What position should the patient be placed in when assisting a patient with meals?

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Provides a balanced diet.  Most of our food intake is carbohydrates with some fat but it is important to include protein and fiber each day because they cannot be stored in the body.  Sufficient liquids are also important.  Check with your dietician if the person is on special diet.

Before meal time, it is important to see that the room in orderly with urinals and bedpan out of the person's sight.

The person should have the opportunity to use the toilet, commode or urinal and to wash his hands before each meal.  Provide mouth gargle if the person cannot get out of bed.

Wash your hands before serving meals.

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Take a real interest in helping the person to enjoy his meal.  Be patient and always be mindful of the person's dignity.

Do not attempt to feed the person if he can eat himself or with the help of assistive devices.  Click here for a pictorial guide of eating an drinking utensils.

Know about special difficulties the person may have.  For instance, difficulties in chewing and swallowing.

Sit the person in a comfortable position in bed or sitting up well supported in a chair before you bring in the food.

Placed the food in such the way so that the person can reach them conveniently.

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Help the person to cut up food if he needs help.

Warn the person if you are offering something hot.

Encourage the person to finish his meal but do not force him.

Observe the person during feeding, i.e. any difficulty in swallowing or any change in general condition.

After meal, help the person to wipe his mouth and attend to his oral hygiene.

Advise the person to remain in sitting position for at least half an hour to prevent gastric reflux .

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Find out what the person is happy to eat and ask if there is anything he really dislikes.  Check whether there are any foods which the person must not eat, either for reasons of belief or because of special medical instructions.

Take trouble with presentation of meals so that the food appears appetising.  When providing the meal on a tray, see that everything needed is attractively  laid out on a clean tray.  Do not overfill containers of drink or soup or they will slop.

Serve food or drinks at luke warm temperature.

Provide variety in the meals to stimulate poor appetite.

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Small helping of appetising food served at shorter intervals are more appealing than large occasional meals.

If the person is suffering from a temporary loss of appetite, a light diet such as porridge is most likely to appeal him.  This is easily digestible, containing plenty of nourishment and has very little bulk.

Keep the person's mouth and tongue moist and clean at all times.  Provides him with mouth gargle to freshen his breathe before eating.

If the person is wearing dentures, check that they are well fitted and that there is no food caught under it.  If so, remove the dentures and rinse them and rinse the his mouth before replacing them.  This will make eating more comfortable and enjoyable.

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Give frequent small amount of nourishing drinks such as Enercal and Sustacal to stimulate appetite.

Use straw or feeder cup to serve drinks if mouth and tongue are sore.

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Make sure the person is sitting in a comfortable, upright position before beginning the meal.

Protect the person with a napkin and the bedclothes with towels if necessary.

Always sit by the person's side and within easy reach.  It is important that you are sat at the unaffected side of the person, for instance stroke patient, so that he can easily participate in the process.

Try to keep the food warm.  If feeding takes a long time, put small amounts of food on extra plate and keep the rest covered until needed.

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If the person has difficulty in swallowing, cut food into very small pieces.  Offer small mouthfuls by using a desert spoon or fork and frequent sips of water or other liquids.  Allow the person time to chew properly and swallow before offering the next mouthful.

Stop feeding if the person is coughing continuously or appears breathless.  These are signs of food entering the respiratory system.

If the person drool or food runs out of one side of his mouth, as in the case of stroke, turning his head slightly to the unaffected side may help.

Wipe the person mouth and chin as necessary.

Remember to give the person your undivided attention throughout the feeding process.

Advise the person to remain in sitting position for at least half an hour to prevent gastric reflux and aspiration which can cause choking.

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Position the person upright in bed and support him comfortably with pillows.  For comatose person, he should be placed in a semi-upright position.

Protect the person's clothes from getting soiled with a waterproof towel.

Offer mouthwash to the person before feeding.

Always remember to talk to the person during feeding even if he is unconscious.

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Pinch the feeding tube before removing the spigot to prevent air from entering the person's stomach.

Ensure that the tube is in the person's stomach before feeding by performing the following tests:

1. pH Test

Withdraw about 5ml of stomach contents with a 20ml syringe and test it with a pH paper.  A pH lesser than 5 indicates that the aspirate is from the stomach.

2. Auscultation Test

In addition to pH Test, use a 20ml syringe to inject 10 to 15ml of air with a slight force into the tube.  If the tube is in the stomach, a gushing sound will be heard over the diaphragm of a stethoscope placed at the epigastria area (2cm below the sternum notch).

Note - Do not rely solely on Auscultation Test as the method of checking nasogastric tube placement. If you are uncertain of the tube placement, do not feed.  Consult your healthcare professionals.

Observe the nature, colour and amount of withdrew stomach contents.  This is necessary to exclude malabsorption of previous feed and review feeding regime.  If amount exceeds or equals the amount of the last feed, seek medical attention.

Do not feed more than 400 ml each time.

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Attach the funnel/syringe to the tube and hold it to the side, at the level of the person's forehead.  Do not held the syringe too high as this would increases the pressure at which the fluid enters the stomach.

Pour in any prescribed medication (powdering the tablets first, if any) followed by the prescribed feed.  Allow it to flow slowly into the stomach by gravity.

Stop feeding immediately if the person coughs or shows signs of distress. This indicates that the feeds may have aspirated into the lungs.

Do not allow the funnel/syringe to become empty during feeding as this would introduce air into the stomach.  Pinch the tube if it is empty to minimise air entering the person's stomach.

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Conclude the feed by flushing the lumen of the tube with water so as to keep it patent.

After feeding, disconnect the funnel/syringe and close the end with a spigot to prevent backflow and leakage.

The person should remain sat upright for at least 30 minutes after feeding to prevent gastric reflux and aspiration which can cause choking.

Record the time, type and amount of fluid given.