Nurse's Pocket Guide

impaired SWALLOWING
NURSING PRIORITY NO. 3.To enhance swallowing ability to meet
fluid and caloric body requirements:
• Refer to gastroenterologist/neurologist as indicated for treatment/interventions
(e.g., reconstructive facial surgery,
esophageal dilatation, etc.) that may result in improved
swallowing.)
• Refer to speech therapist to identify specific techniques to
enhance client efforts/safety measures.
• Encourage a rest period before meals to minimize fatigue.
• Provide analgesics prior to feeding, as indicated, to enhance
comfort, being cautious to avoid decreasing awareness/sensory
perception.
• Focus client’s attention on feeding/swallowing activity.
Decrease environmental stimuli and talking, which may be
distracting or promote choking during feeding.
• Determine food preferences of client to incorporate as possible,
enhancing intake. Present foods in an appealing, attractive
manner.
• Ensure temperature (hot or cold versus tepid) of foods/fluid,
which will stimulate sensory receptors.
• Provide a consistency of food/fluid that is most easily swallowed
(can be formed into a bolus before swallowing), such as
gelatin desserts prepared with less water than usual; pudding
and custard; thickened liquids (addition of thickening agent,
or yogurt, cream soups prepared with less water); thinned
purees (hot cereal with water added); or thick drinks, such as
nectars; fruit juices that have been frozen into “slush” consistency
(thin fluids are most difficult to control); medium-soft
boiled or scrambled eggs; canned fruit; soft-cooked vegetables.
Avoid milk products and chocolate, which may thicken
oral secretions.
• Feed one consistency and/or texture of food at a time.
• Place food in unaffected side of client’s mouth (when one side
of the mouth is affected by condition, e.g., hemiplegia), and
have client use tongue to assist with moving food bolus to
swallowing postion.
• Manage size of bites (e.g., small bites of 1/2 tsp. or less are
usually easier to swallow). Use a teaspoon/small spoon to
encourage smaller bites. Cut all solid foods into small pieces.
• Place food midway in oral cavity; provide medium-sized bites
(about 15 mL) to adequately trigger the swallowing reflex.
• Provide cognitive cues (e.g., remind client to chew/swallow as
indicated) to enhance concentration and performance of
swallowing sequence.
Information in brackets added by the authors to clarify and enhance
the use of nursing diagnoses.
678 Cultural Collaborative Community/Home Care