Nursing In Heart Troubles - Care Of Diet
( Originally Published 1921 )
THE nurse should know that diet in heart disease is to be that which is suited to the individual at the time, rather than a special diet fora special disease. Diet that may be suit-able and necessary at the commencement of the care of a person with heart disease may be entirely too restricted later on, or the reverse.
The general rule may be laid down that in heart disease the stomach must not be over loaded; nor, on the other hand, must the interval between food be so great that the person feels faint. So it is often best to give those with heart disease frequent small meals rather than a few large ones. In heart disease, and, indeed, in all other diseases demanding attention to the diet, it should be remembered that the quantity of food, irrespective of its nature, is often the element of greatest importance. The physician examines the blood, and finds out whether the patient is absorbing a large amount of food or not. Many people are greatly benefited by a reduction in the quantity of food for a while, but after a time this must no longer be continued.
The simplest rule in choosing food for heart trouble is to give from the diet list the kind best liked, provided it does not cause him trouble, and then the nurse should regulate the quantity. The danger of . all rules of diet in heart cases is that the person may think it necessary to continue indefinitely what at one time was necessary, but is so no longer. Many elderly people who have eaten heartily all their lives, if they stick to a strict diet for a few months, can after that follow their inclinations because they have broken up bad habits.
The danger of overeating is slight if only such food is taken as needs to be chewed and that food is well chewed before it is swallowed. The act of chewing becomes irksome when the natural demands of the body have been satisfied, tho one can swallow the same amount of food in solution, as, for instance, in a heavy soup, without being aware that he is taking food in excess.
In cases of high blood pressure it is particularly important to restrict the animal food which has a tendency to raise that pressure; this applies especially to persons who have attacks of real angina pectoris. In valvular disease there is often so much congestion of the digestive organs that it becomes a problem to find by experiment what the person can digest; but no limitations are necessary if digestion is normally carried on. If a person with heart trouble has dropsy, then it is important to restrict the amount of salt as much as possible.
In heart trouble milk is an excellent expedient and it may be given in many forms. Lately soured milk has become fashionable, and is indeed a nutritious and wholesome form of food. It is made by introducing the germs of lactic acid fermentation, just as one introduces yeast to make bread. An exclusive milk diet is not sufficiently nourishing for any but temporary use, or in very sick patients who can not digest anything else.
Dr. Graham Steell, in his book on "Diseases of the Heart," gives the following dietary for chronic heart disease: .
Breakfast China tea, or (ii preferred) coffee and cream. Toast, buttered cold, the bread cut in thin slices so as to be, crisp, and fruit bananas, etc. Sugar is better dispensed with; it may be replaced by "Saxin" if the patient insists upon sweetening his tea or Coffee,
Luncheon Mid-Day Meal Any kind of plainly cooked flesh food, with thoroughly cooked green vegetables, which are often best when passed through a sieve. If desirable, these will carry a large quantity of butter which should be of good quality. If something of the nature of pudding be insisted upon, custard or junket (curds and whey) may be permitted, and even a small amount of cream therewith.
Afternoon Tea At four or five o'clock, a cup of china tea without sugar and with cream. Nothing to be eaten.
Dinner Evening Meal A little clear soup (consommé) which promotes the flow of gastric juice. Any kind of flesh food. Thus, fish and joint may be partaken of, provided the quantities of each be small. Green vegetables, as. before. If only one kind of flesh food has been taken, custard or junket may be allowed but it is not recommended.
Certain concessions may be made to individual patients ; thus, an egg may be allowed with breakfast, or the fat of bacon, provided it causes no indigestion; fruit may be allowed after luncheon or dinner (tho carbohydrate,. it seems to interfere with proteid digestion much less than, say a rice pudding).
Potatoes, bread, and farinaceous puddings are to be forbidden with luncheon and dinner, and little fluid is to be drunk with meals. Half a glass of old whiskey or brandy in half a small tumblerful of water may be allowed with these meals, and in certain cases nearly a glass (best taken in warm water) of such spirit at bedtime. On no account is anything to be eaten with this last allowance.
This is quoted as an example of a dietary, but the selection of a diet must be a matter of judgment on the part of the nurse and physician in each case, and not a matter of the application of specific principles. The feeding of sick people is an art not to be taught by precept; it must be learned by experience. The value of food does not depend so much upon its intrinsic digestibility, so long as the patient is able to digest it, as upon its effect upon the condition of the blood when it has been absorbed. Functional derangement of the intestinal organs may be a temporary danger to heart, patients, but ultimate welfare depends upon the maintenance of a proper balance between over and under nutrition, and the correcting and combating of food poisoning or intestinal fermentation.