CH6 How to conduct swallowing training and feeding?
如何進行吞嚥訓練及餵食
To eat with your own mouth is the greatest happiness in life.What a wonderful thing it is to taste delicious delicacies! However,people might have to eat food through a nasogastric tube temporarily due to illness. Such a tube can be dispensed along with the improvement in health condition of the patient or be utilized as a channel to digest the food that the patient’s mouth can’t eat. Nevertheless, you are responsible to train the swallowing ability of the patient before he/she can eat food through his/her mouth by himself/herself.
能夠從口吃東西，是人生至大的快樂，如果一個人能保有由口享受美味大餐的能力，該是多美好的一件事！病患可能因病暫時以鼻胃管補充養分，但是這管子是可以隨病情改善而拔除或只補充由口所沒辦法吃的食物，不過在讓病患成功的由口吃東西前，需要您訓練他（她）吞東西的能力。
一、When to train him/her to swallow
何時可訓練他（她）吞嚥東西
When the patient gives response to linguistic stimulus and
won’t cough after you dip a cotton swab with water to let him/her
swallow, you may begin training.
如果病患開始對語言刺激有反應，並以棉籤沾水讓病患吞嚥，無咳嗽發生，即可以開始訓練。
二、Things to prepare
您需要準備的用物
1.A towel (to wrap around the body).
毛巾（圍在身上）。
2.Food: Jellies, pudding and bean jellies are the best choices at the beginning of swallowing training. General soft or liquid food can be tried later.
食物：吞嚥訓練初，宜採用果凍、愛玉、布丁、豆花等，成功後可採用一般軟質或液體食物。
3.A food container and a little spoon.
裝食物容器及小湯匙。
三、Procedure
步驟
1.A quiet dining atmosphere should be maintained. Concentrate on feeding.
維持進餐環境安靜，將注意力集中在進食上。
2.Help the patient up at 60-90°. Put a pillow behind the patient’s
head and place a towel under his/her chin. In this way, a comfortable dining posture is achieved.
協助病患起身至60-90 度，以枕頭放頭後，毛巾置於臉頰下，維持舒適的進食姿勢。
3.Let the patient see the food with his/her own eyes to stimulate appetite and excretion of digestive juice.
讓其親眼看見食物，以增加病患食慾，促進消化液之分泌。
4.Feed the patient with a small bite each time and repeat your command of swallowing the food two times.
以口令重複動作，餵一小口食物，並請病患吞嚥兩次進行。
Command
口令
Open your mouth and taste it. Use your tongue to lift thefood to your palate. Draw back your chin and swallow. You may use your hands to assist the patient during the training.(This step is not necessary for patients without swallowing problems.)
打開您的嘴巴，嚐一嚐，用您的舌頭將食物舉至上顎，縮下巴吞下去，其間可用手協助病患（吞嚥無問題的病患可省去此步驟）。
5.Feed the patient in a slow pace and get a proper amount of food every time. For patients having a cerebrovascular accident, food should be placed into the mouth on the healthy side.
餵食時要緩慢，每次送入病患口中的食物份量應適中；如腦中風的病患應將食物放入健側口中。
6.Food ought to be put into the mouth of the patient precisely and another serving can’t be given until you make sure the patient has chewed and swallowed it. Write down patient’s condition while swallowing, the amount and type of food fed and any special situations.
食物應準確放入於其口內，需確定病患已咀嚼吞入後才可再餵食。並記錄吞嚥情形、進食的量與種類，及特別情形之發生。
四、Points for attention
注意事項
1.Stop feeding once the patient starts to cough. Try to feed the patient at least in half an hour. If the patient keeps coughing,feeding should be suspended some time.
當病患發生咳嗽時，請停止餵食，讓病患至少休息半小時後再試。若屢次發生，則可能病患需延後一段時日再試。
2.The patient should sit while being fed and take a rest for 30 minutes before lying down again to prevent food from flowing back.
餵食後需採坐姿休息半小時，再臥床，以防食物逆流。
3.The nasogastric tube or other device needs to be kept during feeding training to supplement water and nutrition.
訓練期間，仍應有鼻胃管留置或其他方式，以補充不足的水分及營養。
4.Start to feed the patient with liquid food after soft food has been fed for some time.
軟質食物進行一段時日，才可進行液體食物餵食。
CH14 Spit stroking and Postural Drainage
拍痰及姿位引流
Once the respiratory tract is obstructed by phlegm (sputum),human life could be in danger. Therefore, it’s very important to take care of his respiratory tract to keep it unobstructed. Besides phlegm (sputum)pumping, phlegm stroking and postural drainage are more useful ways to clear up phlegm (sputum) deep in the lung so as to make breathing smoothly.
一旦呼吸道被痰液堵住會威脅生命，因此照護病患的呼吸道是非常重要的，維持呼吸道通暢除了靠抽痰外，藉著拍痰及姿位引流的方式能更有效清除病患肺深部的痰
液，使病患的呼吸更順暢。
一、Phlegm stroking
拍痰
Stroke the chest on the surface to reduce the amount phlegm(sputum) adhering to trachea wall so that phlegm can be easily coughed out to keep the breathing more smoothly.
叩擊胸部表面，可減少痰液附著於氣管壁，使痰液易於咳出，讓呼吸更順暢。
二、Steps
步驟
1.The caretaker draws his fingers close to make the palm like a cup.
照顧者手指併攏，使手掌呈杯狀。
2.Relax the shoulders and use the strength of the wrist to stroke the back in rhythms.
放鬆肩部，利用手腕的力量，有節奏的叩擊背部。
三、Postural drainage
姿位引流
Consult the doctor or the family nurse to confirm the phlegmatic area of the lung, then make use of the principle of gravity to make the phlegm flow toward the main bronchial tube or the trachea so that the phlegm can be easily coughed out or aspirated.
請教醫師或居家護理師，確定肺部痰多的區域，利用重力的原理，使痰液流向主支氣管或氣管，以便於咳出或抽吸。
四、Steps
步驟
1.Prepare a soft pillow or quilt.
準備軟枕或棉被。
2.Raise the nidus. If the nidus is the upper or middle lobe of the lung, turn the body to the left or the right side and give a support, then operate phlegm stroking for 10-15 minutes.
將病灶部位抬高。肺部上葉及中葉，向左或向右側翻並給予支托，可配合拍痰10-15 分鐘。
3.If the nidus is either side of the lower lobe of the lung, place a soft pillow or quilt under the hips, then place a soft pillow under a shoulder to turn the body to the right or left side.
肺部兩側下葉，利用軟枕或棉被，將臀部墊高，一側肩部置一軟枕，向左或向右側翻。
五、Attention
注意事項
1.The operations mentioned above are not allowed to be made 30 minutes before and one hour after meal.
以上活動不能於餵食前30 分鐘及飯後1 小時內施行。
2.When it’s not proper to pose the patient in special way of lying in case of hypertension or special conditions, it’s proper and effective to turn the patient to the left or right side.
若有高血壓病患或特殊狀況（醫師認定）不宜擺特殊臥位時，左、右側翻亦有不錯成效。
3.Stop the operation immediately when the patient shows uncomfortable
signs such as quick breathing or blushed.
施行時，若有不適狀況，如呼吸加快、臉色潮紅等應立即停止。 |
