Fundamentals - Practice & Skills, part 19: Dysphagia, Diet Types, Foodborne Illnesses, Blood Glucose Measurement
This article covers dysphagia, therapeutic diet types, prevention of foodborne illnesses, and capillary blood glucose measurement. You can follow along with our Fundamentals of Nursing flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.
Dysphagia is a condition where a patient has difficulty swallowing. This means the patient is at an increased risk for aspiration (when something enters the airway or lungs by accident). Solids or liquids could end up going down the trachea instead of the esophagus, which is a choking risk.
Risk factors of dysphagia
There are many risk factors for dysphagia, including nervous system disorders (e.g., stroke, Parkinson’s, dementia, ALS (also known as Lou Gehrig's disease, a myotrophic lateral sclerosis, is a progressive neurodegenerative disease that affects nerve cells in the brain and spinal cord), cerebral palsy, head/neck/esophageal injury, and GERD (gastroesophageal reflux disease).
Signs and symptoms of dysphagia
The signs and symptoms of dysphagia include sustained coughing and clearing of the throat.
The patient may be “pocketing,” which is when food remains in the buccal pocket or buccal pockets (the space between the gum and the cheek).
If they have difficulty eating or drinking, this is a red flag that the patient may be experiencing dysphagia.
Nursing care for patients with dysphagia
Nursing care is very important for a patient with dysphagia.
Assess the patient for swallowing issues at admission (prior to providing any food/liquids).
You can learn more about the flow and sequence of a head-to-toe patient assessment with our Health Assessment Flashcards for Nursing Students.
A patient experiencing dysphagia needs to see a speech-language pathologist for a full swallow evaluation and, possibly, swallowing therapy.
The patient should consume thickened liquids and possibly be placed on a dysphagia diet, which is covered more in depth below.
A patient in hospital should have the head of their bed raised and be put in high Fowler’s position.
Patient teaching for a person with dysphagia
Another critical element when dealing with a patient experiencing dysphagia is to educate them that whenever they have food or water — when they swallow — they should tuck their chin to their chest.
Types of therapeutic diets
A therapeutic diet is any kind of a diet that’s prescribed or per order. A patient in the hospital will usually be on a therapeutic diet.
NPO is an acronym of a Latin term — nil per os (or null per os) — meaning, nothing by mouth. That means the patient should ingest nothing by mouth, including liquids. Nothing goes in.
Clear liquid diet
A clear liquid is a liquid that is transparent and liquid at room temperature — anything that is liquid at room temperature that a light will pass through. A clear liquid diet includes juices like grape juice, apple juice, and cranberry juice, which don't have any pulp or sediment. Also: black coffee, tea, water, broth (not a creamy soup), clear sodas, popsicles, ice chips and jello.
Full liquid diet
Full liquids are any kind of liquid. So, in addition to the clear liquid items listed above are things like orange juice or milk, coffee with creamer, and ice cream.
A soft diet is comprised of soft foods. These foods are low fiber, so they are easily digested, and include low-fat dairy, eggs, pudding, bland vegetables, tofu, and lean skinless meats.
A dysphagia diet includes soft foods that are moistened or pureed, as well as thickened liquids.
A regular diet consists of a normal-consistency intake, the sort of foods that a patient would eat at home.
Prevention of foodborne illness
The prevention of foodborne illnesses includes the following (patient) teaching:
- Hand hygiene — wash hands after using the bathroom and prior to food preparation
- Wash fruits and vegetables thoroughly prior to preparing or eating
- Use separate equipment to prepare raw meats and cooked foods
- Use a meat thermometer to ensure meat is thoroughly cooked
- Refrigerate perishables within 2 hours of purchasing or cooking (or within 1 hour when the outside temp > 90°F)
- Ensure the refrigerator is ≤ 40°F and the freezer is ≤ 0°F
Capillary blood glucose (CBG) measurement
Capillary blood glucose (CBG) measurement is the measurement of a patient's blood glucose level, using blood from a fingertip puncture. A glucometer — an at-home blood-sugar monitoring device — is used to measure the patient’s CBG.
The following are best practices for using a glucometer to assess a patient’s CBG:
- Clean the site (fingertip) with an alcohol swab, then allow skin to dry completely
- Lower the patient’s hand to encourage bleeding
- Hold the lancet to the skin at the lateral, distal end of the fingertip (not the pad of finger)
- Wipe away the first drop of blood with gauze
- Gently touch the test strip to a drop of blood without smearing the blood
- Following the collection of the blood sample, apply pressure to the puncture site with dry gauze
- Dispose of the test strip and lancet appropriately (e.g., sharps box) when done
You can learn about blood glucose labs and more with our Lab Values Study Guide & Flashcard Index, a list of lab values covered in our Lab Values Flashcards for nursing students, an easy reference guide.
