pregnant adolescents are considered, it was seen that 30 (61.2%) had a good knowledge level, 10 (20.4%) had a knowledge of intermediary level, and 9 (18.3%) had a low or insufficient level of knowledge. As for the nutrition habit scores, 28 of pregnant adolescents (57.1%) had fine, and 21 of them (42.7%) had poor and inadequate levels of nutrition habits. Conclusion: When the relation between the hemoglobin levels measured of the pregnant adolescents’ according to the their nutrition knowledge scores and the distribution of their habits was analysed, it was not found meaningful (p > 0.05).

老年髋部骨折患者围术期营养管理最佳证据总结

目的检索老年髋部骨折患者围术期营养管理的相关证据,并对最佳证据进行总结。方法检索中国知网(CNKI)、UpToDate、英国国家卫生与临床示范研究所(NICE)、Cochrane Library、苏格兰大学校际指南协作网(SIGN)、美国国立临床诊疗指南数据库、中国医脉通指南网、PubMed、维普生物医学期刊数据库、ovid(Embase)、中华医学期刊全文数据库、中国生物医学文献和万方医学网中关于老年髋部骨折患者围术期营养管理的临床决策、指南、证据总结、系统评价、专家共识等相关文献,检索时限为2015年1月—2023年9月。结果本研究共纳入13篇文献,包括5篇指南、4篇专家共识、4篇系统评价,从营养支持目标、营养评估与筛查、术前营养支持、术后营养支持、营养干预原则、饮食管理6个方面共汇总出32条最佳证据。结论本研究总结了老年髋部骨折患者围术期营养管理的最佳证据,可帮助医护人员更好地对老年髋部骨折患者实施有效的围术期营养管理。

营养支持专科护士临床教学基地建设的探索

营养支持专科护士培训是培养临床营养高级护理实践人才的重要举措。河南省人民医院作为首批中华护理学会营养支持专科护士京外临床教学基地,通过完善软硬件设施,从组织管理、制度建设、师资管理、培训实施、培训保障和质量控制6个方面建设培训管理体系,初步形成较为合理的营养支持专科护士临床实践培训模式,在师资队伍建设、人才培养、科研创新等方面均取得较好成效。

追踪营养护理在老年结直肠癌手术患者中的应用效果

目的:观察追踪营养护理在老年结直肠癌手术患者中的应用效果。方法:选取2019—2022年该院收治的126例老年结直肠癌手术患者进行前瞻性研究,按照随机数字表法将其分为观察组和对照组各63例。对照组实施常规护理,观察组在对照组基础上实施追踪营养护理。比较两组护理前后营养指标[白蛋白(ALB)、总蛋白(TP)、前白蛋白(PA)、转铁蛋白(TF)]水平、健康状况[卡氏功能状态(KPS)]评分、生命质量[生活质量综合评定问卷-74(GQOLI-74)]评分,以及护理满意度。结果:护理后,观察组TP、PA、ALB、TF水平均高于对照组,差异有统计学意义(P<0.05);护理后,观察组KPS、GQOLI-74评分均高于对照组,差异有统计学意义(P<0.05);观察组护理满意度为98.41%(62/63),高于对照组的85.71%(54/63),差异有统计学意义(P<0.05)。结论:追踪营养护理应用于老年结直肠癌手术患者可提高营养指标水平、健康状况评分、生命质量评分和护理满意度,效果优于常规护理。

1例喉移植患者术后多学科营养支持护理

总结2023年4月29日亚洲首例喉移植患者术后多学科的营养支持护理经验。护理要点包括组建多学科营养管理团队;实施精准化的营养支持:选择恰当的方法建立鼻饲管路、精准配制营养制剂、遵循营养制剂喂养原则、预防误吸、保持鼻饲管道固定通畅、适时监测及处理营养喂养并发症;定期监测营养指标,适时调整营养补给方案,促进患者早期康复。患者术后68 d恢复良好,体质量67 kg, BMI为21.63 kg/m2,血红蛋白89 g/L,总蛋白62.9 g/L,白蛋白39.2 g/L,球蛋白20.7 g/L,身体各项指标达到出院标准,情绪稳定,生活基本自理,顺利出院。

前馈控制理论下肠内营养护理模式在脓毒症患者中的应用

目的 探讨前馈控制理论下肠内营养护理模式在脓毒症患者中的应用效果。方法 通过便利抽样法选取2019年1月至2022年12月南通市第三人民医院住院治疗的脓毒症患者200例,以随机数字表法将其分为对照组和试验组,各100例。对照组采用常规肠内营养护理,试验组在对照组的基础上行前馈控制理论下肠内营养护理。比较护理前后两组机体营养状态、炎性因子水平及病情状态恢复情况。结果 护理后,试验组腹泻、腹胀、呕吐、胃潴留总不良反应发生率低于对照组(P<0.05);护理后,两组白蛋白、前白蛋白、血红蛋白均高于护理前,且试验组高于对照组(P<0.05);两组急性生理学和慢性健康状况Ⅱ评分均低于干预前,且试验组低于对照组(P<0.05)。结论 前馈控制理论下肠内营养护理模式可提升脓毒症患者的营养状态,降低炎症因子水平,促进急性病情和慢性病情的恢复。

