Meal assists, tips, tricks and howto's.

  1. 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
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  2. 34 Comments

  3. by   UM Review RN
    1. Encourage Pt sit up 90 degrees--sitting in a chair is best, if it's possible--and chin tuck and swallow twice for each bite of food. Verbally coach the patient--"OK, here's a spoonful, now tuck your chin," and so on--while feeding and then the patient will get into the habit. Teach the a/o X3 patient that the action of the chin tuck closes the windpipe, so the food goes down the right way.

    2. If you notice wet, "gurgly" speech, drooling, runny nose, coughing while drinking or eating, food pocketing, or failure of patient's adam's apple to move, or no swallow at all, have the patient evaluated with a video swallow. (Obviously if a patient is not swallowing, stop immediately and do a gloved finger sweep to clear out any food and call the doc for NPO and video swallow screen orders.)

    3. Dry patients don't taste food. Patients who don't smell or can't taste their food will eat less. The moister the mucous membranes, the better the elderly patient will taste the food. So offer a nice beverage before the meal and offer fluids between meals.

    Hope that helps! Good luck!
  4. by   SuesquatchRN
    I hate feeding. Hate hate hate it. It's the only part of working LTC I detest.
  5. by   deleern
    I only feed the residents that are having problems, as an LPN we don't have time to stop and do this if i have a free minn. i Chart or am on the phone talking to Docs or leaving mesages for them.... when i Was a CNA I worked the NOC shift. so i was never there for meals.

    but i printed off the information that Angie o Plasty RN submitted to bring to work.... Great Stuff!!
  6. by   BWSPN
    Being a CNA for 10 years I've learned a few tricks. Using a little bit of ice cream on the end of the spoon just to get a hard feed to take a bite. Making a "shake" out of the pureed food and milk. Some people will suck a straw but won't open for a spoon. Sometimes when your doing your best to help someone you do some things that aren't the most appealing. And of course you have to watch for problems.
  7. by   CapeCodMermaid
    You need to know what works for each resident. We had a lady...never ate anything...only drank. Milk with ice cream, shakes with ice cream, melted ice cream. Her weight was stable and the doc was always amazed she looked as good as she did....another resident was a total feed...wouldn't eat unless he started his meal with his dessert...another one had to face the wall because any distraction was too much.
    I hate feeding...especially people who are more dead than alive and neither the family nor the doctor have the courage to say enough.
  8. by   all4schwa
    a spoonful of something cold like applesauce between bites encourages swallowing.

    also, a light stoke with your finger on the neck or jaw will stimulate swallowing.

    some people will go for anything if you add a spoonful of sugar.

    if youre talking about elderly, find out what they do like and do your best to make sure they have it when ever they want. calories are more important at this point than having all the food groups present.
  9. by   Simplepleasures
    I know this sounds totally disgusting but we had a little frail lady that would only eat meat, veges, etc, if it was drowned in chocolate sauce!
  10. by   vampiregirl
    Quote from CapeCodMermaid
    another resident was a total feed...wouldn't eat unless he started his meal with his dessert...
    Smart guy

    Ok, back to the subject at hand... does anyone still use lemon ice?
    I remember we had a older speech therapist who used to recommend this. If I recall correctly, it was something about the cold and the sourness that stimulated swallowing. We would alternate bites of food with bites of lemon ice. I know it sounds odd, but it worked.

    I also like offering lemon ice to end stage terminal patients. Seems to be very soothing.

    By the way, great thread idea!!!
  11. by   RN007
    Quote from ingelein
    I know this sounds totally disgusting but we had a little frail lady that would only eat meat, veges, etc, if it was drowned in chocolate sauce!
    YUMMY! (not!)

    God bless these pts. I hope that when I'm old and frail, I'll have nice people like you to feed and help me.
  12. by   VivaLasViejas
    Quote from CapeCodMermaid
    You need to know what works for each resident. We had a lady...never ate anything...only drank. Milk with ice cream, shakes with ice cream, melted ice cream. Her weight was stable and the doc was always amazed she looked as good as she did....another resident was a total feed...wouldn't eat unless he started his meal with his dessert...another one had to face the wall because any distraction was too much.
    I hate feeding...especially people who are more dead than alive and neither the family nor the doctor have the courage to say enough.
    Feeding was my most disliked LTC task as well. I hated trying to make people eat when the food looked so unappetizing---pureed meats are SO gross---and they didn't want to eat anyway. Their bodies' wisdom was letting them know it was time to start shutting down the works, and yet there we were, forcing them to consume calories their bodies didn't want in a most unappealing fashion.

    That said, it's another thing when people want to eat, but need help to do so. Then we get REALLY silly and insist that they eat their meat and vegetables before they can have dessert........... I'm sorry, but if I'm 90-something and I want my sweets first, I'm going to have them.
    How old does one have to be before he or she gets to make their own decisions?? Just because they may sometimes behave like children, doesn't justify treating them as such.

    I'll never forget the 93-year-old gentleman I was directed to feed one day years ago, when I was in CNA training. I was sent into the room with his tray and explicit instructions to make sure he ate at least half of his meat and veggies before I let him have his chocolate cake. This man was in acute renal failure, on hospice, and he hadn't eaten anything at all in two days; of course, being new, I encouraged him to eat the main course, which he pleasantly but firmly declined. Then I realized something: I was 35 years old. He was 93. And I was going to teach him something about nutrition at this point in his life??

    So I forked up a bite of chocolate cake, which he eagerly accepted along with a sip of milk; then another, and then still another until there was nothing left of the cake but a few crumbs. He belched contentedly, whispered "Thank you", and I took the tray from the room, knowing I'd get a lecture from the nurse but not one bit sorry for what I'd done.

    The resident died later that afternoon, just as I was going off-shift. His little wife, who lived in the same room with him, thanked me for making his last "meal" a good one: "Do you know, that cake was the first thing he's enjoyed in weeks?" she said through her tears. To this day, whenever I run across a "problem eater", I think of that sweet old couple, and ask the resident what he or she prefers instead of trying to impose my idea of what constitutes a proper diet. All the nutrition in the world won't do the resident a bit of good if he won't eat it. (It's hard sometimes to convince the family of this basic truth, but one must try, at any rate. )

    So bring on the ice cream, the gravies and sauces, and the flavors they love. Who cares if they're not consuming the "recommended" foods in the recommended amounts---if you haven't earned the right to live the way you want by the age these folks have attained, there's not much point in living. Food is not just a collection of nutrients; it's a source of pleasure and social contact, and for many older adults in LTC facilities, just about the only one they have left. What right do we have to take that away from them?:trout:

    Just my $.02 worth.
  13. by   RN007
    Marla, what a wonderful testament to your compassion. I learned alot from your post as well as all the others. I agree; this is a great thread. Thanks, Everyone!
  14. by   meownsmile
    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!!!!!

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