Nutrition and Fluids
Assisting with Meals
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Safety
- Assess the patient for signs and symptoms of malnutrition, and identify if the patient is malnourished or at risk for malnutrition.
- Identify if the patient is at risk for dysphagia, and collaborate with other members of the health care team to minimize complications, such as aspiration pneumonia.
- Verify the health care provider’s diet order, and ensure that the patient is receiving the correct therapeutic diet.
- Assess the patient’s level of consciousness before feeding.
- If you suspect that the patient is aspirating, stop feeding the patient immediately, and suction the patient’s airway.
- If the patient’s intake falls below 75% for any length of time, refer the patient to an RD (registered dietitian) for medical nutrition therapy.
Equipment
(Roll cursor over items to see labels)
Stethoscope
Tongue blade
Washcloths and towels
Adaptive utensils
Adaptive utensils
Adaptive utensils
Antiseptic hand gel
Oral hygiene supplies
PrintableDelegation
The skill of assisting a patient with oral nutrition can be delegated to nursing assistive personnel (NAP). However, the nurse is responsible for determining whether the patient is able to receive oral nutrition, which includes assessing the patient’s ability to swallow and identifying any other oral intake restrictions. Be sure to inform NAP of the following:
- Any specific swallowing strategies/techniques unique to the patient
- When to stop feeding; direct NAP to report immediately to you any incidents of coughing, gagging, or difficulty swallowing
Preparation
- Assess the patient’s knowledge of the procedure.
- Ensure that the patient passes flatus, is free of nausea, and has healthy bowel sounds on auscultation.
- Review the health care provider’s diet order for the patient.
- Assess for the presence and condition of the patient’s teeth. Assess the patient’s dentures for fit.
- Assess the patient’s cranial nerve function. Specifically assess cranial nerves V, VII, IX, and X.
- Assess patient's ability to swallow.
- Determine to what extent the patient is able to self-feed. Assess the patient’s physical motor skills, such as the ability to grasp utensils, hold a cup, and move it to the mouth. Evaluate the patient’s level of consciousness, visual acuity and peripheral vision, and mood.
- Assess the patient’s appetite, food tolerance, recent fluid intake, cultural and religious preferences, and food preferences.
- Ensure that the patient is comfortable and will not be interrupted during the meal.
- Collaborate with an occupational therapist (OT) to assess the patient’s ability to self-feed and to obtain recommendations on adaptive equipment and self-feeding supplies.
Follow-up
- Monitor the patient’s body weight daily or weekly.
- Monitor the patient’s laboratory values as indicated.
- Monitor the patient’s intake and output (I&O) and the percentage of food remaining on the tray after each meal.
- Observe the patient’s ability to self-feed, including the ability to feed certain items, and part or all of the meal.
- Observe the patient for choking, coughing, or gagging, and for food left in the mouth while eating.
Documentation
- Document in the patient’s chart his or her tolerance of the prescribed diet. Record the percentage of each meal eaten by the patient (for example, 25% of food consumed at breakfast).
- If the patient is on a calorie count, record the caloric intake. If the patient’s I&O is being evaluated, record the fluid intake.
- If the patient is receiving oral nutritional supplements, such as Ensure or Boost, record the amount of the supplement taken and communicate the patient’s tolerance to the health care team. For example, report whether the patient likes or dislikes the supplement and if the supplement is to fill in or replace any meals.
- Report if the patient experienced any swallowing difficulties or disliked any foods. Report the patient’s refusal to eat.
Review Questions
1. While feeding a patient, the nurse puts the fork down on the tray and turns on the suction machine. Why might the nurse perform this action?
The patient is tilting the head backward while drinking.
The patient is choking.- Food has dripped or spilled onto the patient’s clothing.
- The nurse determines that this is the wrong diet for the patient.
INCORRECT. The nurse would turn on the suction machine while feeding a patient if the patient appeared to be choking. If the patient’s head were tilted backward while drinking, the nurse would instruct him or her not to do so, but would not suction out the beverage if the patient wasn’t gagging, choking, or coughing.
CORRECT. The nurse would turn on the suction machine while feeding a patient if the patient appeared to be choking.
INCORRECT. The nurse would turn on the suction machine while feeding a patient if the patient appeared to be choking. Any food on the patient’s clothing would be brushed off or wiped off with a moist cloth.
