FEEDING THE CLIENT
In the home, the family menu should serve as the basis of the client’s meal whenever possible. This usually pleases the client because it makes her or him feel a part of the family. It also reduces food preparation time and costs.
Family meals are easily adapted for the client by omitting or adding certain foods or by varying the method of preparation. Suppose the client was to limit fat intake and the family menu was the following:
Mashed potatoes with butter
Tossed salad with French dressing
Ice cream with fresh strawberries
Broiling the hamburgers for everyone instead of frying would help limit the fat content. The client’s mashed potatoes might be served with little or no butter, and the peas with only salt and pepper and perhaps a suitable spice, herb, or lemon. The client could be served the tossed salad with fat-free dressing and, for dessert, strawberries with low-fat ice cream. Fat-free milk is a simple substitute for whole milk.
When a meal is served at the bedside, the tray should be lined with a pretty cloth or paper liner. Attractive dishes that fit the tray conveniently without crowding it should be used. The food should be arranged attractively on the plate, with a colorful garnish such as a slice of fruit, parsley, or vege-table stick. The garnish must fit into the client’s diet plan, however. Utensils must be arranged conveniently. Water should be served as well as another beverage (unless it is prohibited by the physician). Foods must be served at proper temperatures.
When the client is on complete bed rest, special preparations are required before the meal is served. The client should be given the opportunity to use the bedpan and to wash before the meal is served. The room can be ventilated and the bedcovers straightened. The client should be helped to a comfortable posi-tion, and any unpleasant sights should be removed before the meal is served. Pleasant conversation during the preparations can improve the client’s mood considerably. Certain topics of conversation can help stimulate the client’s interest in eating. The client might be told that the family is anticipating the same meal. Perhaps the recipes used will interest some clients. Appropriate remarks on the client’s progress, whenever possible, are helpful.
When the meal preparations are complete, the tray should be placed so that it is easy for the client to feed herself or himself or, if necessary, convenient for someone else to do the feeding. If the client needs help, the napkin should be opened and placed, the bread spread, the meat cut, and the straw offered. The client should be encouraged to eat and be allowed sufficient time. If the meal is interrupted, the tray should be reheated and served again as soon as the inter-ruption has resolved.
The tray should be removed and the client helped to brush her or his teeth when the meal is finished. The kinds and amounts of food refused, the time, type of diet, and client’s appetite should be recorded on the client’s chart after each meal. At times, the provider may request a calorie and protein count, which is an accurate report of the types and amounts of food eaten.
If the client is unable to feed herself or himself, the person doing the feeding should sit near the side of the bed (Figure 23-1). Small amounts of food should be placed toward the back of the mouth with a slight pressure on the tongue with the spoon or fork. Clients should not be fed with a syringe. If the client is suffering from one-sided paralysis, the food and drinking straw must be placed in the nonparalyzed side of the mouth. The client must be allowed to help herself or himself as much as possible. If the client begins to choke, help her or him sit up straight. Do not give food or water while the client is choking. The client’s mouth should be wiped as needed. A client diagnosed with dysphagia will require a specialized diet. Depending upon the swallowing abnormality, the client may need pureed foods with either thin or thickened (to a nectar or honey consistency) liquids. A dysphagic client should not use straws.
Special care must be taken in serving a meal to a client who is blind. An appe-tizing description of the meal can help create a desire to eat. To help the client who is blind feed herself or himself, arrange the food as if the plate were the face of a clock (Figure 23-2). The meat might be put at 6 o’clock, vegetables at 9 o’clock, salad at 12, and bread at 3 o’clock. The person who regularly arranges the meal should remember to use the same pattern for all meals. People who are blind usually feel better when they can help themselves.