GI/GU: Oral feeding

As a nursing assistant, you will need to prepare clients for their meals, serve them food, and depending on their needs, assist them in eating.

Now, before we talk about how to do these things, here are some general considerations. Always check that the name on the tray matches the identification card or bracelet of the client and that the meal served follows the nutritional guidelines for that particular client.

Make sure to serve food as soon as it’s ready so that serving temperature is optimal. Ask the nurse how much help the client will need and then confirm with the client.Whenever possible, let them eat in the dining room together with others.

However, in some cases, it’s best to provide a private place. Finally, try to create a friendly atmosphere, keep them company, and help them as much as they need, while encouraging them to participate as much as possible.Okay, so, when preparing a client for their meal, first gather the supplies you’ll need, including gloves, soap, washcloths, paper towels, towels, and washbasin as well as equipment for oral hygiene and a bedpan or urinal.

Make sure to notify them as early as possible to get ready for the meal. Remember to ask them if they need to be accompanied to the bathroom beforehand or offer them a bedpan or urinal.Wear your gloves and assist the client with cleaning their hands, face, and teeth.

If they can’t get up from the bed, fill the washbasin with water and check that it’s warm enough. Then, spread paper towels on the over-bed table, place the basin on top, and help them with hygiene.

If the client is incontinent, make sure they are dry and clean. If they use eyeglasses, hearing aids, or dentures, check that those devices are properly positioned.

Next, check where they’ll be eating and make sure the room is free from disturbing sights, odors, or sounds. If they're eating in the dining room, position them in a chair or wheelchair, so they’re upright; if they’re in bed, raise the head of the bed, so they’re as upright as possible.

Clean and adjust the over-bed table to a suitable height. Some clients might also have dysphagia, meaning difficulty swallowing.

This is often caused by nervous system conditions, like stroke or head trauma or tumors in the mouth or esophagus, blocking the passage of food.

In these cases, the health care provider could order all liquids, like soup, to be thickened, making them less difficult to swallow.

To do that, start adding a thickener to the liquid as slowly as possible until you reach the wanted consistency. This could vary from nectar-like consistency which resembles fruit nectar and is easily pourable, to honey consistency which is slightly thicker and less pourable.

Let the liquid sit for a couple of minutes for the thickener to achieve the ideal effect. Avoid adding ice or any condiments like vinegar or lemon juice afterwards because that could change the consistency again.

Remember to check and readjust the consistency of hot liquids regularly because they tend to become thicker as they cool.

Avoid offering additional water or anything that could melt, like ice cream. Make sure that all liquids provided to the client throughout the day have also been thickened.Now, when serving a meal, start by asking the client if they want to use a clothing protector to keep their clothes stain-free and help them put one on if necessary.

Then, make sure to position the tray as well as napkins or assistive devices within easy reach; for a person eating in bed, this means on the over-bed table.

Uncover the food, open any container, and unwrap the silverware. Depending on the needs of the client, you may also need to help them cut solid food into small pieces, apply butter or cheese on the bread, and add salt or various spices to the food.

This should be based on their preferences but also their nutritional guidelines. For certain clients with vision problems, it may also be helpful to let them know what food is being served and how it’s positioned.

One technique is the clock face method, where you pretend the plate is the face of a clock with six o'clock being closest to the client.

Typically, the protein, like meat or fish, is positioned at 6 o’clock; vegetables at 2 o’clock; and carbohydrates, like rice or pasta, at 11 o’clock.

Assistive devices may also be helpful for physically disabled clients trying to eat independently. These can include plate guards that keep food from falling off the plate, angled utensils that allow rocking motions and can be easier for those with restricted arm movement, as well as cup holders that prevent spills for those with poor grip.

Now, during the meal, it’s important that all clients remain upright to prevent aspiration. This occurs when food, fluid, or even saliva enters the lungs instead of the esophagus.

These can carry harmful microbes into the lungs, leading to aspiration pneumonia. Now, there are various reasons why a client might not be able to feed themselves at all, like if they’re in a full body cast.

To feed these clients, start by making sure that the wheels on the bed are locked and that the side railings on the working side are down.

Place a chair next to their bed and make sure you’re facing them at eye level. Ask them if there’s a particular order in which they’d prefer to eat the food.

Start by filling one-third of the spoon and let them know what you’re about to serve them. Every few bites, allow them to drink some fluids, such as water, coffee, or tea.

Make sure the temperature is not too hot and, if necessary, use straws. For clients with dysphagia, make sure you’re not giving the liquid too quickly because this could lead to aspiration.

For those recovering from stroke, it would be best to direct food to the unaffected side of the mouth. Throughout the meal, make sure to give all clients time to properly chew and swallow the food and wipe their hands, mouth, and chin with a napkin or hand wipe as frequently as needed.

Gently urge them to eat as much as possible but don’t force them.When the client has finished, take the tray and the clothing protector away and assist them with oral and hand hygiene.

If they were in the dining area, help them return to their room. If they ate on their bed, replace any soiled linens, return the side rails to the raised position, adjust the height of the bed and head of the bed, and make sure that the wheels are locked.

In any case, make sure they remain upright for at least 1 hour after the meal to reduce the risk of aspiration.After assisting a client with eating, you should notify a nurse immediately if you notice changes in the person’s appetite, if they ate less than 70% of the food served, or if they complain of nausea or difficulty swallowing.

Also, observe for any signs of aspiration, like coughing, choking, gagging, or difficulty breathing during or after the meal.

Make sure to document these alongside the date and time and the total amount of food and fluids consumed.Alright, as a quick recap...

Prepare a client for their meals by assisting them with elimination; ensuring proper hand, face, and oral hygiene; creating a friendly atmosphere; and by helping them take a comfortable, upright position to prevent aspiration.

Check if they also need thickening of their fluids. Then, serve the food as soon as it’s ready and, depending on their needs and abilities, assist them with eating or feed them.

After the procedure, remember to report any unusual signs or symptoms to the nurse and document the details.