Aspiration

Aspiration Nursing Care Plans Diagnosis and Interventions

Aspiration NCLEX Review Care Plans

Nursing Study Guide on Aspiration

Aspiration happens when the swallowed food, liquid, or foreign object goes into the airway and respiratory tract instead of the digestive tract. Aspiration can also occur when stomach contents regurgitate from the stomach into the throat and enter the airway.

Aspiration is different from choking in terms of airway blockage. In aspiration, the airway is only partially blocked; however, there is a full blockage of airway when a person chokes.

Dysphagia or difficulty of swallowing is the most common cause of aspiration. Dysphagia can be a temporary condition, or a symptom of a serious medical condition such as neurological disorders (e.g., cerebral palsy, Parkinson’s disease, etc.) or cancer (e.g. mouth cancer, esophageal cancer, etc.).

Signs and Symptoms of Aspiration

1. General Signs and Symptoms

  • feeling that there is something stuck in the throat
  • difficulty of swallowing
  • pain triggered by trying to swallow
  • coughing while or after eating/ drinking
  • wet-sounding or gurgling voice when eating or talking
  • feeling congested while or after eating/drinking
  • increased salivation
  • heartburn or chest discomfort
  • shortness of breath
  • fatigue
  • frequent pneumonia
  • trouble chewing
  • sudden fever within 30 minutes of eating

2. Aspiration Symptoms in Infants and Children

Aside from the signs and symptoms above, the following may be observed in pediatric patients suffering from aspiration:

  • weak sucking
  • sudden apnea or tachypnea while or after feeding
  • facial grimace
  • red face and/or watery eyes while or after feeding
  • breathing noises like wheezing after feeding
  • frequent respiratory infections

In some cases of aspiration, there may be no immediate signs and symptoms noted. The aspiration may not be realized until complications like pneumonia occurs.

Causes and Risk Factors of Aspiration

Aspiration can happen due to reduced tongue control. This results to failure of triggering the swallowing reflex. An abnormal swallow reflex due to a neurological disorder may also lead to aspiration.

Throat surgeries and response to certain medications can also result to dysphagia-related aspiration. Dysphagia becomes more likely to occur as a person grows older, thus aspiration is common in elderly patients.

A number of medical conditions may put a person at risk for aspiration. These include:

  • acid reflux
  • seizures
  • coma
  • cancer in any part of the upper digestive system, such as the mouth, throat, and esophagus
  • head and neck injuries
  • stroke
  • eating and drinking too fast
  • dental issues
  • mouth sores
  • cancer treatment of the neck or throat (radiotherapy or chemotherapy)
  • feeding tubes
  • breathing machines
  • cognitive disorders (e.g., dementia)
  • neurological disorders (e.g., Parkinson’s disease)
  • frequent vomiting
  • muscular disorders (e.g., spinal muscular atrophy)
  • impaired mental status or consciousness
  • lung disease
  • delayed growth in children
  • cleft palate in children
  • Down syndrome

Complications of Aspiration

If left untreated, aspiration may lead to the following serious medical conditions:

1. Aspiration pneumonia. Aspirating bacteria from swallowed food, liquid, object, vomit, or saliva may lead to an infection in the lungs.

2. Pulmonary edema and respiratory distress. Liquid that enters the lungs may lead to the congestion of air sacs, which can cause difficulty of breathing and respiratory distress.

3. Malnutrition, dehydration, and weight loss in children

Diagnosis of Aspiration

  1. Physical exam – to check for the signs and symptoms of dysphagia and aspiration
  2. Imaging – the following imaging tests may be ordered by the physician as needed:
  3. X-rays and bronchoscopy – to check the extent of aspiration in the respiratory tract
  4. Modified barium swallow (MBS) – to visualize the throat and esophagus as the patient swallows food and liquids mixed with barium
  5. Fiber-optic endoscopic evaluation of swallowing (FEES) – an endoscopy of the throat and esophagus by inserting a thin tube into a numbed nose
  6. Pharyngeal manometry – the insertion of a catheter into a numbed nose towards the throat to measure the pressure in the upper digestive tract as the patient swallows

Treatment for Aspiration

1. Management of the underlying medical condition. Aspiration can be treated by means of managing its medical cause. For instance, giving medications to stop or control acid reflux can resolve dysphagia and prevent aspiration.

