Feeding a client with facial weakness
After a right-hemisphere stroke, this client has weakness of the left side of the face. On the affected side, sensation and muscle control are reduced, so food tends to collect in the cheek without the client noticing. The nurse therefore places food on the unaffected (right) side of the mouth and checks the affected (left) cheek for pocketed food that could later be aspirated. Food goes to the strong side; the weak side is checked for pocketing.
Why pocketing is dangerous
Food held in the weak cheek can slip into the pharynx after the meal, when the client is no longer focused on swallowing or is lying down, and enter the airway. Because sensation is reduced, the client may not cough effectively, leading to silent aspiration and aspiration pneumonia, a major complication after stroke. Checking the cheek after each few bites and after the meal, and encouraging the client to sweep the cheek with the tongue, removes this risk. Mouth care after meals also clears residue.
| Action | Correct practice | Reason |
|---|
| Placing food | Unaffected side of the mouth | Better sensation and control |
| After bites and meals | Check the affected cheek | Detects pocketed food |
| Position | Upright at 90 degrees, and for 30 minutes after | Gravity aids swallowing and limits aspiration |
| Head during swallow | Chin tuck | Narrows the airway entrance and protects it |
| Diet | Soft foods and thickened liquids as ordered | Slower flow and easier bolus control |
Why the other actions are unsafe
Watch out! Tilting the head back opens the airway and speeds liquids toward it, increasing aspiration risk; the safe posture is a chin tuck. Placing food on the weak side to "exercise" the muscles is not how swallowing therapy works and leads to pocketing and poor bolus control. Raising the head of the bed to only 45 degrees is not enough for meals; the client should sit fully upright at 90 degrees, ideally in a chair, and remain upright for 30 minutes afterward.
Other feeding measures after stroke
The nurse follows the speech therapist's diet orders exactly, offers small bites and sips, allows time between swallows, keeps distractions low, and watches for coughing, a wet or gurgly voice, or drooling, which suggest aspiration and require stopping the meal and reporting. Right-hemisphere strokes can also cause left-sided neglect and impulsivity, so the nurse may need to cue the client to slow down and to attend to the left side of the tray and mouth.
Exam takeaway
Key point! With unilateral facial weakness: food on the unaffected side, check the affected cheek, sit upright at 90 degrees, and chin tuck. Never tilt the head back during swallowing.