INCORRECT. The nurse would turn on the suction machine while feeding a patient if the patient appeared to be choking. The nurse would have determined whether the meal was appropriate for the patient before beginning to feed him or her.
2. What would the nurse instruct nursing assistive personnel (NAP) to do to ensure safety when feeding Salisbury steak to a dependent patient?
- Lower the head of the bed to a 30-degree angle.
- Encourage the patient to drink all fluids first.
- Cut the steak into small, bite-size pieces.
- Ensure that the steak is steaming hot.
INCORRECT. To ensure patient safety, the nurse would instruct NAP to cut the steak into small, bite-size pieces. Lowering the head of the bed to a 30-degree angle could cause the patient to aspirate food or accompanying fluids.
INCORRECT. To ensure patient safety, the nurse would instruct NAP to cut the steak into small, bite-size pieces. The NAP would not offer all of the fluids to the patient to drink first.
CORRECT. To ensure patient safety, the nurse would instruct NAP to cut the steak into small, bite-size pieces.
INCORRECT. To ensure patient safety, the nurse would instruct NAP to cut the steak into small, bite-size pieces. Foods that are steaming hot could injure the patient.
3. When assisting a patient who has self-feeding difficulties, why would the nurse ask the patient to try to self-feed?
- To determine what kind of assistance the patient needs with feeding
- To identify which food item is causing the trouble
- To identify which hand the patient uses for utensils
- To promote the patient’s sense of self-confidence
CORRECT. The nurse would ask the patient to try to self-feed in order to determine what specific assistance or assistive devices the patient needs during meals.
INCORRECT. The nurse would ask the patient to try to self-feed in order to determine what specific assistance or assistive devices the patient needs during meals. A patient with self-feeding difficulties tends to have trouble with many kinds of food, not just with a specific type of food.
INCORRECT. The nurse would ask the patient to try to self-feed in order to determine what specific assistance or assistive devices the patient needs during meals.
INCORRECT. The nurse would ask the patient to try to self-feed in order to determine what specific assistance or assistive devices the patient needs during meals.
4. While feeding a patient recovering from a stroke, a nursing assistive personnel (NAP) becomes distracted and does not watch the patient swallow a bite of food. What would the NAP do to ensure that the patient safely swallowed the food?
- Give the patient a drink to wash down the food.
- Check the patient’s mouth for pocketing.
- Suction the patient’s mouth.
- Give the patient the next bite of food.
INCORRECT. To ensure that a patient with a neurological impairment safely swallowed the food, the NAP would check the patient’s mouth for pocketing. If the patient has not swallowed the food, giving the patient a drink might further complicate the situation.
CORRECT. To ensure that a patient with a neurological impairment safely swallowed the food, the NAP would check the patient’s mouth for pocketing.
INCORRECT. To ensure that a patient with a neurological impairment safely swallowed the food, the NAP would check the patient’s mouth for pocketing. Suctioning would not be necessary unless the patient were choking, gagging, or coughing.
INCORRECT. To ensure that a patient with a neurological impairment safely swallowed the food, the NAP would check the patient’s mouth for pocketing. If the patient has not swallowed the food, giving the patient another bite might further complicate the situation.
5. Why would the nurse want to determine if the patient is passing flatus before giving a meal?
- To ensure that the previous meal has been fully digested
- To ensure that the meal won't make the patient feel uncomfortably full
- To determine whether the GI tract is functioning.
- To determine whether the patient tolerated the foods given during the previous meal
INCORRECT. The nurse would want to determine whether the patient is passing flatus to ensure that the GI tract is functioning. The ability to pass flatus does not indicate that digestion has occurred. Passage of flatus occurs even in people who have been fasting.
INCORRECT. The nurse would want to determine whether the patient is passing flatus to ensure that the GI tract is functioning. The inability to pass flatus would indicate the possibility of GI tract obstruction, and the patient would not be allowed to eat until this possibility is ruled out.
CORRECT. GI tract obstruction prevents the passage of flatus and may make the patient feel nauseated. To ensure that the GI tract is functioning, the nurse would want to determine whether the patient is passing flatus and is free of nausea.
INCORRECT. The nurse would want to determine whether the patient is passing flatus to ensure that the GI tract is functioning. The ability to pass flatus is unrelated to food tolerance.
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