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Supporting Eating and Drinking
CHCICS301A
Eating and drinking
Role of the carer to :
Support client with food and fluid intake, facilitating independence whenever possible
Ensure and monitor client’s intake of food and fluids to be adequate
Be aware of dietary and cultural needsNeed to be aware that clients who require assistance with eating and drinking may be embarrassed, humiliated, resentful, angry or depressed about their situation Carer needs to be unhurried, ensure not to belittle, be at equal level
Things to Think About…
Offer toilet facilities and meet hygiene needs before meal timesOften encouraged to eat in dining area - encourage social interaction, ambulationEnsure correct meals, utensils available, assist as necessary with opening packets etcOffer alternatives if unable to eat food offeredObserve and document inadequate intakeUtilise food charts - likes/dislikes, complaints etcOffer condiments if food blandVary diet and environment eg BBQ’s, McDonalds etc
When/why may eating become difficult?
AllergiesMechanical problem – ill fitting dentures, sore mouth, “dirty” mouthMedications causing dry mouthDifficulty swallowingLoss of appetiteOther symptoms – nausea, bloating, “feeling full”
Disorder or disease of gastrointestinal systemPsychologic or cognitive problem, ie dementiaOther physical restriction – fatigue, limited mobility of arms, loss of motor skills, impaired vision, brain injury, need to remain flat or prone
When eating is a problem…
Assess thoroughly, as to cause of problemEnsure good mouth care – clean teeth and mouth, good fluid intakeOffer frequent, small, preferred meals with attractive presentation, so as not to overwhelm Allow the client time to eat slowlyAvoid substances likely to make a digestive problem worse, ie fizzy drinks, fatty and fried foods, “wind-producing” foods
Offer extras (ie milk drinks), or replacement meals, when it is easier for the person to eat
???use of appetite stimulants (“tonic”, sherry)
Avoid “filling up” on liquids, sip slowly on drinks if nauseated
Encourage client to avoid wearing restrictive clothing, or lying flat after meals to prevent digestive upsets
With a cognition problem, ie client with dementia :
ensure minimal interruption and distractionplace food directly in front of clientutilise finger food if ablekeep prompting and reassuring – but be patient
Principles for assisting with eating and drinking
Preparation of the environmentarea conducive to eating – no unpleasant smells, sights, sounds or treatments at mealtimesencourage client to be out of bed, or even away from bed area (dining room)table correctly positioned, and cleanquiet, no interruptions, activity directed toward meal
Preparation of the carer
hands washed
unhurried, and able to focus on the individual client and their meal
position self appropriately in relation to client, if needing to assist throughout meal (facing, at same level)
Preparation of the clientoffer toilet facilities prior to mealsassist with washing face and hands if requiredin comfortable supported position, sitting as able (normal anatomic position for eating)check mouth - ? dentures in and cleanprotect clothing as necessary – serviettestimulate interest in meal, sight and smell
Provision of the mealverify correct meal to correct clientitems in appropriate position, and that client can reach tray and its contentsensure meal in its appropriate formappropriate cutlery and aids to allow independent eatingassist as required, and with client approval – cutting food, opening packets, pouring fluids
Assisting a client to eat
Use a spoon, in preference to a forkSmall spoonfuls, rather than too largeCheck food temperature – how??Allow time to chew each mouthfulCheck re order of likes, and respect client’s preferencesOffer a drink periodically, and at end of meal
Utilise any appropriate modified utensils, to encourage independenceCommunicate with client throughout meal, but not at the expense of eating!!Be respectful & patientVisually impaired clients need accurate descriptions and directions, often utilising clock faceEnsure client is clean and comfortable
Observations while assisting with eating
Any trouble breathing while eating?
Any difficulty eating, chewing or swallowing?
Any nausea or vomiting?
Any coughing spasm?
Any complaint of pain?
How much was eaten?
Did the client enjoy their meal?
Impaired swallowing
Swallowing is a complex mechanism, involving voluntary and involuntary actions of cranial nerves, tongue muscles, pharynx, larynx and jaw
Any client with neuromuscular disease, involving brain, brainstem, cranial nerves or muscles of swallowing need assessment by a speech pathologist
Poor oral control
Increased risk of aspiration exists (accidental inhaling of food or fluid into lungs), if dysphagia (poor swallowing) is present
Often indicated by : decreased level of alertness, drooling, problems with speech, “wet, gurgly” voice, facial droop, poor lip seal, coughing frequently
If dysphagia exists…
Sit upright, well supportedHead tilted slightly forward, to close off airwayIf facial paralysis is present, place food into unaffected side of mouthCheck cheek pocket frequently for accumulation of food – make sure only one mouthful at a time, and that mouth is completely empty before next oneNeed good oral hygiene
Follow instructions of speech pathologist
May need to reinforce or provide verbal coaching through the swallowing process – “close lips, breathe in through nose, hold breath, push tongue onto roof of mouth, swallow, breathe out and relax”
Observe swallowing closely for delays or difficulty
Need food of appropriate texture – food soft, but not too runny – food often of “mashed potato” consistency, to slow down the passage of the foodFluids are thickened as required, thin fluids are easily aspiratedNeed to remain with client at all times, and ensure no sign of respiratory compromise, ie choking, coughing – stop at any sign of problem, clear mouth if able
Other Types of Feeding
Orogastric
Nasogastric
Percutaneous Endoscopic Gastrostomy
(PEG)
Gastrostomy
Jejuneostomy
Gastrostomy & PEG tubes
Used for > 100 yrs
Placed in patient who will require long term nutritional support (> 30/7)
Need to have intact
oral cavity and oesophagus
Can be inserted under
GA or with sedation
Gastrostomy & PEG tubes
Care of PEG tubes
Requires observation and attention to
feeding
insertion site
prevention of dislodgement/failure
maintenance of weight
maintain mouth care - preventative dental
care
Care of PEG tubes
SKIN CARE
usually washed in shower
sometimes some ooze
stoma site can become irritated from gastric secretions leaking around tube
tube sometimes rotated to prevent skin adhesions growing over
Care of PEG tubes
SIGNS OF INFECTION
Fever, redness of the skin, cloudy
drainage, foul odour or pain at insertion
site are all symptoms of infection
Antibiotic ointment and frequent
cleansing usually clears it up
Care of PEG tubes
DISLODGEMENTOften accidentalPrevent unnecessary pulling or tugging on tube from clothingEnsure properly secured and stabilisedReinsertion should occur as quickly as possible (within hours)Some clients can reinsert their own tube
Care of PEG tubes
FAILUREObstruction very common - feed, pills, kinking etcGenerally try and dislodge obstruction before tube replacedFlushing tube before and after use can prevent blockageMilking tube - gentle pressure and warm water flush and aspirationCoke often used
More troubleshooting
Diarrhea - medications, equipment contamination, fecal impaction, incorrect delivery of formula (too much too soon)Constipation - medications, change in diet, reduced fluid intake, common for 2-3 BA per wkNausea/vomiting - incorrect delivery rate or amount
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