营养支持链式管理在胃癌围术期患者中的应用

目的探讨围术期营养支持链式管理对胃癌患者术后营养状况及营养知信行水平的影响。方法将胃癌患者162例按住院时间分为对照组82例(2021年6—12月入院)、干预组80例(2022年1—6月入院)。对照组实施常规围术期营养管理,干预组实施营养支持链式管理,术后1个月比较2组患者的营养状况及营养知识知信行水平。结果干预组术后1个月总蛋白<60 g/L占比为5.00%,低于对照组的14.63%;干预组术后1个月白蛋白<35 g/L占比为3.75%,低于对照组的13.41%;干预组术后1个月体质量指数(BMI)正常范围者占比83.75%,高于对照组的59.75%,差异有统计学意义(P<0.05)。干预组术后1个月营养知识、支持态度、支持行为维度得分以及营养知信行总分均高于对照组,差异有统计学意义(P<0.05)。结论围术期实施营养支持链式管理能有效增加患者营养摄取量,改善胃癌患者术后营养状况,提升患者营养知信行水平和生活质量。

早期精细化护理干预联合序贯式营养治疗对脑卒中后吞咽功能障碍患者的疗效观察

目的探讨早期精细化护理干预联合序贯式营养治疗对脑卒中后吞咽功能障碍患者的疗效。方法选取2021年1月至2023年6月四川大学华西医院收治的124例脑卒中后吞咽功能障碍患者为研究对象,在组间基线特征可比的原则上,采用随机数字表法分为对照组和观察组,每组62例。对照组给予常规护理干预联合常规营养治疗,观察组给予早期精细化护理干预联合序贯式营养治疗,两组患者均连续治疗3个月。比较分析两组患者治疗前后的吞咽功能、胃肠道屏障功能[二胺氧化酶(DAO)、D-乳酸]、营养状况[白蛋白(ALB)、血红蛋白(Hb)、转铁蛋白(TF)、前白蛋白(PA)]、心理状况与生活质量[症状自评量表-90(SCL-90)评分、吞咽障碍特异性生活质量量表(SWALQOL)评分]。结果治疗前,两组患者的吞咽功能比较差异均无统计学意义(P>0.05);治疗3个月后,两组患者的吞咽功能与治疗前比较均明显改善,且观察组优于对照组,差异均有统计学意义(P<0.05)。治疗前,两组患者的DAO、D-乳酸、ALB、Hb、TF、PA、SCL-90评分、SWAL-QOL评分比较差异均无统计学意义(P>0.05);治疗3个月后,两组患者的DAO、D-乳酸、SCL-90评分与治疗前比较均降低,且观察组低于对照组,差异均有统计学意义(P<0.05);治疗3个月后,两组患者的ALB、Hb、TF、PA、SWAL-QOL评分与治疗前比较均升高,且观察组高于对照组,差异均有统计学意义(P<0.05)。结论早期精细化护理干预联合序贯式营养治疗有利于改善脑卒中后吞咽功能障碍患者的吞咽功能、胃肠道屏障功能、营养状况及心理状况,且可提高患者的生活质量,值得临床应用。

护士在肿瘤患者家庭肠内营养管理中的作用与思考

家庭肠内营养是指将营养液通过胃肠道输送给病情稳定但无法满足营养需要的患者,可以改善患者营养状况、提高其生活质量,是肿瘤患者营养治疗的重要组成部分。患者及照顾者是家庭肠内营养的重要实施者,但常常因为其操作不当、并发症认知不足等问题而出现能量摄入不达标或肠内营养中断的情况,需要营养支持团队的长期监测与管理,目前虽有循证医学证据为肿瘤患者家庭肠内营养管理提供参考,但仍需要本土化的实践验证。护士作为肿瘤患者家庭肠内营养管理团队的重要一员,承担着协调沟通者、教育者、研究者和伦理决策者的角色,从而促进团队间的沟通协调,加强患者的健康教育,保障肿瘤患者家庭肠内营养管理顺利进行。本文介绍了家庭肠内营养的概念与内涵、重点阐述护士在家庭肠内营养管理中的作用与思考,以期对护士在肿瘤患者家庭肠内营养管理中更好发挥作用有所启示。

耳穴揿针对改善胃癌根治术后患者胃肠功能及营养状况的效果

目的探讨耳穴揿针对胃癌根治术后患者胃肠功能及营养状况的影响。方法选取2021年6月—2022年3月江苏省中医院接受胃癌根治术的68例患者为研究对象,按照组间基本特征具有可比性的原则分为观察组与对照组,每组34例。对照组患者予以常规护理,观察组患者在此基础上接受耳穴揿针疗法,两组患者干预3天,对比其胃肠功能恢复情况、术后第3天的胃肠道不良反应、术后第7天的机体营养状况。结果观察组患者术后肠鸣音恢复时间、首次排便时间短于对照组,组间比较差异有统计学意义(P<0.05);两组患者术后首次排气时间比较差异无统计学意义(P>0.05)。观察组患者术后第3天腹胀、恶心呕吐发生率低于对照组,组间比较差异有统计学意义(P<0.05)。术前1 d,两组患者的血清总蛋白(TP)、前白蛋白(PA)比较差异无统计学意义(P>0.05);术后7 d,两组TP水平比较差异无统计学意义(P>0.05),但观察组患者PA水平高于对照组,组间比较差异有统计学意义(P<0.05)。结论耳穴揿针可以促进胃癌术后患者肠鸣音恢复,缩短首次排便时间,有效降低胃癌根治术后患者恶心、呕吐及腹胀的胃肠道不良反应发生率,提高术后患者机体营养水平,从而提升生活质量,促进术后康复。