FEEDING THE SICK
Substances used for food are generally grouped into three classes,
called the three nutrients. The nutrients are: first, the proteids or
nitrogenous substances, which are found in meat, fish, eggs, milk,
cheese, peas, beans, etc.; second, the carbohydrates, which include
sugars and starch; and third, the fats, which are found in butter, oil,
the fat of meat, etc. In addition to the nutrients, water and certain
mineral salts are essential to life, while some indigestible material
like the fibre of vegetables is needed to give bulk and to stimulate the
action of the intestines.
The nutrients furnish the body with materials for growth, and for repair
of tissues worn out by use; they also furnish fuel substances from which
the body obtains its heat and its energy. All three nutrients can serve
as fuel, but the proteids alone can furnish materials for growth and
repair of tissues. In order to be used by the body for any purpose,
nutrients must first go through a series of complicated changes known as
digestion, which renders them soluble so that they can soak through the
walls of the intestine.
THE DIGESTIVE PROCESS
Digestion begins in the mouth. There the food is crushed and its fibres
separated by the teeth, it is moistened by the saliva, and substances in
the saliva begin a chemical action upon the starch. Chewing should be
sufficient to reduce the food to a soft mass well moistened with saliva.
Slow eating is desirable, but the emphasis should be placed on thorough
chewing. For instance, long intervals between bites are of no special
benefit if mouthfuls of food are washed down by swallows of water.
After it has been swallowed, the food passes into the stomach and
remains there for a variable length of time, while it undergoes further
preparation for absorption. It is moved about by the contraction of the
muscular walls of the stomach, so that it becomes mixed with the stomach
juices and more thoroughly softened. Some digestion of proteids goes on
in the stomach, and a little absorption through the walls.
Little by little the food is discharged from the stomach into the small
intestine, and the most important part of digestion then begins. It is
acted upon chemically by a fluid flowing into the intestine from an
organ called the pancreas; this pancreatic juice acts upon all three
nutrients and is of great importance in the digestive process. The bile
and other juices that flow into the intestine perform important
functions also.
The food masses are moved along by rhythmic contractions of the
intestine, and absorption goes on when the food has been so changed that
it can soak through the intestinal walls into the blood and lymph
vessels. The small intestine is about 20 feet long, and consequently
affords a large surface for absorption, as does also the large
intestine, into which the small intestine opens. The blood and lymph
carry the digested food substances to all parts of the body, and thus
the different tissues are provided with the materials they need for
growth, repair, and energy. Excess of food substances may be stored as
fat or expelled from the body.
As the blood and lymph go through the tissues they take from the tissues
the refuse, or the part that remains after the fuel substances have been
consumed. This refuse from the tissues may be likened to the ashes from
a furnace; it is finally eliminated from the body through the kidneys
and lungs, and to some extent through the skin and bowels. The part of
the food that is not digested of course never soaks through the
intestinal walls; it merely passes through the small and large
intestines and is finally expelled as feces or bowel movements. The
characteristic odor of fecal matter results from the action of bacteria
upon it while in the large intestine.
It must be remembered that the body is not nourished merely by
swallowing food: in order to nourish the body food must also be
digested, absorbed, and made use of by the tissues. Many factors may
operate both in health and in sickness to render food indigestible. It
may be originally unsuited to the human digestive apparatus, or spoiled,
or poor in quality, or badly cooked. But even when wholesome in itself
it may be ill-adapted to a particular person at a particular time; thus
it may be too great in amount, or eaten at improper hours. Moreover a
person's own idiosyncrasy or manner of living or fatigue or illness may
render it especially indigestible for him.
Experiments have shown that pain, fear, worry, and other unpleasant
emotions actually stop the action of the digestive juices and check
muscular contractions of the small intestine. Furthermore, even the
absence of pleasant anticipation of food has been shown to delay
digestion for hours. Thus scientific knowledge confirms our common
experience that such mental states seriously interfere with digestion.
The converse is also true. Agreeable taste and odor of food, or even
pleasurable thought of it, start the secretion of digestive fluids. It
is a common saying that the mouth waters at the prospect of inviting
food, but it is less well known that appetizing food does actually start
the stomach juices also. A person who understands the physiological
effect that the emotions have upon digestion is in a far better frame of
mind to cope successfully with the difficulties of feeding the sick than
one who considers sick persons' likes and dislikes entirely irrational.
