Nutrition, Hydration, Assisted Feeding and Tube Feeding

Safe Oral Feeding and Dysphagia Management

Ensuring safe oral nutrition is an essential bedside responsibility for the practical nurse. The RN performs the initial comprehensive nursing assessment and develops the nursing plan of care; a speech-language pathologist performs a comprehensive swallowing evaluation and recommends swallowing strategies, while the RN may perform a swallowing screen according to policy. The practical nurse reinforces swallowing strategies and dietary recommendations established in that plan. Before offering any meal, the practical nurse must verify that the client's dentures are clean, intact, and properly fitted, as poorly fitting dentures can interfere with chewing and increase the risk of choking.

Positioning is one of the most effective measures to prevent aspiration. The practical nurse positions clients at risk for aspiration upright for oral meals, preferably near 90 degrees as tolerated and in accordance with the swallowing plan. If a client has unilateral weakness following a stroke, the practical nurse places food on the unaffected, stronger side of the mouth to promote safe chewing and swallowing. The practical nurse reinforces the chin-tuck swallowing technique only when it is specifically recommended in the swallowing plan; this technique is not appropriate for every client with dysphagia. Similarly, whether a client with dysphagia may use a straw depends entirely on their individualized swallowing plan, so the practical nurse should never assume straws are universally safe or unsafe.

During and after the meal, the practical nurse remains vigilant for signs of aspiration. These signs include coughing, choking, throat-clearing, a wet or gurgling vocal quality, tearing eyes, and sudden cyanosis during meals. If a client coughs or shows signs of choking while eating, the practical nurse immediately stops the feeding, checks the airway, takes immediate action for an airway obstruction if needed, and notifies the registered nurse. After eating, the practical nurse checks the client's mouth for pocketed food, assists the client in clearing it safely, and reports persistent pocketing to the registered nurse. To reduce the risk of regurgitation and aspiration, the practical nurse keeps the client upright after meals, generally for 30 to 60 minutes or as directed in the care plan.