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Supporting Eating and Drinking CHCICS301A
Eating and drinking <ul><li>Role of the carer to : </li></ul><ul><li>Support client with food and fluid intake, facilitati...
<ul><li>Be aware of dietary and cultural needs </li></ul><ul><li>Need to be aware that clients who require assistance with...
Things to Think About… <ul><li>Offer toilet facilities and meet hygiene needs before meal times </li></ul><ul><li>Often en...
When/why may eating become difficult? <ul><li>Allergies </li></ul><ul><li>Mechanical problem – ill fitting dentures, sore ...
<ul><li>Disorder or disease of gastrointestinal system </li></ul><ul><li>Psychologic or cognitive problem, ie dementia </l...
When eating is a problem… <ul><li>Assess thoroughly, as to cause of problem </li></ul><ul><li>Ensure good mouth care – cle...
<ul><li>Offer extras (ie milk drinks), or replacement meals, when it is easier for the person to eat </li></ul><ul><li>???...
<ul><li>With a cognition problem, ie client with  </li></ul><ul><li>dementia :  </li></ul><ul><li>ensure minimal interrupt...
Principles for assisting with eating and drinking <ul><li>Preparation of the environment </li></ul><ul><li>area conducive ...
<ul><li>Preparation of the carer </li></ul><ul><li>hands washed </li></ul><ul><li>unhurried, and able to focus on the indi...
<ul><li>Preparation of the client </li></ul><ul><li>offer toilet facilities prior to meals </li></ul><ul><li>assist with w...
<ul><li>Provision of the meal </li></ul><ul><li>verify correct meal to correct client </li></ul><ul><li>items in appropria...
Assisting a client to eat <ul><li>Use a spoon, in preference to a fork </li></ul><ul><li>Small spoonfuls, rather than too ...
<ul><li>Utilise any appropriate modified utensils, to encourage independence </li></ul><ul><li>Communicate with client thr...
Observations while assisting with eating <ul><li>Any trouble breathing while eating? </li></ul><ul><li>Any difficulty eati...
Impaired swallowing <ul><li>Swallowing is a complex mechanism, involving voluntary and involuntary actions of cranial nerv...
Poor oral control <ul><li>Increased risk of aspiration exists (accidental inhaling of food or fluid into lungs), if dyspha...
If dysphagia exists… <ul><li>Sit upright, well supported </li></ul><ul><li>Head tilted slightly forward, to close off airw...
<ul><li>Follow instructions of speech pathologist </li></ul><ul><li>May need to reinforce or provide verbal coaching throu...
<ul><li>Need food of appropriate texture – food soft, but not too runny – food often of “mashed potato” consistency, to sl...
Other Types of Feeding <ul><li>Orogastric </li></ul><ul><li>Nasogastric </li></ul><ul><li>Percutaneous Endoscopic Gastrost...
Gastrostomy & PEG tubes <ul><li>Used for > 100 yrs </li></ul><ul><li>Placed in patient who will require long term nutritio...
Gastrostomy & PEG tubes
 
Care of PEG tubes <ul><li>Requires observation and attention to  </li></ul><ul><li>feeding </li></ul><ul><li>insertion sit...
Care of PEG tubes <ul><li>SKIN CARE </li></ul><ul><li>usually washed in shower </li></ul><ul><li>sometimes some ooze </li>...
Care of PEG tubes <ul><li>SIGNS OF INFECTION </li></ul><ul><li>Fever, redness of the skin, cloudy drainage, foul odour or ...
Care of PEG tubes <ul><li>DISLODGEMENT </li></ul><ul><li>Often accidental </li></ul><ul><li>Prevent unnecessary pulling or...
Care of PEG tubes <ul><li>FAILURE </li></ul><ul><li>Obstruction very common - feed, pills, kinking etc </li></ul><ul><li>G...
More troubleshooting <ul><li>Diarrhea - medications, equipment contamination,  fecal impaction , incorrect delivery of for...
