Meal assists, tips, tricks and howto's.

[Levin]

I was inspired by the recent bed baths thread in Gen-nurs, and decided to start this one.

Meal assistance (aka "feeds" before the language police)

We all know (I hope) the basic stuff like watching for pooling, and sitting up forward to minimise the risk of it going down the Trachea. (i.e the science component)

I'm sure people have learnt lots of tips and tricks and things to watch out for over the years. (i.e. the art component).

Regards,

Levin

[meownsmile, BSN, RN]

Also with a dry patient, dont be afraid to add a little liquid to the foods to help moisten it up a little to promote swallowing. A patient isnt going to be able to swallow a bolus of bread or dry food if they have no saliva to begin the food breakdown process so help them along a little. Dont be afraid to let them have a sip of liquid between bites. A small sip isnt going to fill them up just help put some moisture to the dry food.

DONT RUSH THEM!!!!!

[nurse kitkat]

Using a teaspoon to feed residents who have small appetites or swallowing difficulties.

Ensure that the food you are feeding to the resident is the right temp. its easy for meat and veg to get cold when there are alot of feeds to get through.

If a resident won't drink from a cup with a spout or starts to cough when given sips take off the spout, it's amazing how many residents drink better from a normal cup.

Milk smoothies made with milk, sustagen, icecream and fruit are very appealing for some residents who have a reduced appetite and helps to increase their caloric intake.

[Simplepleasures]

I hate feeding...especially people who are more dead than alive and neither the family nor the doctor have the courage to say enough.

CapeCod, this IS actually getting scary , but again I agree with you. You have hit it right on the head. I know this may be taken as disrespectful to the patients of LTCs, BUT CapeCod is right, it seems almost sinful to practically force feed these poor old folks, I felt sometimes that they were the living dead.Not the ones who still had some cognition, but the ones just being marginally kept alive by us.

[SuesquatchRN, BSN, RN]

And then come the discussions of g-tubes.

[UM Review RN, ASN, RN]

And then come the discussions of g-tubes.

...and unrealistic docs foisting more guilt upon ignorant family members, who then override the Patient's "No Tube feeding" orders...

:trout: :trout:

[TheOneWithGlasses]

I completely agree with the suggestion to put a little ice cream on the tip of the spoon. We have one resident that won't eat anything unless we do this, but will eat 100% if it's got a little dab of ice cream on it. A lot of times when he starts acting uninterested or refuses to open his mouth we give him a couple bites of just ice cream and that gets him eating again.

Another resident who's on a puree diet will not eat anything from a spoon but if we make a shake out of food and milk or water will drink it. That leads to some pretty nasty concoctions, though, like the "fish shake" that had us giggling and gagging at the same time...she seemed to like it though. She smiled and made her happy noise (a sort of guttural squeal) when we gave it to her.

I don't mind the actual feeding, since it's often the only time in the shift we can sit down and take our time with a task, as well as talk with each other and the residents. What I hate is passing and picking up trays, and also when we're short-staffed and have to feed three or four residents each--no sitting and talking then, that's for sure.

On second thought, one thing that does drive me batty about feeding is the residents who open their mouth a teenytiny amount and you can just barely get the tip of the spoon in there. They just sort of lick the tip of the spoon off and then smack their lips repeatedly**. It takes *forever* to feed them. Our facility doesn't have many of the small coated spoons (which we're not supposed to call baby spoons but that's pretty much what they are) and they're reserved for the residents who eat too fast and choke (the smaller spoon slows them down and they can't cram their mouths as full) so we just have to keep plugging along with the regular spoon.

**I've noticed that a lot of times when they start eating like this it's not too long before they are unable to eat at all. It's like it's the last stage of eating solid foods and it reminds me a lot of how babies react when you first start giving them solid food.

[CapeCodMermaid, RN]

...and unrealistic docs foisting more guilt upon ignorant family members, who then override the patient's "no tube feeding" orders...

:trout: :trout:

luckily, i've never run into a doc who wants to override a no tube feed order. to answer someone else's question, at my old facility, the speech therapist was always recommending lemon ice...."stimulated saliva production to help facilitate easier mastication and bolus formation"....yummy, doesn't that make you want to rush out and get some for yourself!! the speech therapist at my current facility never recommends it. she does go a little over board ordering mbss for people who cough maybe one time eating a meal. i love to cook and i love to eat. i don't eat everything i want now because i am still trying to maintain a 'healthy' weight. but, if i have to be a little old lady living in a home....please give me what i ask for....even if i choke (it's already in my care plan which hangs on the fridge door next to my health care proxy). my favorite doctor had such a gentle way of talking to his patients about end of life issues. he'd tell them that now it was okay to eat their dessert first.

[color=deepskyblue]go patriots!! the next superbowl champions!!!!!!!!!!

[CoffeeRTC, BSN, RN]

Another suggestion...take half of the food off of the plate that is in front of them. Sometimes looking at a large amount of food is overwhelming. After eating most of the "half" I will add some from the other plate...before she would know it...it would almost all be eaten.

Getting speech involved is good. Adaptive equiptment can be ordered.

Don't forget the families. Ask them what the res was like at home..food preferences etc. Maybe the res only had toaste and coffee at breakfast for the last 50+ years...so making them eat a full breakfast isn't gonna work.

Be flexable and creative.

[Levin]

Well I had aged care again today, and I must say, the advice in these two pages ended up being quite useful. Thanks to everyone who contributed.

Cheers

Levin.

[jetscreamer101]

suesquach, couldn't agree more, but I would say one of the things about working LTC that I hate nstead of the only part.

Marla, Thank you for your wisdom. I don't like it when I see staff only serve the main portion of the meal and leave the dessert off and will only give the dessert if they eat a certain amount of their meal. GRRRR

That baby spoon thing with the impulsive eaters is a great idea! I had never thought of that.

[shoreh2000]

what great ideas....buquets for all.

[CrownHunter]

I might be wrong about this but I was under the impression that it was concidered "in bad taste" to mix an elderly persons food in stuff you normally wouldnt mix it in. (ie. choclate and meat) I've worked in a nursing home off and on and the rules have always been if you were caught you were written up for it. but it could be just one of thoes things where it is a facilities call.