Assisting Clients with Eating

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Questions and Answers

A nurse is preparing to assist a client with dysphagia during mealtime. Which intervention is most important to implement before the meal?

  • Offer a choice of dessert.
  • Provide a liquid supplement.
  • Ensure the client is fully rested. (correct)
  • Administer prescribed pain medication.

A client with advanced dementia is having difficulty eating. Which of the following strategies is most appropriate to enhance their nutritional intake?

  • Serving the meal in a dimly lit, quiet room to minimize distractions.
  • Providing a large tray with a variety of food options.
  • Discussing current events to stimulate cognitive function during the meal.
  • Offering foods that can be eaten without utensils. (correct)

When assisting a client with unilateral weakness after a stroke, which action promotes safe swallowing?

  • Encouraging the client to talk while eating to maintain alertness.
  • Placing food on the unaffected side of the mouth. (correct)
  • Tilting the client's head back while swallowing.
  • Offering large bites of food to stimulate swallowing.

A client with visual impairment is having difficulty locating food items on their plate. Which nursing intervention promotes dietary intake?

<p>Describing the location of food using a clock-face reference. (D)</p> Signup and view all the answers

A nurse is caring for a client with a history of aspiration pneumonia. Which food consistency is most appropriate for this client?

<p>Pudding-like consistency (B)</p> Signup and view all the answers

A client who is being fed is coughing frequently during meals. What is the priority nursing intervention?

<p>Stopping the feeding and assessing swallowing ability. (D)</p> Signup and view all the answers

A nurse is preparing to feed a client who has weakness on their right side. Which intervention will best support the client's independence during the meal?

<p>Providing a built-up utensil. (B)</p> Signup and view all the answers

The assistive personnel (AP) is assisting a client with eating. What observation should the nurse instruct the AP to report immediately?

<p>The client is drooling and having difficulty managing secretions. (C)</p> Signup and view all the answers

A nurse is caring for a client with a decreased level of consciousness. What is the most important safety precaution related to feeding?

<p>Elevating the head of the bed to at least 45 degrees. (D)</p> Signup and view all the answers

A client with a new diagnosis of dysphagia is being discharged. Which instruction is most important for the nurse to provide to the client and family?

<p>Take small bites and chew thoroughly. (C)</p> Signup and view all the answers

A nurse observes an assistive personnel (AP) preparing to assist a client with a meal. Which action by the AP requires immediate intervention by the nurse?

<p>The AP adds thickener to the client's water without checking the care plan. (D)</p> Signup and view all the answers

A client is refusing to eat, stating they have no appetite. Which nursing intervention is most appropriate initially?

<p>Assessing for potential causes of appetite loss. (B)</p> Signup and view all the answers

A nurse is caring for a client with arthritis who has difficulty using standard eating utensils. Which assistive device is most beneficial?

<p>Utensils with built-up handles. (B)</p> Signup and view all the answers

After a meal, a client with dysphagia has a persistent cough and a wet, gurgly voice. What is the nurse's priority action?

<p>Initiating immediate suctioning. (A)</p> Signup and view all the answers

A nurse is preparing to assist a client with feeding. Which action should the nurse take first?

<p>Check the diet order. (A)</p> Signup and view all the answers

A client with dementia is easily distracted during meal times. Which environmental modification will promote adequate nutritional intake?

<p>Providing meals in a quiet, private setting. (B)</p> Signup and view all the answers

Which nursing intervention is most effective in promoting a client's appetite?

<p>Offering favorite foods. (D)</p> Signup and view all the answers

A client is receiving pureed foods due to dysphagia. What is an important consideration when serving pureed meals?

<p>Serving each food item separately to allow for individual tasting. (A)</p> Signup and view all the answers

A client reports difficulty swallowing pills. Which intervention is most appropriate?

<p>Crushing the medication and mixing it with applesauce (if appropriate). (C)</p> Signup and view all the answers

A client with a history of stroke is having difficulty swallowing liquids. What is the most appropriate intervention to prevent aspiration?

<p>Adding a thickening agent to the liquids. (C)</p> Signup and view all the answers

A nurse is documenting a client's food intake. Which information is most important to include?

<p>The percentage of the meal consumed. (C)</p> Signup and view all the answers

A client with Parkinson's disease is experiencing tremors that make it difficult to eat. Which utensil modification assistive device is most appropriate?

<p>A weighted utensil. (B)</p> Signup and view all the answers

A client reports a metallic taste in their mouth while eating. Which intervention should the nurse implement?

<p>Use plastic utensils and glassware. (D)</p> Signup and view all the answers

A client is on a sodium-restricted diet. Which food item should the nurse instruct the client to avoid?

<p>Canned soup. (C)</p> Signup and view all the answers

A nurse is caring for a client who is at risk for aspiration. Which action is most important to include in the client's plan of care?

<p>Keeping suction equipment readily available. (C)</p> Signup and view all the answers

Which action by the nurse demonstrates respect for a client's cultural preferences during mealtime?

<p>Offering a substitution if the meal does not meet the client's preferences. (B)</p> Signup and view all the answers

A client with end-stage renal disease is on a fluid restriction. Which intervention is most important to include in the client's plan of care regarding meals?