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Supporting eating and drinking

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Supporting eating and drinking

  1. 1. Supporting Eating and Drinking CHCICS301A
  2. 2. Eating and drinking <ul><li>Role of the carer to : </li></ul><ul><li>Support client with food and fluid intake, facilitating independence whenever possible </li></ul><ul><li>Ensure and monitor client’s intake of food and fluids to be adequate </li></ul>
  3. 3. <ul><li>Be aware of dietary and cultural needs </li></ul><ul><li>Need to be aware that clients who require assistance with eating and drinking may be embarrassed, humiliated, resentful, angry or depressed about their situation </li></ul><ul><li>Carer needs to be unhurried, ensure not to belittle, be at equal level </li></ul>
  4. 4. Things to Think About… <ul><li>Offer toilet facilities and meet hygiene needs before meal times </li></ul><ul><li>Often encouraged to eat in dining area - encourage social interaction, ambulation </li></ul><ul><li>Ensure correct meals, utensils available, assist as necessary with opening packets etc </li></ul><ul><li>Offer alternatives if unable to eat food offered </li></ul><ul><li>Observe and document inadequate intake </li></ul><ul><li>Utilise food charts - likes/dislikes, complaints etc </li></ul><ul><li>Offer condiments if food bland </li></ul><ul><li>Vary diet and environment eg BBQ’s, McDonalds etc </li></ul>
  5. 5. When/why may eating become difficult? <ul><li>Allergies </li></ul><ul><li>Mechanical problem – ill fitting dentures, sore mouth, “dirty” mouth </li></ul><ul><li>Medications causing dry mouth </li></ul><ul><li>Difficulty swallowing </li></ul><ul><li>Loss of appetite </li></ul><ul><li>Other symptoms – nausea, bloating, “feeling full” </li></ul>
  6. 6. <ul><li>Disorder or disease of gastrointestinal system </li></ul><ul><li>Psychologic or cognitive problem, ie dementia </li></ul><ul><li>Other physical restriction – fatigue, limited mobility of arms, loss of motor skills, impaired vision, brain injury, need to remain flat or prone </li></ul>
  7. 7. When eating is a problem… <ul><li>Assess thoroughly, as to cause of problem </li></ul><ul><li>Ensure good mouth care – clean teeth and mouth, good fluid intake </li></ul><ul><li>Offer frequent, small, preferred meals with attractive presentation, so as not to overwhelm </li></ul><ul><li>Allow the client time to eat slowly </li></ul><ul><li>Avoid substances likely to make a digestive problem worse, ie fizzy drinks, fatty and fried foods, “wind-producing” foods </li></ul>
  8. 8. <ul><li>Offer extras (ie milk drinks), or replacement meals, when it is easier for the person to eat </li></ul><ul><li>???use of appetite stimulants (“tonic”, sherry) </li></ul><ul><li>Avoid “filling up” on liquids, sip slowly on drinks if nauseated </li></ul><ul><li>Encourage client to avoid wearing restrictive clothing, or lying flat after meals to prevent digestive upsets </li></ul>
  9. 9. <ul><li>With a cognition problem, ie client with </li></ul><ul><li>dementia : </li></ul><ul><li>ensure minimal interruption and distraction </li></ul><ul><li>place food directly in front of client </li></ul><ul><li>utilise finger food if able </li></ul><ul><li>keep prompting and reassuring – but be patient </li></ul>
  10. 10. Principles for assisting with eating and drinking <ul><li>Preparation of the environment </li></ul><ul><li>area conducive to eating – no unpleasant smells, sights, sounds or treatments at mealtimes </li></ul><ul><li>encourage client to be out of bed, or even away from bed area (dining room) </li></ul><ul><li>table correctly positioned, and clean </li></ul><ul><li>quiet, no interruptions, activity directed toward meal </li></ul>
  11. 11. <ul><li>Preparation of the carer </li></ul><ul><li>hands washed </li></ul><ul><li>unhurried, and able to focus on the individual client and their meal </li></ul><ul><li>position self appropriately in relation to client, if needing to assist throughout meal (facing, at same level) </li></ul>
  12. 12. <ul><li>Preparation of the client </li></ul><ul><li>offer toilet facilities prior to meals </li></ul><ul><li>assist with washing face and hands if required </li></ul><ul><li>in comfortable supported position, sitting as able (normal anatomic position for eating) </li></ul><ul><li>check mouth - ? dentures in and clean </li></ul><ul><li>protect clothing as necessary – serviette </li></ul><ul><li>stimulate interest in meal, sight and smell </li></ul>
  13. 13. <ul><li>Provision of the meal </li></ul><ul><li>verify correct meal to correct client </li></ul><ul><li>items in appropriate position, and that client can reach tray and its contents </li></ul><ul><li>ensure meal in its appropriate form </li></ul><ul><li>appropriate cutlery and aids to allow independent eating </li></ul><ul><li>assist as required, and with client approval – cutting food, opening packets, pouring fluids </li></ul>
