Question

The nurse is caring for a client with myasthenia gravis who might have swallowing impairment. Which diet selection would require intervention by the nurse? A. Boiled potatoes B. Soft scrambled eggs C. Green peas D. Macaroni and cheese

Short answer

Short Answer: Green peas

Step-by-step solution

Identify the key symptom of myasthenia gravis in the exercise:'

In this exercise, the important symptom is swallowing impairment, which is referred to as dysphagia.

Examine each food option and determine the potential difficulties in swallowing:'

Consider the following characteristics of each food item: A. Boiled potatoes - Are generally soft and can be easily mashed. They might not be challenging to swallow. B. Soft scrambled eggs - Are already soft and easy to swallow without requiring much muscle effort. C. Green peas - Are small, round, and potentially slippery when being swallowed. They may require more control over swallowing muscles, which could be challenging for someone with dysphagia. D. Macaroni and cheese - Are soft and have a thick consistency, which is generally easier to swallow.

Determine which food option would require intervention by the nurse based on the analysis in Step 2:

From the analysis, it's evident that the food option that would likely pose the most difficulty for a person with myasthenia gravis and require intervention by the nurse is: C. Green peas - Their size and shape could make it challenging to swallow for someone with impaired swallowing abilities due to myasthenia gravis. So the correct answer is C. Green peas.

Key concepts

Dysphagia Management

Individuals with myasthenia gravis often face a complex challenge known as dysphagia, which refers to difficulty in swallowing. Dysphagia management is crucial to maintain nutritional status and to prevent complications such as choking and aspiration pneumonia. To manage dysphagia, it's important to tailor meals to the individual's needs. Soft, well-cooked foods that are easy to chew and swallow are generally recommended. Foods may also be pureed or blended to a smooth consistency. It's advisable to avoid small, hard foods like nuts or seeds, as well as sticky or overly dry foods, which can be difficult to swallow.Meals should be taken in a relaxed setting, with plenty of time for eating. The use of thicker liquids may be recommended as thinner fluids can be harder to control and may increase the risk of aspiration. The key to dysphagia management is assessing each food item for its ease of swallowing and then modifying the diet accordingly to ensure safety and adequate nutrition.

Swallowing Impairment

Swallowing impairment, or dysphagia, is a distressing condition in which the mechanics of swallowing are interrupted. This impairment can be particularly pronounced in individuals with myasthenia gravis due to weakened muscles in the mouth and throat.
Understanding the Swallowing Process
Swallowing is a complex process that involves the coordinated action of several muscles. The process is divided in three phases: the oral phase, where food is chewed and prepared for swallowing; the pharyngeal phase, involving the movement of the food bolus from the mouth to the throat; and the esophageal phase, where food is propelled to the stomach. Swallowing impairment in myasthenia gravis primarily affects the oral and pharyngeal phases of this process.Adapting Eating Techniques
Patient education on eating techniques is vital. Patients should be advised to take small bites, chew food thoroughly, and to eat slowly to facilitate easier swallowing. Sitting upright during and after meals can also help reduce the risk of aspiration. Occupational or speech therapists may work with individuals to strengthen the muscles involved in swallowing, and to introduce compensatory strategies to make eating safer and more enjoyable.

Nursing Care for Myasthenia Gravis

Effective nursing care for myasthenia gravis (MG) requires a comprehensive understanding of the condition and its impact on patients. Nurses play a pivotal role in the monitoring and supporting of individuals with MG, particularly in managing symptoms like dysphagia.
When caring for patients with MG, nurses must be vigilant for signs of fatigue, especially during meals, and provide rest periods as needed. Monitoring for choking incidents and aspiration is critical. Nurses should educate patients and caretakers on the appropriate dietary selections, which should consist of foods that are easy to chew and swallow such as soft scrambled eggs and mashed potatoes. Foods that are problematic, such as green peas as highlighted in the provided exercise, should be altered or avoided.Furthermore, nurses should work closely with nutritionists to ensure that a patient's diet is not only safe to swallow but also nutritious, accommodating the heightened energy expenditure due to increased effort during eating. Coordination with therapists skilled in dysphagia management can also be beneficial in creating comprehensive care plans. Regular assessments to evaluate the progression of swallowing difficulties and adjustments to care plans are essential to ensure the patient's safety and quality of life.