Connie’s mealtime

Before the meal you should:

Do check that the temperature of the food is not too hot

Do let Connie know what the meal is

Don’t ask Connie to open her mouth as wide as possible. A normal, relaxed, open mouth is all that is required.

During the meal you should:

Do ask her to swallow twice. The SLT recommended this in her report.

Don’t ask her to hold the food in her mouth. This is not a helpful technique for Connie.

Do advise her to tuck her chin down to her chest. The SLT recommended this in her report.

Don’t ask her to tip her head backwards. This is generally a dangerous posture for people with dysphagia as it opens up the airway into a position which is more likely to cause food or drinks to enter it on swallowing.

During the meal you should:

Don’t encourage Connie to eat fairly quickly so that the meal doesn’t go cold. Connie should be encouraged to eat at a relaxed pace, leaving plenty of time between mouthfuls for 2 swallows.

Do offer her regular sips of fluid from her bolus-limiting cup. This would help her to clear any residue and help her to meet her hydration needs.

Don’t talk to her about her family. This may be interesting but could be a distraction when she is trying to concentrate on her swallowing.

You notice she is pocketing some food in her right cheek. You should:

Do tell her to try and use her tongue to clear this. She may just need a verbal prompt to remind her to do this regularly if she has reduced sensation in that side of her mouth.

Don’t put a gloved finger into Connie’s mouth. This would be intrusive and uncomfortable for her and unlikely to be necessary.

Don’t just leave it alone, thinking it will clear itself over the next few hours. She should not be left with reside in her mouth as she may aspirate this later if she changes position or lies down later.

After the meal Connie tells you she is tired. You should:

Do advise Connie that she should remain upright for half an hour after her meal and you make sure she is comfortable in the meantime.

Don’t immediately assist Connie to lie down on her bed so that she can rest for an hour before her next therapy session. The SLT recommended that she remain upright for half and hour so that all residue in her mouth and throat would have time to clear.

Don’t advise her that eating and drinking after a stroke can be tiring and she should lie down after every meal. This may be so, but you should follow the SLT’s advice that she should be kept upright for 30 mins post meal to prevent airway entry of food residue in her mouth and throat.