<p>Substituting solid foods for liquids when possible. (A)</p> Signup and view all the answers

Which action minimizes the risk of foodborne illness when assisting clients with meals?

<p>Washing hands before and after assisting with meals. (D)</p> Signup and view all the answers

A client with mucositis (inflammation of the mucous membrane) due to chemotherapy is having difficulty eating. Which food choice is most suitable?

<p>Warm broth. (B)</p> Signup and view all the answers

A nurse is preparing to administer an oral medication to a client with dysphagia. Which action is most appropriate?

<p>Checking if the medication can be crushed or is available in liquid form. (D)</p> Signup and view all the answers

A client who is postoperative is complaining of nausea and has a poor appetite. Which intervention is most helpful in improving the client's nutritional intake?

<p>Providing small, frequent meals. (A)</p> Signup and view all the answers

A client with diabetes mellitus requires assistance with meal planning. Which dietary guideline is most important for the nurse to emphasize?

<p>Eating meals at consistent times each day. (D)</p> Signup and view all the answers

A client is receiving total parenteral nutrition (TPN). What is the priority nursing assessment related to this form of nutrition?

<p>Checking blood glucose levels. (C)</p> Signup and view all the answers

Before assisting a client with feeding, a nurse reviews the client's chart and notes an allergy to shellfish. Which action should the nurse take?

<p>Inform the dietary department and ensure the meal does not contain shellfish. (D)</p> Signup and view all the answers

A nursing assistant is preparing to assist a client with feeding. Which action requires the nurse to intervene?

<p>The nursing assistant offers the client large bites of food to encourage adequate intake. (C)</p> Signup and view all the answers

A nurse is caring for a client with dysphagia who is on thickened liquids. Which observation indicates that the client is tolerating the diet?

<p>The client has clear lung sounds after meals. (B)</p> Signup and view all the answers

Which communication strategy is most appropriate when assisting a client with cognitive impairment during mealtime?

<p>Using simple, one-step directions. (A)</p> Signup and view all the answers

A client with a tremor is having difficulty feeding themselves. Which of the following interventions is most appropriate to promote independence?

<p>Providing the client with a weighted utensil. (B)</p> Signup and view all the answers

The nurse is assisting a client who has cognitive impairment with feeding. Which strategy would be most effective in encouraging the client to eat?

<p>Providing verbal prompts and demonstrating the next step. (A)</p> Signup and view all the answers

A nurse is caring for a client who is experiencing anorexia. Which of the following actions is most important to implement?

<p>Creating a pleasant and odor-free environment during meal times. (B)</p> Signup and view all the answers

A client coughs and clears their throat several times after taking a sip of water during mealtime. What is the priority nursing action?

<p>Stop feeding the client and assess for signs of aspiration. (B)</p> Signup and view all the answers

The nurse is preparing to assist a client with feeding who has visual impairment. Which intervention is most appropriate?

<p>Describing the location of food on the plate using a clock-face orientation. (A)</p> Signup and view all the answers

Flashcards

Check for Allergies

Determining allergies helps prevent allergic reactions.

Verify Client ID

Ensuring you have the correct patient before intervention.

Use Standard Precautions

Using precautions during contact prevents transmission of infectious organisms.

Assess Consciousness and Swallowing

Necessary to prevent complications such as aspiration and choking.

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Review Medical Record

Reviewing allows the nurse to determine any prescribed diet and identify potential safety concerns.

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Provide Privacy

Providing privacy is a part of maintaining client confidentiality.

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Introduce Yourself

Introducing yourself promotes a therapeutic nurse-client relationship.

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Provide Client Education

Client education decreases anxiety and promotes nurse-client relationship. Also, determine if person has any questions or concerns.

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Assess Preferences and Dietary Needs

Offering a diet that takes the client’s preferences into account increases their motivation for eating.

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Clear Bedside Environment

Creating a pleasant environment helps stimulate the appetite and minimize distractions.

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Assist to Upright Position

Eating in an upright position decreases the likelihood of aspiration.

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Place Protective Covering

Placing a protective covering prevents the client’s clothing from becoming soiled.

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Verify Food Temperatures

Ensuring food temperatures are appropriate prevents the client from sustaining burns.

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Place Food Tray in View

Allowing the client to visualize the food helps motivate them to participate in feeding.

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Encourage Self-Feeding

Promoting independence fosters dignity and improves or prevents decline in motor and congnitive function.

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Provide Small Bites

Providing manageable amounts of food and allowing adequate time for chewing and swallowing decreases possibility of dysphagia and aspiration and preserves the client’s energy.

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Observe Swallowing Ability

These measures decrease the likelihood of aspiration.

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Provide Oral Care

Regular oral care prevents tissue breakdown, dental caries, and infection.

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Ensure Client Comfort

These measures contribute to the client’s comfort.

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Discuss Findings

Discussing findings with the client promotes the nurse-client relationship.

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Ensure Client Safety

Ensure safety to reduce the risk of falls and client injury.

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Assistive Devices

Clients with physical alterations may require adaptive devices.

