一位患有重度失智症的病人需要餵食協助。護理師應採取哪項措施以確保餵食安全？
A client with advanced dementia requires assistance with eating. Which action should the nurse take to ensure safe feeding?
- AKeep the head of the bed at a 30-degree angle during feeding.餵食期間保持床頭處於30度角。
- BCheck the client's mouth for 'pocketing' of food between bites.✓ 正解檢查病人嘴巴是否有食物殘留。
- COffer large bites of food to speed up the feeding process.提供大量食物以加快餵食過程。
- DEncourage the client to use a straw for all liquids.鼓勵病人使用吸管飲用所有液體。
失智症病人常伴隨吞嚥障礙（Dysphagia），其特徵之一是忘記吞嚥或口腔感覺減退，導致食物積存在頰側（稱為 Pocketing）。這會大幅增加之後誤吸的風險。護理師必須在每一口餵食之間，檢查並確保病人已完全吞嚥。餵食應採取小口、緩慢的節奏。使用吸管（D）反而危險，因為吸管會讓液體快速衝擊咽喉，容易引發嗆咳。床頭抬高應至少 90 度（坐直）或至少 45-60 度，30 度（A）太低，不利於吞嚥機制與重力引導食物進入食道。
Clients with advanced dementia often have dysphagia and may forget to swallow or have reduced oral sensation, leading to pocketing of food in the buccal area, which substantially increases aspiration risk. The nurse must check the mouth between bites to ensure swallowing is complete and feed slowly with small bites. Straws (D) deliver liquid rapidly to the pharynx and can cause coughing or aspiration. The head of bed should be at 90 degrees (or at least 45-60 degrees) for feeding; 30 degrees (A) is too low for safe swallowing.
美國 NCLEX 非常看重吞嚥評估（Swallow evaluation）與語言治療師（SLP）的介入，護理師需嚴格執行 SLP 的質地建議（如：濃稠水、軟食）。台灣臨床上，護理師與家屬常是餵食主力，對「Pocketing」的觀察是預防吸入性肺炎的關鍵指標。