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Supporting eating and drinking
 

Supporting eating and drinking

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  • 1. Sustagen milk drinks Ensure replacement meals 3. How can we encourage residents to drink? DISTRIBUTE Fluid consistency changes handout
  • 3. What is the correct position when feeding someone?
  • 5. Serviette vs Bib
  • 3. Homog, mince, cut up 4. Lip plates, angled cutlery, built up handles SHOW OVEARHEAD of Aids
  • 1. Spoon should be 1/3 full
  • 3. Make aware of hot / cold 4. At the end of the meal
  • CVA
  • Jelly often not safe, becomes liquid in mouth and too thin to swallow

Supporting eating and drinking Supporting eating and drinking Presentation Transcript

  • 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 needs
    • Need 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 times
    • Often encouraged to eat in dining area - encourage social interaction, ambulation
    • Ensure correct meals, utensils available, assist as necessary with opening packets etc
    • Offer alternatives if unable to eat food offered
    • Observe and document inadequate intake
    • Utilise food charts - likes/dislikes, complaints etc
    • Offer condiments if food bland
    • Vary diet and environment eg BBQ’s, McDonalds etc
  • When/why may eating become difficult?
    • Allergies
    • Mechanical problem – ill fitting dentures, sore mouth, “dirty” mouth
    • Medications causing dry mouth
    • Difficulty swallowing
    • Loss of appetite
    • Other symptoms – nausea, bloating, “feeling full”
    • Disorder or disease of gastrointestinal system
    • Psychologic or cognitive problem, ie dementia
    • Other 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 problem
    • Ensure good mouth care – clean teeth and mouth, good fluid intake
    • Offer frequent, small, preferred meals with attractive presentation, so as not to overwhelm
    • Allow the client time to eat slowly
    • Avoid 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 distraction
    • place food directly in front of client
    • utilise finger food if able
    • keep prompting and reassuring – but be patient
  • Principles for assisting with eating and drinking
    • Preparation of the environment
    • area conducive to eating – no unpleasant smells, sights, sounds or treatments at mealtimes
    • encourage client to be out of bed, or even away from bed area (dining room)
    • table correctly positioned, and clean
    • quiet, 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 client
    • offer toilet facilities prior to meals
    • assist with washing face and hands if required
    • in comfortable supported position, sitting as able (normal anatomic position for eating)
    • check mouth - ? dentures in and clean
    • protect clothing as necessary – serviette
    • stimulate interest in meal, sight and smell
    • Provision of the meal
    • verify correct meal to correct client
    • items in appropriate position, and that client can reach tray and its contents
    • ensure meal in its appropriate form
    • appropriate cutlery and aids to allow independent eating
    • assist as required, and with client approval – cutting food, opening packets, pouring fluids
  • Assisting a client to eat
    • Use a spoon, in preference to a fork
    • Small spoonfuls, rather than too large
    • Check food temperature – how??
    • Allow time to chew each mouthful
    • Check re order of likes, and respect client’s preferences
    • Offer a drink periodically, and at end of meal
    • Utilise any appropriate modified utensils, to encourage independence
    • Communicate with client throughout meal, but not at the expense of eating!!
    • Be respectful & patient
    • Visually impaired clients need accurate descriptions and directions, often utilising clock face
    • Ensure 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 supported
    • Head tilted slightly forward, to close off airway
    • If facial paralysis is present, place food into unaffected side of mouth
    • Check cheek pocket frequently for accumulation of food – make sure only one mouthful at a time, and that mouth is completely empty before next one
    • Need 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 food
    • Fluids are thickened as required, thin fluids are easily aspirated
    • Need 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
    • DISLODGEMENT
    • Often accidental
    • Prevent unnecessary pulling or tugging on tube from clothing
    • Ensure properly secured and stabilised
    • Reinsertion should occur as quickly as possible (within hours)
    • Some clients can reinsert their own tube
  • Care of PEG tubes
    • FAILURE
    • Obstruction very common - feed, pills, kinking etc
    • Generally try and dislodge obstruction before tube replaced
    • Flushing tube before and after use can prevent blockage
    • Milking tube - gentle pressure and warm water flush and aspiration
    • Coke 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 wk
    • Nausea/vomiting - incorrect delivery rate or amount