吞嚥訓練及餵食（中英文版）

如果要下載英文版的長期照護居家技巧，目前提供較完整的就是桃園縣長照中心所提供的，除了英文版外還有印尼文及越南文，是個值得推薦去看的地方，您可至桃園縣長照中心下載英文衛教單，因為是全英文的衛教單，因此在這補充中文說明方便對照！

THE CHAPTER ON SWALLOW TRAINING & FEEDING　吞嚥訓練及餵食篇

SWALLOW TRAINING & FEEDING 吞嚥訓練及餵食
To enjoy delicacies through the mouth is the most happiness thing in life. If your family member needs to replenish nutrients through a nasogastric tube temporary because of illness, he/she needs your help to train him/her the swallowing skill before he/she can eat through the mouth.享受由口進食的美味，是人生至大的快樂，當您的家人因病暫時以鼻胃管補充養份時，在他可以由口吃東西前，他需要您訓練他的吞嚥能力喔！

WHEN TO TRAIN HIM/HER TO SWALLOW FOOD? 何時可訓練他吞東西
If he/she starts to feel irritate while talking, let him/her swallow some water from soaked cotton wool. You can start the training if there is no coughing. For patient who is weak, unconscious or still asleep, don not rush to do the feed on training. For patient who has upper or lower respiratory tract infected, profuse sputum or is infected with aspiration pneumonia, etc, it is necessary to wait for illness to get better before performing the feed on training under agreement from the doctor.
如果他開始對語言刺激有反應，並以棉籤沾水讓他吞，無咳嗽發生，即可以開始訓練。但對體力虛弱、意識不清或睡覺未醒的病患，別急著做進食訓練。病患上、下呼吸道感染，痰很多時或吸入性肺炎等，需待病症改善，醫囑同意下始給予吞東西訓練

SUPPLIES YOU NEED TO PREPARE 您需要準備的用物
●Towel (for wrapping around the body).毛巾(圍在身上)
●Formula. It is more suitable to use jelly, vegetarian gelatin, pudding, bean curd at the beginning stage of swallow training. After succeeding, it is allowed to choose general soft or liquid formula.食物，吞嚥訓練初宜採用果凍、愛玉、布丁、豆花等，成功後可採用一般軟質或液體食物
●Container for formula and small spoon.裝食物容器及小湯匙
●To maintain the feeding environment quiet and comfortable.維持進餐環境的安靜、舒適

PROCEDURES 步驟
1.Help him/her to sit up till 60~90o, place pillow behind the head, place towel under the chin and maintain a comfortable feeding position.協助坐起至60至90度，以枕頭放頭後，毛巾置於臉頰下，維持舒適的進食姿勢
2.Allow patient to look at the formula to increase his/her appetite and enhance the secretion of digestive fluid.讓其親眼看見食物，以增加病人食慾，促進消化液之分泌
3.Command repeatedly to take in a small mouthful of formula and let him/her swallow each mouthful in two sequences.重覆以口令動作以一小口食物餵食，並請他吞嚥兩次進行
4.Command:口令
open your mouth, try the taste, lift the formula up to the palate with your tongue, contract you chin and swallow it. You can meanwhile assist the patient with your hands.(This procedure can be omitted if the patient has no swallowing problem)打開你的嘴巴，嚐一嚐，用你的舌頭將食物舉至上顎，縮下巴吞下，其間可用手協助病人。（吞嚥無問題的病人可以省去此步驟）
5.Feeding has to be done slowly, to feed in a moderate amount of formula to the patient`s mouth every time. For brain apoplectic patient, the formula has to be placed at the healthy side of the mouth. 餵食時要緩慢，每次送入病人口中食物份量應適中，如腦中風的病人應將食物放入口中健全側邊
6.The formula has to be placed accurately within the mouth, and feed the patient again when he/she has actually chewed and swallowed it.食物應準確放入於口內，需確定病人已咀嚼吞入後才可再餵
7.After eating, please cleanse the mouth and maintain its wetness.食後請清潔口腔並保持潮濕

NOTE　注意事項
1.Stop feeding if the patient coughs and let him/her rest for at least half an hour. If this happens several times, postpone the feeding for some days and try again.當病人發生咳嗽時，請停止餵食，讓病人至少休息半小時後再試，若屢次發生則可能病人需延後一些天再試
2.After feeding, adopt a sit-up position and rest for half an hour, and then lay back as to stop the backflow of formula.餵食後需採坐姿休息半小時，再臥床，以防食物逆流
3.During the training session, it is still necessary to sustain the nasogastric tube or other tube so as to replenish water and nutrients.訓練期間，仍應有鼻胃管留置或其他方式，以補充不足的水份及營養
4.After feeding soft formula for several days, carry out liquid formula feeding then.軟質食物進行一段時日，才可進行液體食物餵食
5.When chocking occurs, help the patient eject the formula immediately: Use finger to it dig out, pat the back, grab the patient`s lower xiphoid from the back and compress upward to encourage vomiting, or use a sputum suction tube to help drawing it out.若發生哽噎、嗆到情形，應立即助其將食物排出，以手挖出食物、拍背、由病人背後抱住病人於劍突下方，向上壓迫，促其嘔吐，或使用抽痰管助其排出