Symptom: Eating, Difficulty

Initial Grading Reminder

Grade 1 (Mild): Symptomatic, able to eat regular diet
Grade 2 (Moderate): Symptomatic and altered eating/swallowing
Grade 3 (Severe): Severely altered eating/swallowing; tube feeding or TPN or hospitalization indicated
Grade 4 (Life-threatening): Life-threatening consequences; urgent intervention indicated

Assessment and Grading

Characterize the symptom (onset, pace)

Ask the patient:

Have you had any difficulty eating in the past? Is this a new or worsening symptom? When did it start or get worse? Has it developed gradually or suddenly?

Grade the symptom

Ask the patient:

How severe is your eating problem? Is eating painful? Do you have sores in your mouth? Are you able to swallow? Are you able to drink?

Patient Query Regarding Other Symptoms/Red Flags

Ask the patient:

Are you feeling faint? Have you passed out?

Patient Factors to Consider That Affect the Approach to Intervention

Consider the following in individualizing the intervention: Is the patient a good or poor historian? Any language barriers or cognitive deficits? Is the patient reliable (able to carry out treatment recommendations)? Does this patient have alcohol/substance abuse issues? Does the patient have transportation? Is there sufficient caregiver support?

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    Suggested Intervention

    Patients with severe or worse (or worsening) eating difficulties should be seen.

    If the patient is feeling faint because of the eating difficulties, they should be seen immediately.

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    Nursing Assessment of Potential Causes

    Mucositis & Xerostomia - Nursing Assessment

    • Look
    • Listen
    • Recognize
    • Look
    • Listen
    • Recognize
    • Look
    • Listen
    • Recognize
    • Does the patient appear uncomfortable?
    • Does the patient appear unwell?
    • Difficulty talking?
    • Licking lips to moisten often?
    • Weight loss?
    • Does the patient appear dehydrated?
    • Does the patient have thrush?
    • Does the patient report?
      • Mouth pain (tongue, gums, buccal mucosa)
      • Mouth sores
      • Difficulty eating
      • Waking during the sleep to sip water
      • Recent dental-related issues
      • Need for dental work (e.g., root canal, tooth extraction)
    • Have symptoms worsened?
    • A history of mouth sores
    • Does patient smoke?
    • Concomitant medications associated with causing dry mouth?
    • Reports of dry mouth often accompany mucositis
    • Other reports of dry membranes (e.g., eyes, nasal passages, vagina)

    Differential Diagnosis

    What do you suspect is the cause of the eating difficulty?