CHAPTER 11: BARRIERS TO ADEQUATE NUTRITION

Question 1

What neurological conditions can result in dysphagia?

Answer 1

▪ Parkinson’s
▪ Stroke
▪ MS
▪ Cerebral palsy

Question 2

What are some nursing interventions for a patient experiencing dysphagia?

Answer 2

▪ Lightly stroke their chin or throat while they’re eating to promote swallowing
▪ Thicken thin liquids
• Thin liquids are not safe aka plain water, you need to add a thickener to them or you need to get some thickened liquids which are easier for them to swallow
▪ Check your pt mouth for food pockets before feeding them more
• Food pocket=don’t actually swallow the food, they will tuck it in between their teeth and their cheeks
▪ Encourage pt to tuck chin against their chest to swallow more easily
▪ Monitor pt during meals and have suction equipment available

Question 3

What education should be provided to families who are economically disadvantaged or lack access to healthy foods?

Answer 3

• Avoid canned, boxed, or processed foods which are often high in calories, fat, and sodium
• Encourage to choose frozen fruits and vegetables which are more affordable and last a pretty long time in the freezer
• Teach pt to read food labels to know which items high fat sodium calories and type of thing and which ones have are more healthy
• If they cannot physically get to a grocery store: arrange for meal delivery services
• Refer to dietician and social services

Question 4

What nursing care should be provided for those who are malnourished, nauseated, or early satiety and/or anorexia?

Answer 4

• Offer multiple small meals per day rather than few large ones
• Limit liquids at meal time (should be drinking in-between meals)
• Cold or room temperature meals are less smelly (decrease nausea)
• Oral care before and after meals
• Increase patient intake by providing supplement drinks in-between meals
• Encourage to consume more food in the morning (when nausea is less and appetite better)
• Do not fill up on low calorie foods, consume small amounts of foods that have high protein, high calorie, nutrient dense ingredients

Question 5

What nursing care should be provided to the visually impaired?

Answer 5

• When deliver their tray, describe what is on their tray using a clock face
• Provide large handle utensils (easier for them to find and grasp)

Question 6

What care should be provided for patients experiencing poor dentition (i.e., lost teeth, dental caries, new dentures)?

Answer 6

• For children, screen and teach about healthy eating
• Fluoridated tooth paste
• Basic dental screen for all clients

Question 7

What care should be provided for patients experiencing cognitive disorders?

Answer 7

• Social service referral or shop with a friend or family member and using a list
• Watch out for nutritional deficits
• Give few nutritious, choices
• Keep eating environment the same and distractions to a minimum
• Remind pt to chew and swallow; stroke chin and throat to promote swallowing

Question 8

What care should be provided for patients experiencing altered sensory perception?

Answer 8

• Social service referral or shop with a friend or family member and using a list
• If have food aversion or nausea when eating  eat cold foods
• If can’t taste  spicy or tangy foods
• If unusual taste in mouth  suck on hard candies, mints or chewing gum
• Avoid empty calories

Question 9

What care should be provided for patients experiencing impaired swallowing?

Answer 9

• Diet and thickened fluids based on speech language pathologist order
• Give time to eat
• Avoid distractions
• Rest before eating
• Tuck chin when swallowing or arch tongue in back of throat

Question 10

What care should be provided for patients experiencing mechanical fixation of the jaw?

Answer 10

• Encourage fluids
• Teach to put straw into space between jaws
• Consult dietician to use liquid meal plan