Supporting eating and drinking

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

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

Supporting eating and drinking

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Supporting eating and drinking

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