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Altered Cognition

Clients with altered cognition may not understand or be able to execute the process of eating and require assistance.

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Concurrent Medical Conditions

Clients who need assistance with eating may also be experiencing anorexia. It's important to meet food preferences.

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Interventions for Unexpected Outcomes

There are several interventions effective at addressing undesirable outcomes for clients who require assistance with eating.

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Allied Health Consults

Ensures that the food is prepared according to the client’s needs.

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Documentation

As part of the implementation phase of the nursing process.

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Define Dysphagia

An alteration in the swallowing mechanism.

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Study Notes

  • Clients might need help with eating, ranging from food presentation to full assistance.
  • Tailor assistance to individual needs, promoting independence while ensuring optimal nutrition and calorie intake.
  • RNs can delegate assisting clients with eating to PNs or APs familiar with aspiration precautions.

Safety Considerations

  • Determine if the client has food allergies to prevent allergic reactions.
  • Always verify client identification to perform the correct procedure on the correct client.
  • Use standard precautions to prevent transmission of infectious organisms.
  • Assess the client’s consciousness, orientation, and physical impairments to prevent nutritional deficits, weight loss, aspiration, and choking.

Equipment

  • Nonsterile gloves and PPE (if indicated) are needed.
  • Prepared food and liquids should match dietary needs and preferences.
  • Use a protective covering like a towel prevent soiling the client's clothes.
  • Napkins or washcloths are needed for client cleanliness.
  • Adaptive devices like glasses, hearing aids, dentures, and utensils can improve the client's experience.
  • Oral care items are needed to provide oral care after meals, promoting comfort and preventing infection.

Step-by-Step Guide

  • Step 1: Review the client’s medical record for allergies, medical history, medications, vital signs, and lab values.
  • Step 2: Gather necessary supplies.
  • Step 3: Provide privacy to maintain confidentiality.
  • Step 4: Introduce yourself, fostering a therapeutic relationship.
  • Step 5: Hand hygiene and PPE prevent infection.
  • Step 6: Use two identifiers to confirm the client’s identity.
  • Step 7: Confirm the client’s allergy status to prevent allergic reactions.
  • Step 8: Educate the client to alleviate anxiety and foster trust.
  • Step 9: Assess level of consciousness, hearing/visual acuity, swallowing ability, and motor skills.
  • Step 10: Consider cultural, religious, and food preferences.
  • Step 11: Clear the bedside of unpleasant items and odors to stimulate appetite.
  • Step 12: Position the client upright to prevent aspiration.
  • Step 13: Use a protective covering to prevent clothing from becoming soiled.
  • Step 14: Verify the food tray matches the prescribed diet and has appropriate temperatures.
  • Step 15: Present the food tray to the client to encourage participation.
  • Step 16: Ask about food preferences, cut food as needed, and ensure items are within reach to enable independence.
  • Step 17: Sit at eye level to socialize and assess the client.
  • Step 18: Encourage self-feeding to promote dignity and maintain function.
  • Step 19: Offer small bites, allow time to chew, and provide drinks for dysphagia and energy preservation.
  • Step 20: Observe the client’s ability to swallow to prevent aspiration.
  • Step 21: Clear the tray and note the amount of food consumed.
  • Step 22: Offer oral care to prevent breakdown, caries, and infection.
  • Step 23: Reposition, assist with hand hygiene, and offer toileting assistance to promote comfort.
  • Step 24: Assist the client to a comfortable position.
  • Step 25: Discuss findings to reduce anxiety and promote engagement.
  • Step 26: Ensure client safety before leaving the room by placing needed items within reach.

Client Considerations

  • Clients with physical alterations may need adaptive devices.
  • Clients with dysphagia are at risk of choking, aspiration, hypoxia, or pulmonary infection.
  • Clients with dementia or altered cognition may need assistance with eating.
  • Clients with concurrent conditions or nausea may need attention to preferences and environment.

Interventions for Unexpected Outcomes

  • For physical alterations, request therapy and nutrition consults for swallowing evaluation, assistive devices, and dietary modifications.
  • For visual impairment, use a clock pattern to describe the meal’s layout.
  • For dementia or altered cognition, prepare food in front of the client and maintain a mealtime routine.
  • Supervise meals, respond to cues, and ensure sensory aids are in use.
  • Offer finger foods, small meals, and one food at a time; stroke the throat to promote swallowing.
  • For dysphagia, discourage talking, ensure rest, position upright, and minimize distractions.
  • Offer food at the client’s pace, alternate solids and liquids, and assess medications.
  • Always provide oral care and request allied health consults.
  • Create a pleasant, calm environment to reduce confusion, sensory issues, and fatigue.
  • Sedatives and hypnotics may impair the gag reflex, increasing aspiration risk.
  • Stroke the client’s throat to promote swallowing.
  • Alternating liquids and solids helps to clear the mouth prior to taking in more food, and reminding the client to avoid talking while chewing or swallowing prevents choking and aspiration.

Documentation

  • Document assessments, interventions, position, percentage eaten, swallowing issues, and any interventions.
  • Accurate documentation ensures data access for the healthcare team.

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