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Name

By Gary Miller,2014-01-16 12:21
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Name

    Agency Name

    Name: Name Date:

    Mealtime Plan (from eating specialist)

RATIONALE:

    Name is at risk for aspiration. She demonstrates moderate-to-severe oropharyngeal dysphagia

    and has a history of documented silent aspiration. She also demonstrates the risky eating

    behavior of rapid eating pace.

FOOD TEXTURE:

    Due to Name’s dysphagia, ALL of her foods must be:

    ? blended/pureed to a smooth uniform applesauce consistency

    ? runny/not thick/not lumpy, pulpy or stringy

    **She should never have solid foods without blending

LIQUID CONSISTENCY:

    ? thin liquids

    ? no carbonated beverages

    ADAPTIVE EATING EQUIPMENT:

    ? small maroon spoon

    ? Sip-A-Mug (transparent cup with a small attached straw and lid)

    ? dycem mat (non-skid placemat)

    ? small scoop dish or scoop bowl

    See the attached sheet regarding how to order replacement adaptive eating equipment.

    ASSISTED EATING TECHNIQUES:

    Degree of Supervision during Eating and Drinking Although Name is a self-feeder, it is very important, for her health and safety, that a caregiver sit

    with her during each meal to visually monitor her eating and drinking. She needs very close

    supervision during all oral intake. STAFF MUST REMAIN NEXT TO HER:

    - To watch and listen for signs of possible distress including coughing, choking, red face,

    tearing eyes;

    - To observe her for safe eating and drinking pace and

    - To provide assistance, as needed.

    Eating/Drinking assistance should be given using verbal and physical prompts, whenever

    necessary.

Mealtime Support Strategies (eating specialist) date

    , Name Page 2

Presentation of Food

    Name is a semi-independent eater and drinker.

    - Set up the lap tray with all appropriate adaptive eating equipment at the beginning of each

    meal/snack.

    - She uses a separate scoop dish or bowl for each food (i.e., meat, vegetable, dessert, etc.).

    - Give her one dish of food at a time.

    - She scoops her foods with her left hand; put the spoon on the left side of her dish.

    - She may need help picking up her spoon at the beginning of the meal and again anytime

    she puts it down. Watch to see and assist if needed.

    - Start with the main dish.

    - Name will usually eat independently.

    - If Name scoops too much food onto her spoon (a heaping amount), the food is too thick.

    Staff must thin the texture of the food so that it cannot be piled onto the spoon. Tell her:

    Name... I need to fix your food. It’s too thick. Wait just a minute and I’ll bring it

    back to you.” Please use a friendly voice when communicating this to her. Praise

    her for waiting.

    - If it appears that Name has not swallowed her food, staff should physically help her to

    wait before taking another bite AND may present an empty spoon or rub her cheeks while

    watching her neck until she has swallowed. When she has been observed to swallow,

    praise her and allow her to continue eating.

    - When she finishes the first dish of food, extend your hand and wait. Say “Give me your

    dish” and she will hand it to you.

    - Offer her a drink between each dish of food being offered.

    - Name may need reminders not to eat food that has fallen onto her bib. If the reminders

    do not work, fold the bib so that the food is not visible or get a clean bib to replace the

    dirty one.

    - Continue this pattern with each dish of food.

    - When the food is gone, give her the remainder of her beverage.

    - Be sure that her mouth is empty of all foods after the meal. Food that remains in her

    mouth after a meal causes risk for aspiration. A sponge tipped toothette may be used to

    clear any food remaining in her mouth after the meal.

Presentation of Liquid

    Due to her risk for GERD, Name should not be offered more than 8 ounces of liquid with each

    meal or at one time between meals. This amount is meant to limit the amount of liquid in her

    stomach and reduce the amount of pressure on the opening between her stomach and esophagus.

    She should not drink carbonated beverages.

    - Name has been in the habit of drinking her beverage ONLY at the end of the meal;

    however, she needs to be ENCOURAGED to take drinks during her meal, after each dish

    of food.

    - She may also need assistance grasping her cup. She should use two hands.

    - If she raises her elbows while drinking, she should be assisted to lower them. This will

    keep her chin lowered while drinking.

    - When she is drinking, watch to see that she takes no more that 2 sips at one time from her

    straw before swallowing. If she attempts to drink more than this, remove the straw from

    her mouth. Tell her “Name, take a rest.”

    - She may need encouragement to finish her beverage.

Mealtime Support Strategies (eating specialist) date

    , Name Page 3

    After a meal, she should not eat or drink again for 60 minutes.

Behavior Support Strategies:

    See Positive Behavior Support Plan

Problems to Watch for During Eating/Drinking:

    Sign or Symptom of Aspiration When it may occur What to do Coughing- may be quiet -during or after -gently remove the

    meals/snacks/medications straw/spoon/dish

    -during or after teeth -encourage coughing

    brushing -wipe away mucous from mouth

    -anytime between if thick

    meals/snacks, -assist her to clear her airway if

    she experiences trouble breathing Red face -with coughing episodes

    -refer to medical emergency

    response plan

    -when breathing has returned to

    normal and her mouth is clear,

    Name may choose to continue

    with her meal.

    **report incident on Individual

    Signs/Symptoms of Asp data

    sheet** Refusal to eat or drink -following a coughing Contact the nurse

    episode at an earlier time IMMEDIATELY

    -with illness or congestion

If Name experiences a seizure during a meal, discontinue the meal until another time. Follow the

    information on the Emergency Medical Response Plan and the Seizure Protocol. If she has

    recently experienced a seizure, she may not be able to feed herself. She should NEVER eat if

    she is not alert! If she is alert at the next meal, but unable to coordinate self-feeding, staff should

    present the same diet to her using the same spoon and cup. If she rejects one meal, report it to

    the nurse and honor her decision to skip the meal. If she continues to reject eating, contact the

    agency nurse and this SLP.

Report any signs or symptoms of aspiration to the agency nurse IMMEDIATELY. Notify this

    SLP regarding any coughing, choking, red face during eating/drinking.

CONTACT PERSON:

    If you need assistance, clarification and/or training on this mealtime program,

    please contact:

    eating specialist’s name and credentials and phone number

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