week 6 feeding techniques, types of diets and dysphagia Flashcards
nursing role in feeding a client
promote adequate nutition prevent dehydration assure apporopriate food prevent injury during feeding promote independence and well-being
what is dysphagia
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
Any foreign material that you take into your
lungs
aspiration
Is aspiration always harmful?
No! All of us aspirate, several times a day.
when is aspiration harmful
Depends on how much, how often, physical
condition, immune status
In most cases, the lungs are able to clear the
material
what are the stages of swallowing and why are they so important
Oral phase
Pharyngeal phase
Esophageal phase
Important because each stage has symptoms
that may justify a Dysphagia Evaluation by
the Speech Language Pathologist.
what is the oral (buccal) phase
Food is broken down by the lips, tongue, teeth,
cheeks, and saliva.
oral (buccal) phase s/s
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
pharyngeal phase does what
2nd phase – when the tongue pushes the food to
the back of the throat.
pharyngeal phase s/s
Choking or coughing during swallowing Foods or liquids go into nasal cavity Difficulty speaking Gurgling Feeling of food “getting stuck” Hoarse voice
what is the esophageal phase
Movement of the food through the esophagus
and into the stomach.
esophageal phase s/s
Pain or burning in chest
Regurgitation while lying down after meals
Feeling of food “getting stuck” in the
esophagus
positioning
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
nursing management for feeding
as in what do you do while you feed
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!
why is it so important to give oral care
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.
how do you provide oral care
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
what is a clear liquid diet
as in what does it consist of
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
what does a clear liquid diet help with
health wise
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
what are examples of clear liquids
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
what is a full liquid diet
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
what are examples of full liquid diets
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
what is a mechanically soft diet
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
examples of mechanically soft diet
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
who would need a pureed diet
For those who have poor chewing and weak
throat muscle
They may not be aware of the need to chew
what are thin liquid
All regular liquids that have a thin consistency in
the mouth.
Water, juice, coffee, tea, ice cream
what are the three types of thickened liquids
Three types
Nectar-like
Honey-like
Spoon thick
why would you use thicken liquids
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.
Nectar thick
Mild muscle weakness in throat or mild weakness
in tongue control
Honey thick
Moderate muscle weakness in throat and poor
tongue control
Pudding thick
Moderate to severe muscle weakness and poor
tongue control.
natural nectar thick liquids are examples of
Thick cream soups
Eggnog
Thick milkshakes
Buttermilk
concerns related to thickners
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