Hi. I'm Meris. And in this video, we're going to be talking about dysphagia, therapeutic diet types, prevention of foodborne illnesses, and capillary blood glucose measurement. I'm going to be following along using our Fundamentals of Nursing flashcards. These are available on our website leveluprn.com if you want to get a set for yourself. And if you already have your own, I'm starting on card number 104 if you want to follow along with me. All right, let's get started.
So first up, we're talking about dysphagia, dysphagia with a G, which means difficulty swallowing. So difficulty swallowing, what's the first thing that should come to your mind when you think of someone who's having a hard time swallowing food or water? I'm going to tell you. It is increased risk for aspiration. That is bold and red on this card, so I would very much know it. If I'm having a hard time swallowing, it could end up going down my trachea instead of my esophagus. So there's lots of different risk factors for this. But I do want to go over some signs and symptoms. If your patient is coughing a lot, if they're clearing their throats, if they're doing what we call pocketing, which is they have food that remains in the buccal pocket or buccal pockets. So that's going to be this pocket between the gum and the cheek. That's called pocketing food. Or if they have difficulty eating or drinking, all of that is going to be a big red flag that your patient is having dysphagia. Now, nursing care is the most important part here. I'm going to tell you there's a lot of bold red stuff on this card, so you really want to make sure you know it. The high points here are that the person that this patient needs to see is a speech-language pathologist for a full swallow evaluation and perhaps even swallowing therapy. We also want to make sure our patient is having thickened liquids and possibly a dysphagia diet, which we're going to talk about next. And then really important is patient teaching. You need to educate your patients that when they swallow, they should tuck their chin to their chest. So they have food or water they need to do this when they swallow, very important.
All right. Let's move on to therapeutic diet types. So this refers to any kind of a diet that's prescribed or per order. This is what's going to be how we know what your patient in the hospital can have. Now, NPO means nothing by mouth. It's Latin for nil per os, so nothing by mouth, including liquids. So nothing goes in. Clear liquids, clear liquids are anything that you can pass a light through that is liquid at room temperature. So this means transparent and liquid at room temperature. So juices like grape juice, apple juice, cranberry juice, all of those that don't have any pulp or sediment, those are clear liquids. Black coffee, tea, water, broth - as long as it's just broth and not a creamy soup - all of those are going to be clear liquids and also things like popsicles and ice chips. Now, full liquids are going to be any kind of a liquid. So this could be all of the clear liquid items. But then also things like orange juice or milk, coffee with creamer, ice cream. Again, remember liquid at room temperature. Now soft in dysphagia diets are a little bit similar. You're going to see some things in common. But soft diet is soft food. It's going to be low fiber, so it's easily digested. Now, dysphagia is also going to have soft foods because they are moistened or pureed. But big thing to know here - we talked about before - is thickened liquids. And then the regular diet is just the normal consistency intake like what a patient would eat at home.
All right. So moving on, let's talk about prevention of foodborne illnesses. This is going to be patient teaching. Lots of red and bold stuff here on this card that's very important to know, so I would review this. Big thing is going to be hand hygiene before preparing meals and before eating, using separate equipment to prepare raw foods and cooked food so we don't cross contaminate, and then using a meat thermometer to make sure that meat is fully cooked. There's some more teaching on there that I would recommend reviewing in your own time as well.
And then lastly, we're going to talk about capillary blood glucose measurement. So this is how we use a glucometer to assess a patient's blood glucose level. You're going to see we have a bunch of best practices here, but I just want to point out a few. The first is that when we clean the skin with an alcohol swab, we need to let it dry completely so that the wet alcohol does not affect the readings. We want to use a lancet, which is the needle that punctures the finger. We want to use it on the lateral aspect of the finger, not the finger pad. There's a lot of nerves, a lot of sensation right here in the middle, so use the sides of the finger, not the finger pad, and then make sure that you wipe away the first drop of blood. So we're going to get that first drop of blood, wipe it away, and then use the second one to get the actual reading. So there's more information on this card, as well, but those are the big highlights that I want to hit for you.
So I hope that review was helpful. If it was, please go ahead and like this video. It would mean the world to me. If you have a great way to remember something, I want to see it in the comments. And I know that other people watching want to know as well. And be sure to subscribe to our channel because you want to be the first to know when the next video comes out. The next video in the series is going to be talking about nasogastric or NG tubes. Super-duper important for school so you want to be up to date with all of that. All right, thanks so much and happy studying.
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