Question

1. You have been providing care for Mrs. Stern, who is terminally ill at home. You prepare her meals and she enjoys custard and scrambled egg. During the past two days, while feeding her, you notice that she often coughs after having sips of water or juice. What would be the action required in this case and why?
2. Mrs. Stern has dementia. She refuses to eat her lunch and when you try to encourage her, she shouts and pushes the plate away. What could you do to get her to eat her lunch?
3. Mrs. Stern is now receiving nourishment via a G-tube. How should you position Mrs. Stern and why?
4. Mrs. Stern today, yells “I am wet again” and starts crying you are about to leave. She tells you that she is always wet. You notice for the second time today that the site where the gastrostomy tube has fluid that again has soaked through her clothes. She tells you her skin is burning. You ask Mrs. Stern if you can look and you immediately notice a very red area surrounding the tube insertion point.  
5. What do you do?
6. What do you think is happening?
7. Can this be harmful to Mrs. Stern’s skin if left like this?
8. At a retirement home in the community, you are assigned to aid a client at feeding time. In the dining room, while assisting the person with his meal, you observe that the person beside him is not eating his breakfast, lunch and supper. What is your responsibility, and what steps would you take?
9. You have a client who is receiving nutrition through their intravenous therapy. While assisting the client to put on a new hospital gown after his partial bath, you notice the site where the intravenous is inserted in the client’s arm is swollen, red and is leaking fluid. What do you do in this situation? Is this normal?

Answer 1

Mrs Stern might have aspiration while having juice or water.she is terminally ill,chances of oral -pharyngeal dysphagia is common in these type of patients.It should  be managed carefully as it may lead to complications like dehydration,malnutrition,bronchospasm,upper airway obstruction,chest infection as well as aspiration pneumonia.the best action required is head end elevation and watch for cynosis.Discuss with doctor and start gastric tube feeding.

Dementia patients always have less interest in food.it may due to difficulty in swallowing,less taste,difficulty in swallowing or digesting food.Serve food in an attractive way may make her attraction towards food.use colour plates rather than white plates to serve food.decorate plate.I will  show her how to eat and she may follow the steps to eat.make eye to eye contact,show her expressions like the food is delicious.give her finger foods like nuts,crisps,fruits etc and give her often as nutritious meal is very important for dementia patients.

Positioning the patient is the first step in gastric tube feeding.make sure that the tube is secured.Elevate head atleast 30 degree to prevent aspiration.Elevation always helps the food to pass easily through the tube and reach the stomach.It also prevents aspiration as chances of aspiration is more if we feeds patient in lying position.

The dressings around the gastrostomy tube will change and will apply a foam dressing along with aluminium hydroxide ointment.redness around gastostomy tube may due to skin excoriation as a result of gastic leakage.It might be harmful and leads to infection if left untreated.the dressings should always kept neat and should managed in a sterile way.

while assisting my patient in feeding i can ask him why you are not eating after asking permission from my patient.i can inform the staff assigned to him that he is not eating.

A swollen,red leaking iv site is not normal.It is a sign of visual infusion phlebitis.The infusion should be stopped immediately and cannula also should removed.The arm should be elevated and a saline soak or anti inflammatory cream to be applied.a new cannula to be inserted on another arm to continue the intravenous therapy.