1. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Considerations Involved in Preparing a Resident for Mealtime Offer bedpan or urinal or assist to bathroom or remind resident to go to the bathroom Wash resident’s hands or remind him/her to wash hands. Provide oral care before breakfast. Make sure dentures, glasses, and hearing aid are cleaned and are properly in place. Assist resident to dining room, if indicated on care plan. Assist to chair and position at table. Protect clothing with napkin, towel, or clothing protector. Do not refer to it as a “bib.” Cover medical appliances, such as urinary catheter bags.

2. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Considerations Involved in Preparing a Resident for Mealtime If resident is unable to go to the dining room, assist to chair, if indicated on care plan. Position resident comfortably with overbed table in convenient position. Protect clothing with napkin, towel, or clothing protector. If resident is unable to get out of bed Elevate head of bed and position resident in as near a sitting position as possible with overbed table in convenient position. Protect clothing with napkin, towel, or clothing protector.

3. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Considerations Involved in Preparing a Resident for Mealtime Prepare the surroundings of the resident. Put away equipment. Remove smells of recent BM by airing room. Odors that remain indicate a cleaning problem. Place fresh glass of water within reach at all times. Straighten linens. Provide privacy for residents who have unusual eating habits.

4. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Preparing and Serving Food Trays Check name (and room number) to make sure resident gets correct tray. Check tray to make sure everything is on it according to posted menu and resident’s diet order. Check to make sure any required assistive devices are on the tray. If resident cannot eat when tray is served, take tray away and keep it warm. Serve trays promptly so food temperature is maintained. Serve one tray at a time to avoid contamination of second tray in another resident’s room. Carry tray at waist level, not on shoulder next to hair. Ensure that each resident who should have a tray receives one. If a resident does not have a tray upon completion of tray pass, notify charge nurse.

5. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Preparing and Serving Food Trays See that the general appearance of the tray is orderly and tidy. Trays must be served and residents fed promptly upon delivery of tray. If a resident is not eating, say, “I’ve noticed you’re not eating. What can I do to help you?” Do not put plate covers on the floor.

6. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Assisting the Resident to Eat Place the tray on the table with main dish closest to the resident. Arrange everything so the resident can reach it. Remove food covers and put them to one side or return them to the kitchen. NOTE: Do not place covers on floor or on utility carts. Open milk cartons, cereal boxes, and anything else that may be difficult for the resident to manage if the resident requires or requests help. Help resident with cutting food, buttering bread, pouring liquids, etc. Provide a straw for the resident who is unable to use a cup. Encourage resident to do as much for themselves as possible.

7. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Allow the resident time to give thanks before the meal if he/she wishes. Assisting the Resident to Eat Use adaptive equipment as necessary for the resident to be able to eat on his/her own according to care plan. Built-up utensils (See Figure 2.1.) Plate guards Band to hold utensils (See Figure 2.2) Drinking cup (See Figure 2.3.) Swivel spoon or fork Extended handles Nosey cup (See Figure 2.4.) Plastic/rubber-coated infant-size spoon Figure 2.1 – Built-up Utensils

8. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Figure 2.2 – Elastic Utensil Holder Figure 2.3 – Drinking Cup Figure 2.4 – Nosey Cup

9. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Stay with resident until you are certain he/she can manage independently. Assisting the Resident to Eat Note and record amount of food eaten. Report change of appetite to charge nurse. Note foods resident is not eating and report findings to charge nurse. Immediately after the meal, report to the charge nurse which foods a resident who is diabetic has not eaten. Observe any changes in eating habits. A change may indicate mouth/tooth pain.

10. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Feeding a Resident Place resident in an upright position. Place tray so resident can see food. Protect resident and bed linens with towel, napkin, or clothing protector as needed or desired. Nurse assistant should be in sitting position while feeding the resident. NOTE: It is permissible to sit beside the resident when feeding him/her. Avoid rushing or hurrying the resident. Describe the meal to the resident in a positive fashion. Use a straw for giving liquids as per the care plan. Cutting a straw in half helps residents who are weaker. Encourage resident activity. Have him/her hold bread grasp glass, etc. Fill spoon half full to avoid spilling and to give manageable amounts of food.

11. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Feeding a Resident Serve food in order of resident’s preference. (Get a substitute from the dietary department if the resident requests it.) Offer liquids and solids alternately to provide moisture for chewing. Give resident sufficient time to chew and swallow food thoroughly, as well as time to breathe between bites. Offer butter, sugar, and seasonings to the resident unless there are special diet restrictions. Tell the resident what each bite is, as offered. Warn residents when offering something hot. Keep conversation with resident friendly and discuss pleasant subjects. Wipe mouth as needed and when finished.

12. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring After-meal Care Take tray away when resident is finished eating. Report comments regarding food to charge nurse. Do not leave dirty dishes in front of resident. Remove napkin, towel, or clothing protector. Make sure resident’s clothing is clean; change if soiled by spilled food. Assist resident from dining room. Wash face and hands. Assist with or remind resident of mouth care. Encourage participation in an activity. Keep resident in upright position to minimize gastroesophageal reflux (heartburn).

13. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring After-meal Care Assist resident in room or in bed. Wash face and hands. Assist or give mouth care. Make comfortable and place signal light within reach. CAUTION: Resident should be kept in upright position for 1 hour after meals to minimize reflux into the esophagus. Put personal articles where resident can reach them. Note how much and what the resident eats. Record the percentage of food eaten. Any changes in eating habits can signal changes in physical condition; report to charge nurse. Wash your hands

14. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Residents with Special Eating Problems Resident with paralysis or weakness of muscles used for eating Resident should be sitting in upright position to aid swallowing. Gag and cough reflexes may be absent, making it easier for resident to choke. Feed into side of mouth that is not paralyzed. Remind the resident to think about swallowing. Give small amounts of food and allow the resident plenty of time to chew. With gloved hand, clean out paralyzed side of mouth frequently with a swab if needed.

15. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Residents with Special Eating Problems Resident who is visually impaired Identify everything on the tray. Identify placement of food on tray by comparing to positions of the hour hand on a clock (milk at 2:00, meat at 7:00, etc.). Placement should be the same at each meal. (See Figure 2.5.) Warn resident which liquids are hot. Tell resident where utensils are. Resident who is comatose, unconscious, or unresponsive Do not give oral liquids or food. Resident often receive nutrition by another method, such as tube feeding.

16. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Figure 2.5 – Food Tray for Resident Who Is Visually Impaired

17. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Residents with Special Eating Problems Resident on transmission-based precautions Follow facility’s transmission-based precaution procedure. If you don’t know, ask. Paper dishes are sometimes used. If metal or china utensils are to be used, check with charge nurse about how they are to be handled. The charge nurse gives special instructions in transmission-based precaution techniques to the nurse assistant when this becomes necessary in a long-term care facility.

18. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Thickened Liquids (See HO 1 and HO 2.) Some residents experience difficulty swallowing due to a stroke, neurological impairment, or muscular disease. These residents are at high risk for choking and aspirations (drawing food or an object into the lung when breathing in). A speech-language pathologist (SLP) can evaluate a resident who is experiencing a swallowing problem and can help develop a plan that minimizes the risk of aspiration. The SLP, in cooperation with the resident’s physician, evaluates the result of special x-rays or swallowing studies that provide information on the resident’s ability to swallow. Based on the outcome of the x-rays, the resident may be placed on “thickened liquids,” which is one of the most common ways a resident can be helped.

19. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Thickened Liquids Liquids are thickened to three different consistencies: nectar, honey, and pudding. CAUTION: It is the responsibility of a CNA to ensure that all the resident’s liquids, both at meals and in between meals, are the appropriate consistency as indicated in the care plan when they are served to the resident. Overthickening or underthickening puts the resident at risk for choking. In some facilities, the dietary department is responsible for thickening liquids on meal trays. The nursing staff may thicken liquids given on the division such as water at the bedside or liquids given with medication. Follow facility policy. In other facilities it is the responsibility of the nursing staff or the restorative feeding team to ensure that all liquids are thickened before they are served. The amount of thickener to be added to the liquid depends on the consistency desired and the amount and thickness of liquid in the container or glass.

20. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Thickened Liquids Thickeners come in individual premeasured packets containing 6.5 g or in large multidose canisters. Generally, a thin liquid such as water or juice can be thickened using the following formulas: One packet of thickener/8 ounces liquid = syrup/nectar consistency Two packets of thickener/8 ounces liquid = honey consistency Three packets of thickener/8 ounces liquid = pudding consistency Add thickener to the liquid and immediately stir for 10 seconds. It takes 3-5 minutes for the liquid to reach the desired consistency.

21. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Thickened Liquids If a liquid is thicker than water or juice (e.g., soup or milk shake), adjust the amount of thickener added. It is important that the nurse assistant is capable of thickening liquids before performing the task independently. The most common mistake made with thickener is that it is not allowed to sit for the required 3-5 minutes before serving. It is also important to read directions on the package of the brand of thickener your facility uses. One of the most common ways a resident can be helped is through using thickened liquids.

22. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Feeding with Tubes Types of feedings Intravenous (IV) Gastrostomy (G) Nasogastric (NG) Responsibilities Procedure performed by licensed personnel Nurse assistant’s responsibility is to observe and report anything unusual. General nursing care Know where the tube is and its location in the body. Make certain tubes are not coiled under the resident. Check that resident is comfortable.

23. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Feeding with Tubes CAUTION: Elevating HOB 30° places the resident at increased risk of pressure ulcer development. Maintain the turning schedule per the care plan. Figure 2.6 - 30° Angle Keep HOB elevated 30° to prevent aspiration with NG or G tube feedings. (See Figure 2.6.)

24. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Feeding with Tubes Provide oral hygiene every 2 hours if patient is NPO. Report: Change in vital signs Elevated temperature Redness and swelling of the site of the tube Difficulty breathing Restlessness/anxiety Regurgitation (return of solids or fluids to the mouth from the stomach) of tube feeding into mouth

25. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Feeding with Tubes Observe and report: Pain at site Swelling or drainage at site Change in skin color at site Any change in respiration or chest pain Any rash Restlessness or anxiety Leaks in tube Kinks in tube Tube tangled Tube under resident Wet dressing at insertion site Blood in tubing

26. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Feeding with Tubes Gastrostomy (G) feedings – a tube surgically inserted into the resident’s stomach to instill liquid nourishment – Observe and report: Drainage or skin breakdown around tube Resident complains of nausea or fullness. Diarrhea or constipation Check if tube is anchored and report to charge nurse. Do not retape tube. Anything unusual about feeding Any kinks in tube Nasogastric (NG) tube feeding – A tube is passed through the resident’s nose and down the esophagus to the stomach to provide liquid nourishment. The resident is usually in a sitting position when the feeding is administered and in a position that aids digestion at the completion of the procedure. (See Figure 2.7.)

27. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Figure 2.7 – Nasogastric Tube

28. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Feeding with Tubes Observe and report: Nausea or complaint of fullness Choking Diarrhea or constipation Anything unusual about feeding Any kinks in tube Always give good mouth care to the resident with nasogastric/gastric tubes to help prevent any infection of the mouth and to aid in resident’s comfort.

29. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring The nurse performs nasogastric tube feeding for long- term nutrition. Note the following: Keep head of bed elevated approximately 30° to prevent regurgitation. Feeding with Tubes Resident needs frequent mouth care (every 2 hours). Keep nostrils clean. Inform nurse if the tape that is holding the tube in place becomes loose.

30. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Choking (See HO 3.) Cause in elderly Elderly are more prone to choking due to weakened muscles of the mouth and throat. Food, saliva, or medication can cause a blockage of the respiratory tract. Improperly fitting dentures or no dentures can make chewing difficult. Large pieces of food can easily slip down the throat. After a stroke, gag and swallowing reflexes may be diminished. When feeding a resident, take the following precautions to avoid choking: Cut food in small pieces. Do not rush resident. Allow him/her time to chew the food thoroughly and swallow it before giving more. Make sure dentures are in place and fit well.

31. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Choking If choking occurs: Act quickly. Start procedure to clear airway in conscious resident. Observe if there is obstruction. Ask resident if he/she is choking. Ask resident if he/she can speak. If the resident can speak or is coughing, do not intervene. Coughing is the most effective way to dislodge material from the airway. Stay close and encourage coughing. Starting the procedure to clear airway at this point may cause him/her to breathe in harder and force the object further down in the respiratory tract.

32. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Choking If at any point the resident develops difficulty breathing or is unable to cough or speak, start the procedure to clear airway. The procedure is usually sufficient to “pop” the obstructing object out of the resident’s airway. The maneuver forces air out of the lungs pushing the object out with it.

33. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Conclusion Mealtime is very important for the long-term care resident. For many, it is the highlight of the day, something that he or she looks forward to. Make it an enjoyable and pleasant experience. See that the tray is served in as attractive and sanitary a manner as possible. Keep in mind all of the things that need to be done for each resident before and after each meal.

34. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Steps of Procedure for Feeding the Resident Who Is Helpless 1.Wash your hands. 2.Provide before-meal care; offer resident bedpan or urinal; wash resident’s hands and face; position resident in full upright and sitting position. 3.Wash your hands. 4.Check food tray before serving to make sure it is the correct one. 5.Place food tray in front of resident on table or overbed table. 6.Allow resident to give thanks if he/she wishes. 7.Explain that you will help resident eat. 8.Spread napkin, towel, or clothing protector to protect clothes and linen.

35. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Steps of Procedure for Feeding the Resident Who Is Helpless 9.Sit down in chair facing resident. 10.Prepare food: cut up meat, butter bread, pour tea or coffee, etc. 11.Season food as resident wishes within dietary guidelines. 12.Ask resident in what order he/she wants food served; name each mouthful of food as you offer it. 13.Let resident help self is possible. 14.Use assistive devices per care plan. 15.Use spoon to give small bites (fill spoon half full) and feed slowly, allowing time for chewing, swallowing, and breathing. 16.Alternate liquids and solids.

36. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Steps of Procedure for Feeding the Resident Who Is Helpless 17.Wipe resident’s mouth as needed. 18.Warn resident when giving something hot. 19.Take tray away as soon as resident is finished. 20.Note foods and amounts eaten. 21.Provide after-meal care: wash resident’s hands and face; remove napkin. Reposition and lower HOB as per care plan. Make sure resident is comfortable; place call light within reach. 22.Wash your hands. 23.Record observations and report anything unusual to the charge nurse.

37. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Steps of Procedure for Serving a Food Tray 1.Wash your hands. 2.Check the food tray with the dietary card and the resident’s ID band to make sure it is correct. 3.Serve one tray at a time to avoid contamination. 4.Serve trays promptly so food temperature is maintained. 5.Carry the tray at waist level, not on the shoulders next to hair. 6.See that the appearance of the tray is orderly and contains utensils, napkin, and condiments, as allowed. 7.If the resident requires assistive feeding device(s), make sure they are on the tray.

38. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Steps of Procedure for Serving a Food Tray 8.Assist in food preparation as needed. Open milk cartons, butter the bread, cut meat, etc. 9.Encourage the resident to do as much as possible. 10.Remove the tray when resident has finished eating. Note the foods and amounts eaten. 11.Wash your hands.

39. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Steps of Procedure for Clearing Airway Obstruction in Resident Who Is Conscious 1.Call for help as you approach the resident. Instruct a coworker to call the charge nurse. Notify the 911 or EMS system according to facility policy. 2.Tell the resident you are going to help. 3.Position yourself behind the resident if the resident is standing or sitting. 4.Slide your arms under resident’s arms, wrapping both of your arms around resident’s waist. 5.Make a fist and place thumb of this fist against the midline of the resident’s abdomen, just above the navel. NOTE: Keep your fist below the resident’s rib cage and avoid the area just below the sternum.

40. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Steps of Procedure for Clearing Airway Obstruction in Resident Who Is Conscious 6.Grasp your fist with free hand. 7.Apply pressure as an inward and upward thrust. 8.Deliver inward, upward thrusts until the item is dislodged or resident becomes unconscious. 9.Continue until obstruction is cleared or medical support arrives.

41. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Steps of Procedure for Clearing Airway Obstruction in Resident Who Is Unconscious 1.Call for help as you approach the resident. Instruct a coworker to call the charge nurse. Notify the 911 or EMS system according to facility policy. 2.Check for unresponsiveness and no breathing. 3.Turn resident on back. 4.Put on gloves. 5.Open airway by tipping head back and lifting jaw. This is called the head tilt/chin lift maneuver and it is designed to open the airway. Look, listen, and feel for breathing. a.With resident’s face up, open mouth and grasp tongue and jaw between thumb and index finger. Draw tongue forward. Do not let mouth close.

42. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Steps of Procedure for Clearing Airway Obstruction in Resident Who Is Unconscious CAUTION: Do not force object further into the throat. 6.Insert mouthpiece. Attempt breathing (one breath every 5 seconds). Attempt to give two breaths. 7.If unsuccessful, reposition patient and reopen airway. b.Insert index finger of other hand down along side of cheek toward the base of the tongue. c.Sweep around mouth. Bend finger into a hook and attempt to bring foreign object up into mouth if you can see it. d.If possible, remove object from mouth. 8.Insert mouthpiece. Attempt breathing.

43. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Steps of Procedure for Clearing Airway Obstruction in Resident Who Is Unconscious NOTE: Fingers should point toward the resident’s chest. a.Straddle resident at the level of the hips. b.Position the heel of one hand on the resident’s abdomen at the midline, between the navel and rib cage. c.Keep hands below resident’s rib cage, avoiding the area just below the sternum. d.Place free hand over the positioned hand and put your shoulders directly over the resident’s abdomen. e.Press hands inward and toward resident’s diaphragm, as if you are trying to push toward the resident’s upper back. 9.If efforts to ventilate are unsuccessful, provide abdominal thrust five times.

44. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Steps of Procedure for Clearing Airway Obstruction in Resident Who Is Unconscious a.With resident’s face up, open mouth and grasp tongue and jaw between thumb and index finger. Draw tongue forward. Do not let mouth close. b.Insert index finger of other hand down along side of cheek toward the base of the tongue. 11.Reopen airway. Insert mouthpiece. Attempt breathing. c.Sweep around mouth. Bend finger into a hook and attempt to bring foreign object up into mouth if you can see it. d.If possible, remove object from mouth. CAUTION: Do not force object further into the throat. 12.Repeat procedures until airway is cleared and/or life support is available. 10.Remove mouthpiece. Check for foreign object.

45. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Steps of Procedure for Clearing Airway Obstruction in Resident Who Is Unconscious 13.If breathing, remove mouthpiece. Place the resident in the recovery position, on left side. 14.Remove gloves and discard in appropriate container. Wash hands.

46. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Steps of Procedure for Thickening Liquids 1.Wash your hands. 2.Identify yourself and greet the resident. 3.Explain what you are going to do. 4.Check the care plan or meal card to determine appropriate thickness required for liquids (syrup/nectar, honey, or pudding consistency). 5.Gather the necessary equipment: thickener, measuring device if the thickener is not in premeasured packets, spoon, and liquids to be thickened. 6.Measure both the liquid and the thickener according to the measurements provided for the brand of thickener being used. 7.Using a glass or container that allows extra room for stirring, stir the liquid briskly and then slowly add the measured thickening agent.

47. Nurse Assistant In a Long-Term Care Facility Unit IV: Food Service Lesson Plan 2: Serving, Feeding, and Monitoring Steps of Procedure for Thickening Liquids 8.Stir mixture briskly for at least 10 seconds or until thickener is dissolved. 9.Before serving, allow 3-5 minutes for liquid to reach the appropriate consistency. 10.To avoid lumping when thickening hot liquids or coffee, always create a whirlpool in the liquid before adding the thickener. 11.Add additional amounts of liquid or thickener to achieve desired consistency as indicated in the care plan. 12.When using small amounts of thickener for syrup/nectar consistencies, restir after 3 minutes to prevent settling.