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