# Situation: A 68-year-old man is on the medical ward on day 4 after an ischemic stroke in the right cerebral hemisphere. He did not receive reperfusion therapy. He has left-sided weakness, is alert, and has hypertension. He passed a bedside swallow screen yesterday. Speech therapy has ordered soft foods and thickened liquids. He has weakness of the left side of the face. Which action should the nurse take when helping him eat?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630317  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 68-year-old man is on the medical ward on day 4 after an ischemic stroke in the right cerebral hemisphere. He did not receive reperfusion therapy. He has left-sided weakness, is alert, and has hypertension. He passed a bedside swallow screen yesterday.

Speech therapy has ordered soft foods and thickened liquids. He has weakness of the left side of the face. Which action should the nurse take when helping him eat?

## 보기

1. Place food on his right side and check his left cheek **✔ 정답**
2. Tilt his head back slightly as he swallows each bite
3. Place the food on his left side to work the weak muscles
4. Raise the head of the bed to 45 degrees during meals

**정답: 1**

## 해설

After a stroke, food is placed on the unaffected side of the mouth, where sensation and control are better, and the affected cheek is checked for pocketed food that could be aspirated. The client sits upright at 90 degrees for meals and for 30 minutes after, and swallows with a chin tuck rather than with the head tilted back.

## 심화 해설

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.

## 임상 시나리오

Safe Feeding After StrokeLeft facial weakness and dysphagia precautions
Place food on the unaffected (right) side of the mouth, where sensation and control are better, and check the left cheek for pocketed food.

Sit him upright at 90 degrees for meals and for 30 minutes afterward. Use a chin tuck when swallowing, with soft foods and thickened liquids as ordered.

Offer small bites, allow time, and cue him to attend to the left side, since right-hemisphere stroke can cause neglect and impulsivity.

CautionCoughing, a wet voice, or drooling during meals suggests aspiration. Stop feeding and report. Never tilt the head back to help swallowing.

## 핵심 개념

- **Dysphagia** — Difficulty swallowing that increases the risk of aspiration.
- **Pocketing** — Collection of food in the weak cheek after stroke, which can later be aspirated.
- **Chin tuck** — Lowering the chin toward the chest during swallowing to help protect the airway.
- **Silent aspiration** — Entry of food or fluid into the airway without coughing or other visible signs.
- **Left-sided neglect** — Inattention to the left side of the body or space, common after right-hemisphere stroke.

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