FEEDING THE SICK
Nourishing the sick is not always an easy problem, but its importance
can hardly be overestimated. Indeed, proper feeding in many illnesses
makes the difference between life and death. The actual amount of
nourishment needed in sickness is often less than in health, but it may
be just as great, or even greater if the illness causes increased tissue
waste. Yet the digestive process of a sick person must be rendered as
little laborious as possible, all foods ordinarily difficult to digest
must be eliminated, certain others must be withheld or restricted
according to the nature of the sickness, and in addition one may have to
deal with an appetite that is capricious, diminished, or totally absent.
Diet for the sick is often a part of medical treatment; in such cases
the doctor will prescribe special diets and his orders must be carefully
carried out. Except for special diets, food for the sick is generally
divided into four classes: first, liquid or fluid diet; second,
semi-solid diet; third, light or convalescent diet; and lastly, full
diet. These diets are not very sharply distinguished.
LIQUID DIET generally includes milk, eggnog, albumen water, broths,
soup, beef juice, thin gruel, and beverages. Liquid diet makes least
demand upon the digestive powers, because it consists of food already
dissolved and therefore nearer the condition in which it can be
absorbed. Moreover, it is less likely than other foods to contain excess
of fat, improperly cooked starches, and other indigestible material.
Liquids must be given at regular intervals and at shorter intervals than
solid foods; 6 to 8 ounces every two or three hours is not too much if
the patient can take it. The doctor usually specifies the amount and the
interval. Some patients will take more nourishment at one time if the
interval is slightly increased.
SEMI-SOLID DIET includes all fluids and in addition soft milk toast,
soft cooked eggs, well cooked cereal, custards, ice cream and ices,
junket, and gelatine jellies. Liquid or semi-solid diet is commonly
given in acute fevers because digestive juices and other fluids of the
body are then diminished, and also because their digestion places a
minimum of work upon a system already burdened with bacterial poisons.
LIGHT OR CONVALESCENT DIET generally means a simple mixed diet. In
addition to the articles in the two preceding diets it includes oysters,
chicken, baked potatoes, most fruits except bananas, simple desserts,
white fish, and other meats and vegetables added judiciously until full
diet is reached. Fried foods should not be included.
FULL DIET means an unrestricted menu, but even from full diets
especially indigestible foods should be excluded. The principles of
feeding sedentary persons as described in manuals of dietetics apply to
patients who are obliged to be inactive although not really ill, as for
example, a patient suffering from a broken leg. Ordinarily in such
cases, as in other kinds of illness, the appetite is greatly diminished,
but a word of warning should be given against overfeeding patients whose
meals are their chief interest. Such patients are only too likely to
interpret full diet as anything they desire in any quantity at any time
of day or night, and then to attribute their discomfort and irritability
to their illness rather than to overeating.
Constipation is especially stubborn in sickness, since the patient is
deprived of his usual exercise and variety of food. So far as possible
the bowels should be regulated by diet. Laxative foods include most
vegetables with a large amount of fibre, coarse cereals and flour, oils
and fats, and most fruits and fruit juices. Unfortunately many laxative
foods are difficult for sick persons to digest and must therefore be
used with caution. A glass of hot or cold water or orange juice an hour
before breakfast may be helpful, and at bed time hot lemonade, oranges,
prunes, figs, or other fruit if allowed.
It is essential for patients to drink water freely, and it should be
given between meals and also between liquid nourishments. Persons
inexperienced in the care of the sick frequently make the mistake of
bringing water only when a patient asks for it.
Many acute illnesses begin with fever, headache, sore throat, and
especially among children with vomiting, diarrhœa, and other digestive
disturbances. In such cases all food should be withheld until the doctor
comes, but boiled water, hot or cold, should be given freely. Efforts to
tempt the appetite are then mistaken; few people are injured and many
are benefited by omitting food even for 24 hours at the beginning of an
acute illness, and with few exceptions a doctor can be found in a
shorter time.
SERVING FOOD FOR THE SICK.--Food for the sick should always be most
carefully prepared and of the best quality, and in addition it should be
as inviting, as varied, and as well served as possible. Neglect in these
respects is inexcusable. Even slight carelessness in preparing or
serving food may arouse disgust and thus banish permanently some
valuable article from the dietary.
Trays, dishes, tray cloths, and napkins for the patient must be
absolutely clean and as attractive as possible. Cracked or chipped
dishes should not be used. Individual sets of dishes for the sick may be
purchased, and their convenience makes them well worth their price.
Paper napkins may be used in many cases to save laundry work; clean
white paper is always superior to soiled linen.
