NURSE-3101 Lecture Notes - Lecture 13: Odynophagia, Dentures, Dietitian

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Published on 8 Nov 2016
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Department
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Chapter 35 Nutrition
Nutrition Assessment
Recent changes in dietary intake.
Recent changes in appetite; loss of appetite.
Difficulty chewing (condition of teeth; use of dentures).
Difficulty swallowing (coughing, gagging, choking).
Food allergies.
Diet prescribed by doctor. Do you follow it?
Who does the shopping? Who does the cooking?
Food preferences; cultural preferences; religious needs.
Assess Risk of Aspiration
Aspiration
o Misdirection of oropharyngeal secretions/gastric contents into larynx/lower
respiratory tract.
HIGH RISK
o Decreased alertness; decreased gag/cough reflex; difficulty managing saliva;
stroke; neuromuscular disorders.
Look for drooling.
When swallowing, look for watery eyes, difficulty swallowing, coughing, choking.
o No symptoms if silent aspiration.
Try a little drink of water or a small amount of soft food like mashed potatoes.
Stimulating Appetite
Illness and pain contribute to poor intake.
Check appearance, quality of food.
Obtain foods which suit patient preferences.
Delay non-urgent procedures so patient can eat.
Patient may eat foods from home if compatible with diet.
o Teach family what is OK.
Give anti-nausea medications before meals.
Assist with providing good oral hygiene.
Control odors during mealtimes.
If patient absent from room during meal, order late tray or keep food warm until patient
returns.
Let pts eat together if the setting permits it.
Know how much your patient eats and how your patient eats.
Work with dietary to get patient food which fits their diet and their preferences.
Consult the dietician!
o Can alter diet and work with patient to find likes and dislikes.
Assisting with Eating
Upright, seated position in bed or sit on side of bed if safe to do so.
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o Even better, sit in chair or wheelchair.
Use a towel to protect clothing.
Get tray ready so patient can eat.
o Open containers like juice or milk cartons.
Position food where patient can reach it.
o If only uses left arm, put things on the left
Special utensils if used
o built-up spoon or roller knife
If feeding patient, go slow and give small bites and sips.
Assisting Visually Impaired Patients with Eating
Relate items on plate to a clock face
o “The peas are at twelve o’clock”
Explain where everything is.
Plate guard or compartmentalized plate.
Use straws if not contraindicated.
Aspiration Precautions
Best to sit in wheelchair/chair.
Go slow. Small sips and bites.
Place food in stronger side of mouth.
Pureed or mechanical soft diet.
Thickened liquids because they provide more stimulus to swallow than thin liquids.
“Chin tuck.” Tuck chin to chest when swallowing.
One-to one monitoringnurse must remain with patient at all times when patient eating.
Commercially prepared thickeners added in dietary or by nurse at bedside.
SYRUP (NECTAR) consistency
o Pours like pancake syrup.
HONEY consistency
o Pours very slowly like honey.
PUDDING consistency
o Doesn’t pour; thick like pudding.
If patient unable to safely swallow pudding consistency liquids, patient must be made
NPO and fed by feeding tube.
Exact precautions for each patient per speech therapist.
Feeding Patient with Dysphagia
Rest period prior to meals.
Oral care prior to meal.
Speech therapist may feed some meals.
Mechanical soft diet includes chopped or ground meat.
Some find thickened liquids unpalatable.
Limit distractions so patient focuses on swallowing.
Alternate solids and liquids.
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Assess for signs of aspiration while eating:
o Coughing; choking.
o Voice change; hoarseness; gurgling after swallowing.
o Frequent throat clearing.
o Complaint food is “stuck” or “won’t go down.”
o More severe: regurgitation thru nose/mouth; cyanosis.
Inspect mouth for retained food after meal.
Diet Orders
NOTHING BY MOUTH (NPO).
o Before diagnostic tests or surgery.
o If patient has severe nausea/vomiting; inability to chew or swallow; acute GI
problems; comatose; during labor and delivery.
Patient NPO more than 2 days needs IV fluids or enteral/parenteral
nutrition.
CLEAR LIQUIDS.
o Post-op; nausea; prior to diagnostic tests; during labor; whenever something light
is needed.
Clear broth; coffee; tea; clear fruit juice (apple, cranberry, grape); gelatin;
popsicles.
FULL LIQUIDS.
o Post-op; oral surgery; sore throat; painful swallowing; must be free of nausea.
All clear liquids plus: all juices; milk; oatmeal; cream-based soups;
pudding; custard; ice cream.
PUREED DIET.
o Poor dentition; impaired swallowing due to stroke; more stimulus to swallow than
clear/full liquids.
Scrambled eggs; pureed meats; pureed vegetables; pureed fruits; mashed
potatoes and gravy.
Thickened liquids if stroke/neuromuscular disorder.
MECHANICAL SOFT DIET.
o Same as pureed diet but patient has better ability to chew/swallow; more
satisfying than pureed diet.
Foods chopped, ground, or mashed; pancakes; cottage cheese;
chopped/ground meat; cooked vegetables; canned fruit; bananas; avoids
raw fruit and difficult to chew foods.
SOFT DIET.
o Easy to chew, swallow, and digest.
o Basically a regular diet minus the Doritos and the spicy stuff.
Pasta; moist, tender meat; cooked vegetables; soft fruit; cake.
REGULAR (GENERAL or HOUSE) DIET.
o Eat whatever you want! No restrictions unless specified.
DIET AS TOLERATED (DAT).
o Nurse has discretion to advance diet when patient tolerating current diet without
any difficulties.
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