tips for feeding a stroke patient?

Published

I have a stroke patient that is almost impossible to feed. She had the stroke about 2 wks ago, and is completely dependent/verbally unresponsive/still sleeping most of the time.

The SLP told gave me a couple of tips (including tapping her cheek and throat gently which only works for about 5 mouths full, then she just won't open her mouth no matter what I do), and told me that I just "need to be really patient". Duh.

I am being as patient as I can, but at this rate, I literally CANNOT spend the amount of time reqired to get her all the food she needs. It would take me over an hour and a half to feed her a single bowl of puree. Her family will not consider a feeding tube.

The nurses, of course, do not seem to understand that I have other feeders that need to eat, as well as a full patient load. They have also told me that most of the other CNA's have been charting her as having eaten 60-70% of her food at every meal. I think the CNA's are lying because there is NO WAY they could get her to eat that much unless they spent 3-4 hours per shift just feeding her.:confused:

Any tips?

Up Vote Up Vote ×
Specializes in Acute Care, Rehab, Palliative.

I have had lots of experience with stroke patients and there really isn't a lot you can do if she stops after a few mouthfuls.I have had one like that for about six months now and once she stops opening up we stop feeding. You can't force it or you run the risk of the patient aspirating.Thankfully her family us not going the feeding tube route. I have seen too many patients with no quality of life and a body that is breaking down but they are kept alive by that darned feeding tube.

Don't feel guilty if you are doing your best.

Up Vote Up Vote ×
Specializes in LTC, assisted living, med-surg, psych.

You may want to check with your facility's speech therapist again. They can try a drinkable puree diet with supplements, which may get more calories in and requires less energy on the part of the patient. Of course, there is always the danger of aspirating because staff may be tempted to go TOO fast with her feedings; but with proper precautions it might be the way to go until somebody wises up and recommends hospice services for her.

Personally, I'm with the resident's family on this one; a feeding tube would be inappropriate, and force-feeding is cruel and unusual punishment IMO. This lady is not going to be with you very long if she continues to refuse food, and I think she knows this on some level.

Up Vote Up Vote ×

I agree with what the other two posters have said. Also, and this is the most frustrating thing I see, but if the nurses say that she is eating 60-70% when others feed her it is entirely possible that either the other CNAs, or the nurses, are lying. :crying2:

Up Vote Up Vote ×

I feel the same way about the feeding tube. It's just so sad. :-(

Thanks for sharing- I worry that her family isn't ready to accept what looks like it is inevitable. I guess that just takes time.

Up Vote Up Vote ×

I am not recommending that you try this unless the nurse is okay with it, but I am thinking that the other CNA's might be putting the food in a cup for this resident to eat faster.

Up Vote Up Vote ×

As others have said, you certainly shouldn't forcefeed her, but the food in a cup idea might be worth asking the nurse about. I work at a home for severely developmentally disabled children, and several of them have a hard time eating from a spoon but do really well with thickened consistency liquids/foods fed from a flexible plastic cup.

You definitely want to ask before you try, but it might help.

If not, just do what you can do! Sometimes people are just ready to give up, and I know if I were in that mindset, I'd hate to be forcefed.

Up Vote Up Vote ×
Specializes in CV Surgical, ICU.

Even if she had a stroke she still is very likely to have her wits about her. Is she awake enough to give yes or no cues? Try asking her if she's still hungry. What I'm getting out of this is maybe a sad woman who just lost a lot of her ablities after having took a stroke, and who simply may not have the desire to eat. And if that's the case I don't think using tricks to get an extra couple of bites in is really going to do her any good at that point. Could be time for hospice/Care & Comfort measures?

Up Vote Up Vote ×
Specializes in LTC.

Have you point blank asked the other CNAs how they get this woman to eat so much of her meal? If they're not fudging the amount then they should be able to give you a few tips. Maybe they're giving this woman something else, like tomato soup or ice cream. Like the other responders, I've found that a lot of residents who don't seem that into eating anymore are a lot more willing/able to drink their food. Usually these people are on a puree diet so I'll mix their food in a cup with some milk, soup, ice cream, or whatever else (sometimes you have to get creative to make it appetizing), hand them the cup and they'll drink it right down. And even those that still eat will sometimes have an aversion to utensils. So I make a sandwich with their food (if they're not puree) and they have no trouble. Or sometimes people get overwhelmed by the sheer amount of food on their tray (or the mix of smells) so I hide the tray somewhere else and give them one thing at a time. I never thought of that until an alert resident told us to do that with her or she couldn't bring herself to eat. We even have a couple people who won't eat unless you let their tray sit there and get cold.

Up Vote Up Vote ×

I love this site and all of you for sharing!

I have asked the other CNA's and they get a little sheepish- that's why I suspect that they might be fudging the chart. The patient is fairly new to us though, so I will keep asking other CNA's as time goes by.

I did not think of trying the cup, but I will certainly ask the nurse.

The patient doesn't yet answer questions (verbally or with cues), but every now and again, she does give me these cute little barely there smiles, and she sometimes nudges me with her finger when I rub her hand to get her attention, so I really do feel like she's still "in there".

Again, thanks everyone for sharing their advice/opinions, and I will keep checking back for more!

Up Vote Up Vote ×
Specializes in CV Surgical, ICU.
so I really do feel like she's still "in there".

She most definitely is, most residents in the same situation are even if it doesn't seem that way :)

Up Vote Up Vote ×

What shift do you work? And what meal is it that she is not eating well at?

I know that some people naturally tend to eat more at some meals and less at others. For example, I am a heavy breakfast and dinner eater, but I usually prefer only a light lunch. Think of friends and family you have that always skip breakfast, etc.

She may never have eaten much at whatever meal it is you are having trouble with, so she could be just continuing that pattern now.

Up Vote Up Vote ×
+ Join the Discussion