week 6 feeding techniques, types of diets and dysphagia

Question 1

nursing role in feeding a client

Answer 1

promote adequate nutition
prevent dehydration
assure apporopriate food
prevent injury during feeding
promote independence and well-being

Question 2

what is dysphagia

Answer 2

impairment of the emotional, cognitive, sensory and/or motor acts involved with transferring a substance from the mouth to stomach, resulting in failure to maintain hydration, and posing a risk of choking and aspiration

Question 3

Any foreign material that you take into your

lungs

Answer 3

aspiration

Question 4

Is aspiration always harmful?

Answer 4

No! All of us aspirate, several times a day.

Question 5

when is aspiration harmful

Answer 5

Depends on how much, how often, physical
condition, immune status
In most cases, the lungs are able to clear the
material

Question 6

what are the stages of swallowing and why are they so important

Answer 6

Oral phase
Pharyngeal phase
Esophageal phase
Important because each stage has symptoms
that may justify a Dysphagia Evaluation by
the Speech Language Pathologist.

Question 7

what is the oral (buccal) phase

Answer 7

Food is broken down by the lips, tongue, teeth,

cheeks, and saliva.

Question 8

oral (buccal) phase s/s

Answer 8

 Drooling
 Pocketing food
 Food not being completely chewed
 Tilting head when eating
 Difficulty speaking
 Holding food in mouth
 Complaint of trouble swallowing liquids
 Delayed or very slow swallowing

Question 9

pharyngeal phase does what

Answer 9

2nd phase – when the tongue pushes the food to

the back of the throat.

Question 10

pharyngeal phase s/s

Answer 10

Choking or coughing during swallowing
 Foods or liquids go into nasal cavity
 Difficulty speaking
 Gurgling
 Feeling of food “getting stuck”
 Hoarse voice

Question 11

what is the esophageal phase

Answer 11

Movement of the food through the esophagus

and into the stomach.

Question 12

esophageal phase s/s

Answer 12

Pain or burning in chest
Regurgitation while lying down after meals
Feeling of food “getting stuck” in the
esophagus

Question 13

positioning

Answer 13

90 degrees at the hips, 45 degrees at the
neck
Decreased tongue control allows food to fall into
the airway. Sitting upright prevents this.
Use pillows or towels to insure proper
placement in a chair.
Patient should remain upright for 15-30
minutes after a meal.
Food residue on the back of the tongue could fall
into the airway. Sitting upright helps clear this
residue

Question 14

nursing management for feeding

as in what do you do while you feed

Answer 14

Monitor for a swallow before providing the
next bite.
 Offer a drink between bites of food.
 Allow for multiple swallows.
 Remind the patient to tuck chin before
swallowing.
 Verbal and tactile cues.
 DON’T RUSH!

Question 15

why is it so important to give oral care

Answer 15

One of the worst things a patient can
aspirate on is their own spit.
Old spit has a high bacterial load.
Aspiration of oral secretions is the number one
cause of bacterial aspiration pneumonia in the
elderly.
Oral care 3-4 times a day.

Question 16

how do you provide oral care

Answer 16

Brush teeth and gums and tongue with
toothpaste.
 Suction as necessary
 Brush gently
 Use oral swabs if patient cannot tolerate
brushing.
 Clear residue from the mouth – it will grow
bacteria

Question 17

what is a clear liquid diet

as in what does it consist of

Answer 17

Anything you can see through
Water, broth, gelatin, tea, apple juice
These liquids will not leave a residue in the
digestive tract
Does not provide many calories so should
only be used for a short period of time
Used before procedures (colonoscopy)
Used after surgeries or if nausea, vomiting

Question 18

what does a clear liquid diet help with

health wise

Answer 18

Helps maintain adequate hydration
Provides some important electrolytes, such
as sodium and potassium
Gives some energy at a time when a full diet
isn’t possible or recommended.
Keeps stomach and intestines clear
Limit strain to your digestive system

Question 19

what are examples of clear liquids

Answer 19

Plain water
Fruit juices without pulp, such as apple
juice, grape juice or cranberry juice
Strained lemonade or fruit punch
Clear, fat-free broth (bouillon or consommé)
Clear sodas
Plain gelatin
Honey
Ice pops without bits of fruit or fruit pulp
Tea or coffee without milk or cream

Question 20

what is a full liquid diet

Answer 20

Fluids and foods that are normally liquid
Foods that turn to liquid when they are at
room temperature, like ice cream.
Strained creamy soups, tea, juice, Jell-O,
milkshakes, pudding, and popsicles.
Easier to digest than solid food
Gives the proteins, fluids, salts, and minerals
needed for energy

Question 21

what are examples of full liquid diets

Answer 21

Water
Fruit juices, including nectars and juices with pulp
Butter, margarine, oil, cream, custard, and pudding
Plain ice cream, frozen yogurt, and sherbet.
Fruit ices and popsicles
Sugar, honey, and syrups
Soup broth (bouillon, consommé, and strained cream
soups – but NO solids)
Sodas, such as ginger ale and Sprite
Gelatin (Jell-O)
Boost, Ensure, Resource, Sustacal. and other liquid
supplements
Tea or coffee with cream or milk and sugar or honey

May also include:
Cooked, refined cereals, such as Cream of
Wheat, cream of rice, oatmeal, grits, or
farina
Strained meats, like the ones in baby food
Potatoes pureed in soup

Question 22

what is a mechanically soft diet

Answer 22

Recommended for people who have trouble
chewing, confused people who take in too
many bites at one time, or people who may
be unaware of the need to push food to the
back of the tongue.
Ease of chewing may be increased by
mashing, chopping, or blenderizing
Liquids may need to be added to allow the
mashing, chopping or blending

Question 23

examples of mechanically soft diet

Answer 23

Soft breads
 Cooked cereals
 Canned fruit, fruit juices
 Cooked vegetables
 Ground meat
 Soft scrambled eggs
 Cooked dry beans and peas
 soft cheese such as ricotta and cottage
cheese
 Yogurt without fruit, custards and puddings
 Cream soups, noodles

Question 24

who would need a pureed diet

Answer 24

For those who have poor chewing and weak
throat muscle
They may not be aware of the need to chew

Question 25

what are thin liquid

Answer 25

All regular liquids that have a thin consistency in
the mouth.
Water, juice, coffee, tea, ice cream

Question 26

what are the three types of thickened liquids

Answer 26

Three types
Nectar-like
Honey-like
Spoon thick

Question 27

why would you use thicken liquids

Answer 27

Reasons
 Dysphagia – difficulty swallowing
 Problems with pharyngeal clearance
 Aspiration of thin liquids
 Thicken to increase the patient’s control of the
food bolus in the mouth.

Question 28

Nectar thick

Answer 28

Mild muscle weakness in throat or mild weakness

in tongue control

Question 29

Honey thick

Answer 29

Moderate muscle weakness in throat and poor

tongue control

Question 30

Pudding thick

Answer 30

Moderate to severe muscle weakness and poor

tongue control.

Question 31

natural nectar thick liquids are examples of

Answer 31

Thick cream soups
Eggnog
Thick milkshakes
Buttermilk

Question 32

concerns related to thickners

Answer 32

Dehydration – patient is not getting enough
fluids
Know the fluid volume of the cups and glasses in
the facility so that fluid intake can be accurately
tallied.
Aspiration – if fluids are not thickened to the
correct consistency
To avoid this, follow the directions exactly