|
Guide to Serving Meals
►
|
Provides a
balanced diet. Most of our food intake is carbohydrates with some
fat but it is important to include protein and fiber each day because
they cannot be stored in the body. Sufficient liquids are also important.
Check with your dietician if the person is on special diet.
|
|
► |
Before meal time, it is important
to see that the room in orderly with urinals and bedpan out of the person's
sight.
|
|
► |
The person should have the opportunity
to use the toilet, commode or urinal and to wash his hands before each
meal. Provide mouth gargle if the person cannot get out of bed.
|
|
► |
Wash your hands before serving meals.
|
|
►
|
Take a real interest in helping the
person to enjoy his meal. Be patient and always be mindful of the
person's dignity.
|
|
► |
Do not attempt to
feed the person if he can eat himself or with the help of
assistive devices. Click
here for a pictorial guide of eating an drinking
utensils.
|
|
► |
Know about special difficulties the
person may have. For instance, difficulties in chewing and swallowing.
|
|
► |
Sit
the person in a comfortable position
in bed or sitting up well supported in a chair before you bring in the
food.
|
|
► |
Placed the food in such the way so
that the person can reach them conveniently.
|
|
►
|
Help the person to cut up food if
he needs help.
|
|
► |
Warn the person if you are offering
something hot.
|
|
► |
Encourage the person to finish his
meal but do not force him.
|
|
► |
Observe the person during feeding,
i.e. any difficulty in swallowing or any change in general condition.
|
|
► |
After meal, help the person to wipe his
mouth and attend to his oral hygiene.
|
► |
Advise
the person to remain in sitting position for at
least half an hour to prevent gastric reflux .
|
|
Overcoming Physical Disabilities
If the
person
has weak grip as in arthritis sufferers, elderly or disabled people,
eating and drinking can make mealtimes very tiring. Make use of
special cutlery and crockery to overcome these problems. Click
here for a pictorial guide of items that facilitate
eating and drinking.
A light feeding cup or a glass with an angled straw are easier for
helpless person to drink from. A deep bowl and light, thick-handled
cutlery are best for someone with a weak grip.
Never attempt to feed a person if his disabilities can be overcome
by the use of proper utensils. It is important for the person's
dignity and self-respect that he is able to eat independently again as
soon as possible.
How to Encourage Eating
►
|
Find out what
the person is happy to eat and ask if there is anything he really dislikes.
Check whether there are any foods which the person must not eat, either
for reasons of belief or because of special medical instructions.
|
|
► |
Take trouble
with presentation of meals so that the food appears appetising.
When providing the meal on a tray, see that everything needed is attractively
laid out on a clean tray. Do not overfill containers of drink
or soup or they will slop.
|
|
► |
Serve
food or drinks at luke warm temperature.
|
|
► |
Provide variety
in the meals to stimulate poor appetite.
|
|
►
|
Small helping
of appetising food served at shorter intervals are more appealing than
large occasional meals.
|
|
► |
If the
person
is suffering from a temporary loss of appetite, a light diet such as
porridge is most likely to appeal him. This is easily digestible,
containing plenty of nourishment and has very little bulk.
|
|
► |
Keep
the person's mouth and tongue moist and clean at all times. Provides him with mouth gargle to freshen his breathe before
eating.
|
|
► |
If the
person
is wearing dentures, check that they are well fitted and that there
is no food caught under it. If so, remove the dentures and rinse
them and rinse the his mouth before replacing them. This
will make eating more comfortable and enjoyable.
|
|
►
|
Give
frequent small amount of nourishing drinks such as Enercal and Sustacal
to stimulate appetite.
|
|
► |
Use
straw or feeder cup to serve drinks if mouth and tongue are sore.
|
|
Guide to Feeding a Person
►
|
Make sure
the person is sitting in a comfortable, upright position before beginning
the meal.
|
|
► |
Protect
the person with a napkin
and the bedclothes with towels if necessary.
|
|
► |
Always sit by
the person's side and
within easy reach. It is important that you are sat at the unaffected
side of the person, for instance stroke patient, so that he can
easily participate in the process.
|
|
► |
Try to keep the food warm. If
feeding takes a long time, put small amounts of food on extra plate and
keep the rest covered until needed.
|
|
►
|
If
the person has difficulty in swallowing,
cut food into very small pieces. Offer small mouthfuls by using
a desert spoon or fork and frequent sips of water or other liquids.
