ch45: nutrition -- interventions

Question 1

assess current meds or sedative use that can impair cough/swallowing reflex and for any meds that dry oral secretions

Answer 1

medication side effects can increase risk of developing dysphagia

Question 2

assess mental status

Answer 2

disorientation + inability to follow commands = higher risk for dysphagia

Question 3

obtain baseline assessment with O2 sat

Answer 3

monitor ability for pt to breathe + assess for aspiration risk

Question 4

provide pt rest time before meals

Answer 4

weakness + fatigue = risk for aspiration

Question 5

penlight + tongue blade to gently inspect mouth for food pockets

Answer 5

pockets of food = dysphagia

Question 6

position upright (90 degrees) or highest allowed

Answer 6

safe swallowing and enhances esophageal motility

Question 7

provide appropriate thickness of liquids

Answer 7

thin liquids = difficult to control + more easily aspirated

Question 8

chin down position

Answer 8

help reduce aspiration

Question 9

verbal coaching

Answer 9

verbal cueing = keeps pt focused on swallowing

Question 10

use sauces, condiments, gravies

Answer 10

creates a bolus of food and prevents pocketing

Question 11

oral hygiene after meal

Answer 11

reduces plaque + secretions + risk for pneumonia

Question 12

what to do when pt coughs, gags, and has food stuck in throat

Answer 12

stop feeding –> NPO
notify health care provider
anticipate consultation

Question 13

perform physical assessment of abdomen

Answer 13

absent bowel sounds, pain, tenderness, distension = contraindication of feeding tube

Question 14

semi fowlers with head tipped forward

Answer 14

helps with closure of airway and passage of tube into esophagus

Question 15

measure distance from tip of nose == earlobe == xyphoid process

Answer 15

most traditional method to approximate length needed to reach stomach

Question 16

dip tube with surface lubricant in room temp water

Answer 16

activates lube to facilitate passage of tube into nares and GI tract

Question 17

swallow water with straw

Answer 17

facilitates tube passage

Question 18

emphasize mouth breathe + swallow during insertion

Answer 18

facilitate tube passage and alleviates pt fears

Question 19

check for tube position using penlight and tongue blade

Answer 19

tube might be coiled or kinked in the trachea

Question 20

contact radiology for xray of chest/abdomen

Answer 20

radiographic examination is most accurate method

Question 21

have feeding formula at room temp

Answer 21

cold = gastric cramping and discomfort bc it isn’t warmed by mouth and esophagus

Question 22

shake formula container well and clean top of canned formula with alcohol swabs

Answer 22

ensures integrity of formula; prevents transmission of microorganisms

Question 23

keep pt in high fowlers or elevate HOB at least 30 degrees or 45 degrees

Answer 23

elevation = prevent pulmonary aspiration

Question 24

return associated contents to stomach slowly when checking gastric contents

Answer 24

prevents loss of nutrients and electrolytes in discarded fluid

Question 25

after feeding, flush tubing with 30mL of water

Answer 25

provides source of water to maintain fluid and electrolyte balance, clears tubing of formula and helps maintain tube patency

Question 26

rinse bag and tubing with warm water

Answer 26

clears old tube feedings and reduces bacterial growth