Before the tray is brought to the bedside, everything should be arranged
so that the patient can eat in comfort. It is bad management to let the
soup cool while the patient's pillows and table are being adjusted. In
setting the tray great care should be devoted to placing the articles
conveniently, and to the appearance and garnishing of the food. Careful
serving requires more thought, but little if any more actual time than
slovenly serving. Dishes should not be so full that food is spilled in
transit; hot dishes should be covered; hot dishes should reach the
patient hot, and cold dishes cold. Liquid nourishment in a glass or cup
should be served on a small tray or plate covered with a doily. Neither
glass nor cup should be held by the rim.
It is not uncommon to overload trays and to serve everything at once in
order to save steps, but a patient is ordinarily more interested in a
meal that is served in courses unless very long intervals elapse
between. Moreover, if the meal is served in courses he is not tempted to
eat dessert first and then to refuse the rest of the meal. If food is
given sufficiently often it is safer to err on the side of serving too
little at a time rather than too much, since the sight of large amounts
of food is often disgusting.
The patient's likes and dislikes should be considered as far as
possible, but most patients should not be consulted about their menus
beforehand. Great variety in one meal is not necessary; it should be
introduced by varying successive meals. An article that has been
especially disliked should not be served a second time, unless it can be
disguised beyond a possibility of detection. An article of food to which
a patient objects should be removed at once; one may appear disappointed
if it seems wise, but should never argue. When patients persistently
refuse necessary nourishment a difficult situation is presented;
persuasion and every form of ingenuity must be used, and the doctor's
coöperation enlisted. When, for example, a strict milk diet is ordered
for a patient who announces that he never takes milk in any
circumstances the situation may seem hopeless but it is not necessarily
so.
TO FEED A HELPLESS PATIENT.--Helpless and weak patients must be assisted
to eat or drink. A napkin should first be placed under the patient's
chin. The attendant should place her hand under the pillow, raise the
head slightly, and hold the glass to his lips with her other hand. An
ordinary tumbler can be used by a patient lying down if it is not more
than a quarter full, or a special feeding cup may be purchased. Bent
glass tubes may be used for cool liquids; they should be washed
immediately after use. A child who can sit up sometimes takes more
nourishment if it is given through a soda water straw.
If the patient must be fed with a spoon care should be taken that the
liquid is not too hot, but the attendant should not blow upon it to cool
it. It should be given from the point of a spoon placed at right angles
to the lips, and plenty of time between mouthfuls should be allowed. A
swallow should not be given at the moment when the patient is drawing
the breath in. Great patience is required if a helpless person is to be
fed acceptably. The attendant should sit by the bedside rather than
stand, should present at least the appearance of having unlimited time,
and should endeavor not to deprive the patient in any way of the
satisfaction he may derive from his nourishment.
EXERCISES
1. What needs of the body do food substances supply?
2. Give an outline of the digestive process.
3. Describe the effect of different mental states upon digestion, and
give examples of the ways by which a knowledge of these effects may be
utilized in feeding patients.
4. Why is the problem of nourishing the body of especial importance in
sickness?
5. Name the four ordinary classes of diet for the sick, and mention all
the articles you can belonging to each class.
6. Why is constipation a common ailment among patients confined to bed,
and what attempts should be made to overcome it by the diet?
7. Why is it necessary for sick persons to drink water freely, and what
efforts should the attendant make to encourage them to do so?
8. Describe the proper serving of a patient's tray.
9. How should helpless patients be assisted to eat?
FOR FURTHER READING
Health and Disease--Roger I. Lee, Chapter II.
The Human Mechanism--Hough and Sedgwick, Chapters VIII, XIII, XIX.
Notes on Nursing--Florence Nightingale, Pages 63-79.
How to Live--Fisher and Fisk, Chapter II.
Bodily Changes in Pain, Hunger, Fear and Rage--Cannon, Chapter I.
Food for the Invalid and the Convalescent--Winifred S. Gibbs.
Practical Dietetics--Pattee, Chapters IV, V.
Feeding the Family--Rose.
Diet in Health and Disease--Friedenwald and Ruhrah.
Feeding Children from Two to Seven Years Old--New York City Department
of Health.
American Red Cross Text Book on Home Dietetics--Ada Z. Fish.
Emergency Cooking--Pamphlet 708, American Red Cross.
War Diet in the Home--Pamphlet 706, American Red Cross.
Red Cross Conservation Food Course for Children and Special
Classes--Pamphlet 705, American Red Cross.