'Just Feed Me': Restorative Care Versus Doing It For Him
Mr. R is 68 and had an ischemic stroke 18 days ago with left-sided weakness. Before the stroke he lived alone and cooked his own meals. The OT note says he can feed himself with a plate guard and a built-up spoon in his right hand. The speech therapist cleared him for a mechanical soft diet with thin liquids using a chin tuck, and flagged the left cheek for pocketing. At lunch he pushes the spoon away and says, 'Just feed me, it takes too long.' He has taken about 4 ounces of fluid since 0700, his mouth is dry, and his urine output over the last 8 hours was 180 mL, dark yellow.
1. Mr. R asks you to feed him. What do you do?
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Do not take the spoon away from him. Set him up to succeed, and let him do the work.
Set-up that makes self-feeding possible:
- Sit beside him at eye level, on his right side - his strong side.
- Position the tray so the food sits in his field of vision; use the plate guard, non-slip mat, and built-up spoon as OT directed.
- Cut food, open cartons, remove lids, and place the spoon in his right hand.
- Allow real time - 30 to 45 minutes - and do not hover or sigh.
Why not just feed him:
- Feeding him tonight is faster for you and worse for him. Self-feeding is the OT plan; it preserves arm function, dignity, and the habit of eating, and it is exactly what he needs to go home.
- It is also safer. When he paces himself he manages his own swallows; a rushed feeder loads bites faster than he can clear them.
- Being fed teaches dependence in a resident who was independent three weeks ago.
If fatigue wins: feed the last few bites, then document how much he ate and that he fatigued. Report the refusal and the fatigue to the nurse and OT - a change like this needs the care plan looked at, not silently worked around.
2. What positioning and swallowing precautions do you use during the meal, and what would make you stop?
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Position:
- Sitting upright, ideally 90 degrees, head midline and slightly forward with a chin tuck on the swallow as the speech therapist directed.
- Food to the right (unaffected) side of the mouth.
- No straw unless specifically ordered; no talking with a full mouth; no rushing.
During the meal:
- Small bites, alternate solids with liquids, and check the left cheek for pocketing every few bites - he will not feel it there.
- Keep him upright for about 30 minutes afterward.
Stop and report immediately if you see: coughing or throat clearing with eating, a wet or gurgly voice, tearing eyes, a change in breathing, food or liquid coming back, or a sudden drop in alertness. Those are aspiration signs, not 'eating too fast.'
Reasoning: the ST clearance is conditional - it is a clearance with a chin tuck and a texture level, not a blanket permission slip. Your job is to hold the conditions in place and to notice when they stop working. Aspiration in a stroke resident often happens silently, so the pocketing check matters as much as the cough.
3. He is barely drinking and his output is low. What do you notice, what do you report, and what do you not do on your own?
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What you notice:
- 180 mL of urine in 8 hours is roughly 22 mL/hour, below the usual 30 mL/hour benchmark.
- Dark yellow, concentrated urine plus a dry mouth plus low intake are a cluster, not three separate trivia items.
- Other signs to check: dry mucous membranes, poor skin turgor, sunken eyes, new confusion or sleepiness, rising pulse, low-grade temperature, constipation.
What you report: exact intake and output totals, the color and amount of urine, and how long he has been refusing fluids. Dehydration in a stroke resident can present first as confusion or a new swallowing problem, so the nurse needs the numbers, not 'he's not drinking much.'
What you do not do: you do not decide on your own to push large volumes of fluid at him. He has a modified texture and liquid order, and a stroke history means his swallow status can change - he may need to be re-screened. Offer small amounts frequently within the care plan, encourage preferred fluids, record every milliliter, and let the nurse decide about the plan or a re-check. Forcing fluids on a resident with dysphagia is how aspiration happens.