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Part II Nutrition Assessment, Consequences, and Implications

BOX 10.7 Caring for a Client with Swallowing Difficulties ●

Check tray for proper diet. ● Help client to eat slowly.

● Sit on the client’s weaker side.

● Present small bites of food. Each bite should be approximately 1 tsp or less, as directed by the therapist. ● Allow sufficient time for the client to swallow.

● Encourage the client to “double swallow”—that is, first swallow food, then dry swallow once. ● Check that the client’s mouth is empty before continuing. ● Encourage the client to use tongue movements.

● Make sure that the client’s head is tilted slightly forward. ● Create an environment free of distractions.

● Guarantee that the client’s dentures are in place and fit well. ● Ensure adequate lighting, but not glaring light.

● Check that food is within 12 inches of reach, if the client is self-feeding. ● Present foods, drinks, and medications from the midline position. ● Alternate food and liquids.

● Serve food at appropriate temperatures.

● Provide adequate time for the client to eat or to be assisted (up to 45 minutes). ● Ensure safety by having suctioning equipment readily available. ● Be certain that the client sits upright for 30 minutes after the meal. ● Perform complete oral hygiene after all meals.

● Report any choking or coughing to the nursing supervisor and/or rehabilitation professional.

Do not do the following: ●

● ● ●

stand to assist clients because that causes them to lift their heads and extend their necks; assist the client if the client is lying down or reclining; rush the client or assist with meals too rapidly;

assist the client when head is tilted backward (“bird feeding”); ● provide medicine during choking or coughing; or

● change the client’s program without consulting the therapist or supervisor.

Positioning tips: ●

In most cases, the person should be positioned with the head slightly flexed. ● Head should be at a 90° angle with chin just slightly tucked. ● Shoulders should be slightly forward. ● Trunk should be leaning slightly forward. ● Hips should be flexed at slightly more than 90°. ● Knees should be flexed at 90°. ● Feet should be flat on the floor.

● The upper extremities should be placed so that elbows can be used to increase stability if needed.

Source: Kawashima K, Motohashi Y, Fujishima I. Prevalence of dysphagia among community-dwelling elderly individuals as estimated using a questionnaire for dysphagia screening. Dysphagia. 2004;19:266-271.