Assessment Nursing Diagnosis Objectives of Care Intervention Rationale Evaluation

Subjective Imbalanced Nutrition: Less Short term Independent Short Term

> “Nastroke si papa mga 3
days ago lang, di pa siya
nakakain ng maayos kasi
hirap lumunok.” As
verbalized by the patient’s
son
Objective
W : 158
H : “6”5”
BMI : 18.7
Patient is conscious and
cooperative
Patient has an intact
swallowing reflex
Than Body Requirements After 3 hrs. of nursing  Establish rapport  To establish
Goals were fully met because
related to dysphagia intervention the patient’s nurse-patient the SO was able to
secondary to CVA caregiver: relationship demonstrate the correct
 Identify  Promote proper  Elevating the feeding techniques and was
interventions and positioning when head of bed 30 able to verbalize importance
actions to promote feeding degrees aids in of time for feeding.
intake and prevent swallowing and
aspiration. reduces risk for Long Term
aspiration with Patient was able to achieve
 Demonstrate eating. and maintain proper weight
and nutritional status
feeding techniques  Performed patient  Only feed what
throughout
that best fits the feeding of tolerated patient can
patient’s needs. diet and gave patient swallow. Proper
specific instructions instruction and
 Verbalize the to follow during focused
importance of feeding. concentration on
allowing ample time specific steps
for eating or feeding reduce risk
Long Term
After 2-3 days of nursing  Check for coughing  These signs
intervention: or choking during indicate
eating and drinking. aspiration.
 Patient takes
adequate amount of  Check for residual  Pocketed food
calories or nutrients food in mouth after may be easily
to maintain a eating. aspirated at a
healthy weight later time.

 Keep patient in an  Upright position

upright position for guarantees that
30 to 45 minutes food stays in the
after a meal. stomach until it
has emptied and
decreases the
 chance of
aspiration
following meals.

 Performed health  It is common for

teaching on how to family members
take care of patient to disregard
to SO necessary dietary
restrictions and
give patient
inappropriate
foods that
predispose to
aspiration.

 Place suction  With impaired

equipment at the swallowing
bedside, and suction reflexes,
as needed. secretions can
rapidly
Dependent accumulate

 Consult with the  Speech

patient’s therapist for pathologists
evaluation and specialize in
instruction regarding impaired
patient diet. swallowing.

Dysphagia is the difficulty of swallowing. The causes for dysphagia problems vary, and treatment depends on the cause. Nonetheless this is a problem especially in one’s diet.

Therefore when feeding a patient with dysphagia precautions are needed, as well as considering the type of foods the patient can tolerate.
Levels of a dysphagia diet

The International Dysphagia Diet Standardization Initiative (IDDSI) has created a diet plan or framework for people with dysphagia. The dysphagia diet has levels that rate drinks and foods on a
thickness scale from 0 to 7. Drinks are ranked from 0 to 4. Foods are ranked from 3 to 7, depending on thickness. The food levels are:

 Level 3 (moderately thick). These are foods that:

o Don't require chewing

o Have a smooth texture but are not lumpy

o Can be eaten with a spoon, but not with a fork

o Are not thick enough to stand stiff on a plate. For example, not stiff like molded gelatin.

 Level 4 (pureed, extremely thick). These foods:

o Can often be eaten with a spoon, but sometimes a fork

o Can't be drunk from a cup

o Don't need to be chewed

o Can be molded, such as gelatin

o Are not sticky or lumpy

o Fall off a spoon all together when tilted and still hold shape on a plate. For example, pudding.

o Can't be poured but move very slowly if the plate is tilted

 Level 5 (minced, moist). These foods:

o Can be eaten with a fork or spoon, or a chopstick if you have good hand control

o Can be scooped and shaped on a plate. For example, mashed potatoes.

o Are soft and moist but don't separate into liquid

o May have small lumps that can be mashed with the tongue
  Level 6 (soft). These foods:

o Are tender, moist, and bite-sized

o Can be eaten with a fork, spoon, or chopsticks but don't need a knife to cut

o Must be chewed

 Level 7 (regular). These are:

o Normal, everyday foods of varying textures, including soft, stringy, and hard and crunchy

o Foods that can be eaten by any method. For example, from a cup or using utensils.

o Foods that need to be chewed, with all types of textures and may have pieces that can't be swallowed, such as gristle

Decreased saliva can make swallowing difficult for the patient. Moistening or lubricating food before feeding improves the ability to swallow. Applesauce are one of the many that can be used
to lubricate foods.

Dairy products should be avoided because it can lead to thickened secretions, which greatly inhibits the patient’s ability to swallow

Fluids are essential to maintain body functions. Usually 6 to 8 cups of liquid are needed daily. For some dysphagia patients, this may present problems because thin liquid can be more difficult to
swallow, which can lead to dehydration and further serious health problems. In this case, fluid can be thickened to make it easier to swallow. But first you need to consult the patient’s therapist
regarding thickened fluids because this affects the effectivity of medicines

Health teaching of the patient’s caregiver or family should be conducted with a teach-back type of teaching and should include

What kind of foods or fluids should be avoided when feeding the patient

Positioning of patient during feeding

Time allowance so that patient can chew thoroughly

Moistening or lubricating dry foods to facilitate swallowing

Monitoring patient for signs of aspiration

Monitoring the weight of the patient

Assessment of dehydration
2. List at least four dietary treatment guidelines for peptic ulcer disease. Include the rationale for each

Dietary Fiber
A diet high in soluble fiber decreases the risk of developing ulcer disease. Aim to include good sources of soluble fiber at each meal. Fiber helps because it can lower the amount
of acid in your stomach while easing bloating and pain. Plan to incorporate good sources of soluble fiber for each meal.

Foods rich in fiber are vegetables, fruits, oatmeal and oat bran, barley, peanut butter, nuts, nut butters, and legumes such as lentils, dried beans, and peas are good sources. A diet
high in soluble fiber may help to prevent ulcers from coming back.

Avoid coffee and alcohol

Caffeine increases stomach acid, but it does not seem to cause ulcers or make their symptoms worse. Drink caffeine containing beverages in moderation. Alcohol increases
stomach acid so it can interfere with ulcer treatment.

Cranberry Juice Cocktail

When antibiotics are used to eradicate infection, the bacteria may mutate and become resistant to treatment. Cranberry helps by either not allowing the bacteria to attach itself or by
disengaging it from the body once it is attached, and prevent inflammation.

Assess Your Individual Tolerance

No evidence suggests that spicy or citrus foods affect ulcer disease, although some individuals do report worsening of symptoms after eating these types of foods. It is important to
find out what works for you. If you notice that your symptoms get worse after eating certain foods, then limit or avoid them so you can feel your best, making sure that you don’t
eliminate an entire food group.