Aspiration Precautions

What are some examples of "verbal coaching" that can be used when feeding the adult dependent patient who has difficulty swallowing? Select all that apply.

- "Open your mouth." - "Raise your tongue to the roof of your mouth." - "Close your mouth and swallow." Rationale: Verbal coaching may consist of something like the following: "Open your mouth. Feel the food in your mouth. Chew and taste the food. Raise your tongue to the roof of your mouth. Think about swallowing. Close your mouth and swallow. Swallow again. Cough to clear the airway." It is important to respect the patient's dignity and to keep the patient focused on the task at hand. Distractions should be minimized.

Which of the following are appropriate measures to help the patient with dysphagia to swallow and prevent aspiration? Select all that apply.

- add thickener to thin liquids - place food on the unaffected side of the mouth - place the patient in the high-fowler's position - provide verbal coaching Rationale: Patients with dysphagia (impaired swallowing) require special precautions to prevent aspiration. Maintaining an upright position to enhance the effects of gravity is important. When feeding the patient, the nurse should place food on the unaffected side of the mouth (as in patients with hemiparesis) and observe the swallowing event closely for delays. Providing verbal coaching throughout the swallowing process can greatly help the patient swallow more effectively. Food that is the consistency of mashed potatoes is easiest for patients with dysphagia to swallow. Liquids and solids are more likely to pose a threat. In some cases, thickeners may be added to food or fluids to increase the consistency and thus allow the patient more control of the volume in the mouth. Distractions should be reduced, and therefore it is more important to keep the patient focused on swallowing when talking. The nurse may provide encouragement to increase the patient's confidence in the ability to swallow. Although a lap protector may be used, it will not influence the ability to reduce aspiration. Instead have suction equipment available.

A hospitalized patient has repeatedly refused her meals. What should the nurse do? Select all that apply.

- determine the patient's food preferences - determine whether the patient is in pain Rationale: The nurse should first try to identify and resolve possible problems while retaining the patient's independence. Determine whether the patient has other food preferences, cultural influences, or religious restrictions. Determine whether different times of the day are better. Determine whether discomfort or anxiety should be treated before eating. Determine whether the patient is mentally incapable of cooperating. If the problem cannot be resolved, the health care provider may be notified for further orders. Offering to feed the patient may be demeaning. The nurse may ask whether the patient would like seasonings added but should avoid adding them unless instructed. Administering vitamins with minerals would require a health care provider's order.

A patient has severe rheumatoid arthritis affecting her hands. What measures can be taken to facilitate optimum nutrition? Select all that apply.

- determine the patient's food preferences - provide adaptive utensils (e.g., large handles) - attach a plate guard to the plate Rationale: Determining the patient's food preferences promotes the patient's appetite, regardless of physical ability. Providing adaptive utensils can enable the patient to remain independent in eating. Large-handled utensils facilitate a patient with a poor grasp. A plate guard enables a patient to push the food up against the plate guard so as to fill the fork or spoon. Finger foods that are small may be more difficult for a patient with a poor hand grasp to obtain. A patient with visual impairment may benefit from having the location of food identified on the plate as if it were a clock.

In the change of shift report, the nurse was told a patient requires "minimal assistance with meals." What should the nurse expect to do for the patient at mealtime? Select all that apply.

- open packages and cartons - assist the patient to an upright position - ask the patient if he or she needs the nurse to cut up the food or butter the bread - document the intake Rationale: The patient requires some assistance but is able to feed himself or herself. The nurse should position the patient appropriately for safe eating and assist the patient with setting up the meal tray: open packages, cut up food, apply seasonings/condiments, butter bread, and place a napkin. If appropriate, the nurse may place adaptive utensils on the tray and instruct the patient in their use. The patient should be encouraged to remain as independent as possible in self-feeding. A patient who is able to eat without assistance may have the correct tray left to be picked up when the patient is finished. Whether the patient is independent or requires assistance, the nurse should document the intake.

A patient has been recently admitted to the hospital. What indications, if observed, may suggest that the patient has dysphagia (difficulty swallowing)? Select all that apply.

- persistent drooling - change in voice after swallowing - wet, gurgly voice Rationale: The nurse should assess the patient for difficulty swallowing. The presence of drooling, problems with speech, and a wet, gurgly voice indicate difficulty with muscle control and may put the patient at risk for aspiration. Loss of appetite does not indicate difficulty swallowing. Although the nurse should ensure that the patient is fully awake before feeding, drowsiness does not indicate dysphagia.