Eating and drinking - Assisting a family member


Assisting a family member

Assisting a family member

Eat and drink

Difficulty swallowing Nasogastric tube PEG Oral hygiene Hygiene aids
  • Difficulty swallowing
    • Organization of the environment
    • Accommodation of the patient
    • Texture of food
    • Feeding mode
    • Administration of drugs
  • Nasogastric tube
  • PEG
  • Oral hygiene
  • Feeding aids

Food has multiple aspects: providing elements to produce energy, socialize, feel satisfied; there are sciences that deal with nutrition and its alterations (nutrition disorders).

By feeding, the foods that are ingested are transformed into assimilable elements that are made available for use, while the unusable substances are eliminated. The organism, being continuously engaged in an operation of "construction" and "destruction", needs to replenish the destroyed material. Since the body needs various nutrients, contained in different proportions in foods, it is imperative that the diet is as varied as possible. Like any human need, this too is affected by psychosocial and physiological factors. Water is of fundamental importance for all vital processes: when ascertaining the need for assistance in feeding, hydration is the first aspect to consider.

The objective data to be sought, in the analysis of the need to feed, must highlight all the factors that can be an obstacle, such as:

  • mouth injury;
  • lack of teeth (edentulous);
  • nausea;
  • difficulty bringing food to the mouth;
  • depression.

Since nutrition is influenced by many variables, it is necessary to probe them one by one with the doctor or be directed by the nurse in the analysis of situations that limit the satisfaction of food needs.

The purpose of this discussion is not to recommend one food over another, or to give indications on the nutrients or which supplement to use, but to help tackle problems that prevent proper nutrition: for example how to feed a person who has difficulty in to swallow, or how to clean a patient's mouth.

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Difficulty swallowing

Difficulty swallowing (dysphagia) is a common problem in a number of neurological diseases (Parkinson's, stroke, multiple sclerosis, lateral amyotrophic sclerosis); also the use of drugs can cause dysphagia, as well as physiological aging.

Patients with tracheal cannulae may experience food inhalation episodes caused by dysphagia.

Dysphagia is often an unrecognized problem which, however, if properly addressed, allows those affected by it to limit complications (inhalation pneumonia and suffocation) and improve swallowing.

The signs that can make one think of a dysphagia problem are the following:

  • suffocation when swallowing;
  • suffocation when swallowing liquids;
  • hoarseness;
  • inability to manage mouth secretions;
  • uncoordinated chewing;
  • food "packed" in the cheeks;
  • cough when feeding;
  • regurgitation of fluids from the mouth and nose;
  • hoarse voice after meal.

Very often people with dysphagia tend to feed and hydrate less and are therefore more exposed to the risk of malnutrition and dehydration. The approach to the person suffering from dysphagia must include various aspects:

  • organization of the environment;
  • accommodation of the patient;
  • texture of food;
  • power mode.

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Organization of the environment

As far as the organization of the environment is concerned, make sure that the place where the patient must eat is discreet and peaceful: it is essential to avoid distracting attention with television or other stimuli.

Before proceeding to the accommodation of the patient, make sure of the level of consciousness: if the individual is asleep he must be awakened, otherwise he will have to wait. Never take a person who is napping or not awake!

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Accommodation of the patient

The positioning of the person with dysphagia plays an important role. The ideal position is that of sitting with flexion of the hips at 90 °, feet resting and head slightly flexed forward. The studies also highlight basic aspects of the position of the head during swallowing: if this is tilted backwards, swallowing will be quite difficult (just try to swallow with the head in this position to realize it firsthand).

In subjects with stroke and with permanent damage to one side of the body (hemiplegia), rotation of the head towards the sick side tends to exclude the portion compromised by the swallowing activity thus making the operation less difficult. Even the inclination of the head from the healthy side, therefore stronger, tends to exclude the side with deficit.

The use of collars to keep the head stable is not recommended as it could prevent swallowing: it is better to support the head with your hand. In any case, before introducing food it is advisable to check that the mouth is moist and, if dry, it must be moistened with a few drops of water or lemon to favor the production of saliva.

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Texture of food

The diet and consistency of foods are of great importance. Liquids must be dense and the diet semi-solid and homogeneous. The reason is easy to understand: filamentous or chopped foods require greater coordination than homogeneous substances. Excessively liquid foods should be avoided, as well as all products that melt in the mouth, such as chocolate and ice. Mixed foods such as minestrone, which contains liquid and solid parts, can create significant problems in the synchronism of swallowing; rice, being made up of many grains, exposes to the risk of aspiration. Foods that contain seeds and in general all foods that require laborious chewing are not indicated.

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Feeding mode

As for the feeding methods, keep in mind that, in order to prevent the subject from turning his head back looking into the eyes of the person assigned to help him during the feeding, it is advisable that those who take the feed sit with the head at the same height as the one of the patient or even lower. The amount of food to be administered per bite should not exceed one teaspoon.

It is very important to respect the necessary time, not to be in a hurry and not to let the individual speak while eating. Food should be introduced into the front of the mouth without pushing deeply; if the subject has a stroke, food will be introduced into the healthy part of the mouth. It is recommended to alternate solid and liquid foods and to encourage coughing after swallowing to keep the throat clean.

At the end of the feeding it is very important to check that the subject has no food in his mouth. After the meal, the patient should remain seated for 30 to 60 minutes.

Then there are some incorrect maneuvers that are often seen to be performed and which must be absolutely avoided. In particular, the use of straws and syringes to feed the patient is strongly discouraged, both because of the difficulty of dosing the quantity introduced and because it is not possible to control the speed of the flow pushed into the oral cavity. If the individual gets tired a lot during meals, it is better that they are divided, distributing up to 6 snacks throughout the day. Bear in mind that the patient must never eat alone.

If the patient has difficulty swallowing liquids, it is advisable to use substances capable of thickening drinks or preparations of gelled water. In the pharmacy there are powdered products to thicken ready-to-use liquids and drinks.

Weight control should be done at least once a week; body temperature is also recommended to detect signs of lung infection early.

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Administration of drugs

Finally, a brief mention of the administration of pills and capsules to dysphagia patients. If their use becomes necessary, these drugs should be minced before administration. However, it is always advisable to ask the doctor or pharmacist if the drug in use can be crushed, since some modified-release preparations do not have to be shredded.

In the same way, it is good to also ask if it is possible to open the capsules, as the drug contained in them can inactivate in contact with gastric juices: it will be up to the doctor or pharmacist to suggest the most suitable formulation. It is also advisable to check whether the drugs prescribed for the dysphagic patient are available in formulations more suitable for his condition, such as the tablets that dissolve in the mouth (orodispersible).

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