Chapter 29

Question 1

anorexia

Answer 1

loss of appetite

Question 2

aspiration

Answer 2

breathing foreign body (food / liquid, etc.) into lungs

Question 3

dysphagia

Answer 3

difficulty swallowing

Question 4

enteral nutrition

Answer 4

inserting tube through mouth into the GI to give nutrients; feeding tube

Question 5

gavage

Answer 5

process of giving feeding tube

Question 6

regurgitation

Answer 6

backward flow of stomach content into mouth

Question 7

what affects general dietary practices (eating and nutrition habits) ?

Answer 7

• start in childhood
• culture
• religion
• food preferences
• income

Question 8

what can affect appetite / bodily reactions to food ?

Answer 8

• illness
• food allergies / intolerance
• anxiety
• pain
• depression
  etc.

Question 9

what will you do if person uses adaptive devices ?

Answer 9

make sure they have device

Question 10

what aspects of mouth affect chewing ?

Answer 10

mouth, teeth, gum condition
- oral pain
- sores
- gum disease
- dental / denture problems

Question 11

what must you do when feeding person w/ dysphagia ?

Answer 11

• know signs / symptoms of dysphagia
• follow ordered diet / care plan
• know aspiration precautions
• report changes in way of eating
• report signs / symptoms of dysphagia at once

Question 12

sign / symptoms of dysphagia ?

Answer 12

• avoiding foods that need chewing / certain temps / textures
• eats slowly
• often coughs chokes during / after swallowing
• food often spills out of mouth
• food pockets kept in mouth

Question 13

special diets for dysphagia ?

Answer 13

• mechanical soft; soft / moist / chopped foods
• pureed; smooth uniform texture but hold shape
• liquids are thickened as needed (nectar-thick, honey-thick, pudding-thick)

Question 14

nectar-thick liquids

Answer 14

mildly thick
- drips off of spoon
- can be drank through straw

Question 15

honey-thick liquids

Answer 15

moderately thick
- slowly drips off spoon like honey
- can be drank out of cup

Question 16

pudding / spoon-thick liquids

Answer 16

extremely thick
- liquid keeps form on spoon and does not drip
- serve w/ spoon

Question 17

aspiration precautions to take ?

Answer 17

• help person eat; follow care plan
• position upright (fowlers / high fowlers)
• remain upright about 1 hours after eating
• support upper back, shoulders, neck w/ pillows
• check inside mouth for pockets of food and remove if any
• mouth care after eating

Question 18

CMS requirements for food served in nursing centers ?

Answer 18

• nutrition is met
• religious / cultural / preferences are met
• diet is balanced
• well-seasoned / appetizing
• served at correct temp (hot at hot, cold at cold)
• other food offered if food is refused
• provide 3 meals a day and bedtime snack
• provides adaptive equipment / utensils

Question 19

social dining program in a nursing home

Answer 19

table sits 4-6 persons
- set daily menu items
- served like restaurant

Question 20

low-stimulation dining program in nursing home

Answer 20

seating is chosen by staff
- distractions are prevented

Question 21

restaurant-style menu dining program in nursing home

Answer 21

food selected from menu for more choices
- served like restaurant

Question 22

open dining program in nursing home

Answer 22

buffet open for several hours
- available to eat any time

Question 23

how to promote comfort for eating ?

Answer 23

• provide oral hygiene; dentures are in place
• eyeglasses / hearing aids in place
• assist w/ elimination
• incontinent persons clean / dry
• person in comfortable / upright position
• reduce / remove unpleasant odors / visuals / sounds
• assist person w/ hand hygiene

Question 24

what should person do before eating ?

Answer 24

• eliminate
• oral hygiene
• hand hygiene

Question 25

what should you do if food is not served within 15 min ?

Answer 25

ensure temp is still good - if not correct temp, get fresh food

Question 26

how should meals be served ?

Answer 26

assigned order of food by care plan

Question 27

when are snacks served ?

Answer 27

upon arrival to nurse unit

Question 28

info you need to serve meal trays ?

Answer 28

- food allergies / intolerances - adaptive equipment needed - if person needs help w/ certain skills (cutting food, opening bottles, etc.) - if food / fluid intake are measured

Question 29

how to remove food pockets from mouth ?

Answer 29

persons chin tipped downward and sponge swabs are used to remove food

Question 30

how to ensure meal is correct for the person ?

Answer 30

- check items w/ dietary card - 2 identifiers from ID band (full name / DOB)

Question 31

how should you feed person ?

Answer 31

- sit facing person - ensure person's hands are watched before / after meal - order of food that they prefer - 1/3 full spoonful (smaller person if care plan says) - encourage all they can do on their own safely (hold their own drinks if they can; never hot drinks) - offer fluids often to ensure mouth has no food before offering more - follow activity limits - allow time to chew / swallow /talk

Question 32

how will you describe position of food to visually impaired person ?

Answer 32

use numbers of a clock to describe plate positions

Question 33

how to feed persons w/ dementia ?

Answer 33

- meal times / settings consistent - calm / quiet setting - limit food choices - snacks where person can see them - small meals throughout the day

Question 34

nasogastric (NG) tube

Answer 34

feeding tube inserted through nose into the stomach

Question 35

gastronomy tube

Answer 35

feeding tube inserted through stomy in stomach

Question 36

risks of enteral feeding tubes ?

Answer 36

- diarrhea - constipation - delayed stomach emptying - aspiration

Question 37

when can aspiration from enteral feeding tubes happen ?

Answer 37

- during insertion; tube can slip into the airway (x-ray taken after insertion) - tube moving out of place; sudden movements / poor positions - regurgitation; delayed stomach emptying / overfeeding RN always checks tube placement; never CNA

Question 38

how to prevent regurgitation / aspiration of enteral feeding tubes ?

Answer 38

- fowlers / semi fowlers during feeding and at least an hour after feeding - avoid left side lying; prevents stomach emptying into small intestine

Question 39

care measures for enteral feeding tubes ?

Answer 39

every 2 hours: - oral hygiene / mouth rinse - lip care

Question 40

how to prevent irritation / pressure of enteral feeding tubes on the nose ?

Answer 40

- clean nose / nostril every 4-8 hours - secure tube to nose w/ tube / tape holder; avoid re-taping - secure to person garment at shoulder area

Question 41

how to secure enteral feeding tube to person's garment

Answer 41

it is placed to the side to one of the soldiers - tape to garment - rubber band around tube is used to pin to garment