Allow the person time to chew properly and swallow before offering the
next mouthful.
|
|
► |
Stop
feeding if the person is coughing continuously
or appears breathless. These are signs of
food entering the respiratory system.
|
|
► |
If the person drool or food runs out
of one side of his mouth, as in the case of stroke, turning his head slightly
to the unaffected side may help.
|
|
► |
Wipe
the person mouth and chin as necessary.
|
|
► |
Remember to
give the person your undivided attention throughout the feeding process.
|
|
► |
Advise
the person to remain in sitting position for at
least half an hour to prevent gastric reflux and
aspiration which can cause choking.
|
|
Nasogastric Tube Feeding
When the person is unable to eat by mouth or when he is unconscious, a
tube may be inserted into the stomach through the nose to provide drinks and
nutrients. Nasogastric feeding is the method of choice when the
person needs fluid but is not able to swallow though his stomach can tolerate
fluid. The nurse will show you how to tube feed until you are competent
enough to do it your own.
Below are tips for nasogastric feeding:
►
|
Position
the person upright in bed and support him comfortably with pillows. For
comatose person, he should be placed in a semi-upright position.
|
|
► |
Protect
the person's clothes from getting soiled with a waterproof towel.
|
|
► |
Offer
mouthwash to the person before feeding.
|
|
► |
Always
remember to talk to the person during feeding even if he is unconscious.
|
|
►
|
Pinch
the feeding tube before removing the spigot to prevent air from entering
the person's stomach.
|
|
► |
Ensure
that the tube is in the person's stomach before feeding by performing
the following tests:
1.
pH Test
Withdraw
about 5ml of stomach contents with a 20ml syringe and test
it with a pH paper. A pH lesser than 5 indicates
that the aspirate is from the stomach.
2.
Auscultation Test
In
addition to pH Test, use a 20ml syringe to inject 10 to 15ml of air
with a slight force into the tube. If the tube is in the stomach, a
gushing sound will be heard over the
diaphragm of a
stethoscope placed at the epigastria area (2cm
below the sternum notch).
Note -
Do not rely solely on Auscultation Test
as the method of checking nasogastric tube
placement. If you are uncertain of the tube placement, do
not feed. Consult your healthcare
professionals.
|
|
► |
Observe
the nature, colour and amount of withdrew stomach contents. This is necessary
to exclude malabsorption of previous feed and review feeding regime.
If amount exceeds or equals the amount of the last feed, seek medical attention.
|
|
► |
Do not
feed more than 400 ml each time.
|
|
►
|
Attach
the funnel/syringe to the tube and hold it to the side, at the level of
the person's forehead. Do not held the syringe too high as this would
increases the pressure at which the fluid enters the stomach.
|
|
► |
Pour
in any prescribed medication (powdering the tablets first, if any) followed
by the prescribed feed. Allow it to flow slowly into the stomach by
gravity.
|
|
► |
Stop
feeding immediately if the person coughs or shows signs of distress.
This indicates that the feeds may have aspirated into the lungs.
|
|
► |
Do not
allow the funnel/syringe to become empty during feeding as this would introduce
air into the stomach. Pinch the tube if it is empty to minimise air
entering the person's stomach.
|
|
►
|
Conclude
the feed by flushing the lumen of the tube with water so as to keep it patent.
|
|
► |
After
feeding, disconnect the funnel/syringe and close the end with a spigot to
prevent backflow and leakage.
|
|
► |
The
person should remain sat upright for at least 30 minutes after feeding to
prevent gastric reflux and aspiration which can
cause choking.
|
|
► |
Record
the time, type and amount of fluid given. |
|
|
|
|