NCMA 215 Course Task 15 - Lecture Module Week 9: Andrea B. Autor BSN 2YC-2

NCMA 215 Course Task 15 - Lecture Module
Week 9
Andrea B. Autor BSN 2YC-2
1. Discuss a nursing care plan that deals with the responsibility for feeding
clients with dysphagia. Include safe procedures and features of foods to be
considered.
When you have difficulty swallowing or dysphagia, it takes extra time and
effort to get food or drink from your mouth to your stomach. When the muscles and
nerves that help carry food through the throat and esophagus aren't operating properly,
it causes heartburn. It can be a fatal complication that is either temporary or permanent.
A structural abnormality, interruption or failure of neuronal pathways, decreased
strength or excursion of muscles involved in mastication, facial paralysis, or perceptual
impairment can all cause aspiration of food or fluid. With aging or inactivity, the
swallowing muscles can weaken. It's a typical problem among the elderly, particularly
those who've had a stroke, suffered a head injury, have head or neck cancer, or suffer
from degenerative neurological illnesses like multiple sclerosis, amyotrophic lateral
sclerosis, or Parkinson's disease. Dysphagia can strike anyone at any age, but it is
more common among the elderly. Swallowing issues have a variety of origins, and
treatment varies depending on the cause.
As a nurse, the first thing I should do is to assess the patient with dysphagia.
Assessment is necessary to identify potential issues that may have contributed to
dysphagia, as well as to address any difficulties that may arise during nursing care.
Examiner's thumb and index finger are placed on the patient's laryngeal protuberance to
assess swallowing ability. Ask the patient to swallow; notice how the larynx rises. With a
tongue blade, test for a gag response on both sides of the posterior pharyngeal wall
(lingual surface). When deciding when to feed, don't rely on the presence of a gag
response. The lungs are usually protected against aspiration by reflexes as cough or
gag. When reflexes are depressed, the patient is at increased risk for aspiration. Next is
to evaluate the strength of facial muscles. Cranial nerves VII, IX, X, and XII control
motor function in the mouth and pharynx. Coordinated function of muscles innervated
by these nerves is necessary to move a bolus of food from the mouth to the posterior
pharynx for controlled swallowing. Next is to check for coughing or choking during
eating and drinking because these signs indicate aspiration. Then, observe for signs
associated with swallowing problems because it’s a sign of swallowing impairment.
After assessing and observing the patient, next thing to do is to give them therapeutic
nursing interventions. Provide oral care before feeding. Clean and insert dentures
before each meal. Optimal oral care promotes appetite and eating. If patient has
impaired swallowing, do not feed until an appropriate diagnostic workup is completed.
Ensure proper nutrition by consulting with physician for enteral feedings, preferably a
PEG tube in most cases. Feeding a patient who cannot sufficiently swallow results in
aspiration and possibly death. Enteral feedings via PEG tube are generally preferable to
nasogastric tube feedings because studies have shown that there is increased
nutritional status and possibly improved survival rates. Reassure the patient to chew
completely, eat gently, and swallow frequently, especially if extra saliva is produced.
Give the patient with direction or reinforcement until he or she has swallowed each
mouthful. Such directions assist in keeping one’s focus on the task. Keep patient in an
upright position for 30 to 45 minutes after a meal. An upright position guarantees that
food stays in the stomach until it has emptied and decreases the chance of aspiration
following meals. Discuss the importance of exercise to enhance the muscular strength
of the face and tongue to enhance swallowing. Muscle strengthening can facilitate
greater chewing ability and positioning of food in the mouth. Educate patient, family, and
all caregivers about rationales for food consistency and choices. It is common for family
members to disregard necessary dietary restrictions and give patient inappropriate
foods that predispose to aspiration.
2. List at least four dietary treatment guidelines for peptic ulcer disease.
Include the rationale for each.
 Aim to include good sources of soluble fibre at each meal. Vegetables,
fruits, oatmeal and oat bran, barley, peanut butter, nuts, nut butters, and
legumes such as lentils, dried beans, and peas are good sources.
Rationale: A diet high in soluble fibre may help to prevent ulcers from
coming back.
 Drink caffeine containing beverages in moderation. The recommendation
is no more than 400mg of caffeine per day, which is the same as about
three 250 mL (3 cups) of coffee.
Rationale: Caffeine increases stomach acid, but it does not seem to cause
ulcers or make their symptoms worse.
 If spicy foods bother you, avoid or eat less of them. You can continue to
eat spicy foods if they don't cause you discomfort.
Rationale: Spicy foods do not cause ulcers, but they may make symptoms
worse in some people.
 If you drink alcohol, do so in moderation. The recommendation is a limit of
15 drinks a week for men, with no more than 3 drinks a day on most days,
or 10 drinks a week for women, with no more than 2 drinks a day on most
days.
Rationale: Alcohol increases stomach acid so it can interfere with ulcer
treatment.

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