  14. 14. Assisting a client to eat <ul><li>Use a spoon, in preference to a fork </li></ul><ul><li>Small spoonfuls, rather than too large </li></ul><ul><li>Check food temperature – how?? </li></ul><ul><li>Allow time to chew each mouthful </li></ul><ul><li>Check re order of likes, and respect client’s preferences </li></ul><ul><li>Offer a drink periodically, and at end of meal </li></ul>
  15. 15. <ul><li>Utilise any appropriate modified utensils, to encourage independence </li></ul><ul><li>Communicate with client throughout meal, but not at the expense of eating!! </li></ul><ul><li>Be respectful & patient </li></ul><ul><li>Visually impaired clients need accurate descriptions and directions, often utilising clock face </li></ul><ul><li>Ensure client is clean and comfortable </li></ul>
  16. 16. Observations while assisting with eating <ul><li>Any trouble breathing while eating? </li></ul><ul><li>Any difficulty eating, chewing or swallowing? </li></ul><ul><li>Any nausea or vomiting? </li></ul><ul><li>Any coughing spasm? </li></ul><ul><li>Any complaint of pain? </li></ul><ul><li>How much was eaten? </li></ul><ul><li>Did the client enjoy their meal? </li></ul>
  17. 17. Impaired swallowing <ul><li>Swallowing is a complex mechanism, involving voluntary and involuntary actions of cranial nerves, tongue muscles, pharynx, larynx and jaw </li></ul><ul><li>Any client with neuromuscular disease, involving brain, brainstem, cranial nerves or muscles of swallowing need assessment by a speech pathologist </li></ul>
  18. 18. Poor oral control <ul><li>Increased risk of aspiration exists (accidental inhaling of food or fluid into lungs), if dysphagia (poor swallowing) is present </li></ul><ul><li>Often indicated by : decreased level of alertness, drooling, problems with speech, “wet, gurgly” voice, facial droop, poor lip seal, coughing frequently </li></ul>
  19. 19. If dysphagia exists… <ul><li>Sit upright, well supported </li></ul><ul><li>Head tilted slightly forward, to close off airway </li></ul><ul><li>If facial paralysis is present, place food into unaffected side of mouth </li></ul><ul><li>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 </li></ul><ul><li>Need good oral hygiene </li></ul>
  20. 20. <ul><li>Follow instructions of speech pathologist </li></ul><ul><li>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” </li></ul><ul><li>Observe swallowing closely for delays or difficulty </li></ul>
  21. 21. <ul><li>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 </li></ul><ul><li>Fluids are thickened as required, thin fluids are easily aspirated </li></ul><ul><li>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 </li></ul>
  22. 22. Other Types of Feeding <ul><li>Orogastric </li></ul><ul><li>Nasogastric </li></ul><ul><li>Percutaneous Endoscopic Gastrostomy (PEG) </li></ul><ul><li>Gastrostomy </li></ul><ul><li>Jejuneostomy </li></ul>
  23. 23. Gastrostomy & PEG tubes <ul><li>Used for > 100 yrs </li></ul><ul><li>Placed in patient who will require long term nutritional support (> 30/7) </li></ul><ul><li>Need to have intact </li></ul><ul><li>oral cavity and oesophagus </li></ul><ul><li>Can be inserted under </li></ul><ul><li>GA or with sedation </li></ul>
  24. 24. Gastrostomy & PEG tubes
  25. 26. Care of PEG tubes <ul><li>Requires observation and attention to </li></ul><ul><li>feeding </li></ul><ul><li>insertion site </li></ul><ul><li>prevention of dislodgement/failure </li></ul><ul><li>maintenance of weight </li></ul><ul><li>maintain mouth care - preventative dental care </li></ul>
  26. 27. Care of PEG tubes <ul><li>SKIN CARE </li></ul><ul><li>usually washed in shower </li></ul><ul><li>sometimes some ooze </li></ul><ul><li>stoma site can become irritated from gastric secretions leaking around tube </li></ul><ul><li>tube sometimes rotated to prevent skin adhesions growing over </li></ul>
  27. 28. Care of PEG tubes <ul><li>SIGNS OF INFECTION </li></ul><ul><li>Fever, redness of the skin, cloudy drainage, foul odour or pain at insertion site are all symptoms of infection </li></ul><ul><li>Antibiotic ointment and frequent cleansing usually clears it up </li></ul>
  28. 29. Care of PEG tubes <ul><li>DISLODGEMENT </li></ul><ul><li>Often accidental </li></ul><ul><li>Prevent unnecessary pulling or tugging on tube from clothing </li></ul><ul><li>Ensure properly secured and stabilised </li></ul><ul><li>Reinsertion should occur as quickly as possible (within hours) </li></ul><ul><li>Some clients can reinsert their own tube </li></ul>
  29. 30. Care of PEG tubes <ul><li>FAILURE </li></ul><ul><li>Obstruction very common - feed, pills, kinking etc </li></ul><ul><li>Generally try and dislodge obstruction before tube replaced </li></ul><ul><li>Flushing tube before and after use can prevent blockage </li></ul><ul><li>Milking tube - gentle pressure and warm water flush and aspiration </li></ul><ul><li>Coke often used </li></ul>
  30. 31. More troubleshooting <ul><li>Diarrhea - medications, equipment contamination, fecal impaction , incorrect delivery of formula (too much too soon) </li></ul><ul><li>Constipation - medications, change in diet, reduced fluid intake, common for 2-3 BA per wk </li></ul><ul><li>Nausea/vomiting - incorrect delivery rate or amount </li></ul>

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