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Assisting Residents with Meals

One of your most important duties as a temporary nurse aide is to help residents with meals. Although you might think this is a simple task, it requires a lot of attention (Figure 6-1). Your ability to do it well directly affects residents’ nutritional status and overall health.

Preparing Residents for MealsResidents more fully enjoy their meals when they are properly prepared for them. Before meals, some residents may need assistance combing or brushing their hair. Some female residents may need help with their makeup. If needed, help the resident with toileting before taking them to the dining room. Encourage residents to use their dentures, glasses, and hearing aids. These devices improve residents’ functional abilities and help them be more independent. Help residents with handwashing and oral care as needed. Oral care before meals may improve residents’ taste sensitivity to some food flavors.

If a resident is eating in bed, elevate the head of the bed to at least 30 degrees. Make each resident as com-fortable as possible. Use clothing protectors or napkins to protect their clothing.

Assisting with FeedingMany residents can eat independently or with a little help from a staff member. Other residents must be fed. These residents totally depend on you and your coworkers to meet their nutritional needs. An occupational therapist may assess residents who are difficult to feed or who have special problems. The therapist will train you to use special feeding techniques,if needed.

When you feed a resident, imagine how it would feel to be in his or her situation. Before leaving the resident, ask yourself:

■ Have I done all I can to encourage this resident to eat?■ Have I provided the best nutrition possible?

Figure 6-1 Some residents may need help cutting their food.

Assisting Residents with Dysphagia

Some residents may have difficulty swallowing. This con-dition, called dysphagia, can be caused by a stroke, brain or spinal cord injury, certain diseases (such as Parkinson’s disease), and certain immune, muscular, and digestive problems.

Residents with dysphagia may choke or aspirate some of their food. Aspiration means that food that enters the mouth is misdirected into the airway instead of passing through the esophagus into the stomach. Pneumonia or a lung infection may result, which can be fatal. Residents

Figure 6-2 Special utensils, cups, and plates may be used by some residents to help them eat independently.

Nutrition

may be reluctant to eat if they are afraid of choking. Thus, they may not eat enough and may lose weight.

Many problems caused by dysphagia can be corrected with proper diagnosis and treatment. The therapist or nurse may give you special instructions for feeding a resident in a way that prevents problems. Positioning the resident is very important. Follow the therapist’s instructions carefully to help the resident swallow without choking.

The therapist may also recommend a modified diet. A pureed diet or thickened liquids may make swallowing easier. A powdered product may be used as a thickening agent. Often, liquids continue to thicken for some time after the powder is added. To get the desired consistency, wait a minute or two before adding more thickener; you may not need it. Some residents tolerate thick liquids better than thin liquids. Thickeners can also be added to water, coffee, and other beverages. Many facilities offer prethickened liquids.

How do you recognize dysphagia? Observe residents for symptoms such as the following. Report any of these to the charge nurse:

■ Hoarse, breathy voice■ Gurgling breathing■ Drooling■ Feeling that something is caught in the throat■ Repeatedly clearing the throat■ Repetitive rocking motion of the tongue from front to

back■ Coughing before, during, or after swallowing food,

liquid, or medication■ Needing to swallow three or four times after each bite■ Pocketing food in the side of the mouth

A resident may also be a “silent aspirator.” This meansthat dysphagia may be present even though the resident does not have obvious symptoms. Silent aspiration may be indicated by unexplained weight loss, decreased appe-tite, or a long-lasting low-grade fever. If you observe one or more of these symptoms, discuss your observations with the charge nurse.

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DISCLAIMER: AHCA/NCAL has created this course to assist providers to recruit and train temporary staff during the national emergency caused by the coronavirus pandemic. Federal and/or state requirements may need to be waived to permit individuals under this training program in your location. Employers should check with their state survey agencies and their state occupational licensing agencies where applicable to ensure individuals trained under this program are permitted to assist with care in your location.