2. Referral to a speech-language pathologist (SLP) or speech and language therapy (SALT) team. An SLP or SALT team can help determine swallowing problems and create a treatment plan to improve swallowing, manage dysphagia, and prevent aspiration.

3. Surgery. In severe or recurrent cases of aspiration, a surgical intervention may be required. The surgery involves creating a flap closure to prevent food, liquid, or other foreign bodies to enter the airways.

4. Repositioning. An unconscious patient can be turned on one side to prevent aspiration.

Prevention of Aspiration

The healthcare provider can advise the following actions to prevent aspiration:

1. Eat and drink slowly and chew food thoroughly.

2. Ensure correct posture when eating or drinking. It is ideal to sit upright while eating or drinking, or at least lift oneself using a wedge pillow. Do not eat or drink while lying flat. Stand or sit upright at least 30 minutes after eating or drinking.

3. Feed the baby on an angled position and not when he/she is lying down.

4. Avoid distractions while eating or drinking, such as watching TV or talking on the phone.

5. Cut food in smaller pieces.

6. Avoid eating dry food, or increase its moisture by means of adding sauce.

7. Maintain proper dental hygiene and have regular dental check-ups.

8. Stop smoking.

9. In patients with feeding tubes, check the placement of the tube first before starting the feed. Ensure to take time in administering the feed.

Nursing Care Plans for Aspiration

Nursing Care Plan 1

Nursing Diagnosis: Risk for Aspiration related to decreased ability to swallow secondary to multiple sclerosis                                        

Desired Outcome: The patient will be able to avoid any aspiration or developing aspiration pneumonia.

InterventionsRationale
Assess airway patency.Maintaining an open and clear airway is vital to retain airway clearance and reduce the risk for aspiration. 
Assess the patient’s ability to cough out secretions.Multiple sclerosis features neuromuscular weakness and may limit the patient’s ability to clear the airway.
Refer the patient to SLP or speech and language therapy (SALT) team.MS can diminish or reduce the patient’s ability to swallow. The patient can aspirate, which can cause respiratory problems. The SALT team are specialists in assessing the ability to swallow and recommending diet, thickness of liquids to drink, and techniques to improve the ability to swallow.
Encourage a Fowler’s position when the patient is eating/ feeding the patient.To prevent food or liquid to be aspirated into the airways and lungs.
Follow the SLP or SALT team’s advice on the appropriate diet of the patient as well as the proper thickness of the drinks.To prevent food or liquid to be aspirated into the airways and lungs.

Nursing Care Plan 2

Nursing Diagnosis: Risk for Imbalanced Nutrition: Less Than Body Requirements related to dysphagia and aspiration

Desired Outcome: The patient will either regain normal swallowing capacity or be able to improve nutrition by tube feeding. He/she will also obtain understanding of food options to support nutrition supplementation.

InterventionsRationales
Document the patient’s weight. Weight the patient daily in the mornings.Weight loss can be measured accurately with a patient’s actual weight rather than by estimate. The patient’s weight is also an ideal tool in the assessment of a person’s nutritional requirements.
Start the patient on a food diary and assess caloric intake.A record of what the patient eats can help direct treatment.
Assess what the patient can safely eat and drink.Patients with dysphagia and aspiration may be able to tolerate thickened liquids and pureed food. Assessing what the patient can tolerate will help support nutrition and arrange food choices to become available.
Promote a semi or full Fowler’s position during feeding. An upright position or elevating the head to at least 30 degrees aids in swallowing and reduces the risk for aspiration.
Refer the patient to the dietitian and/or nutritionist.A dietitian can help the medical team assess the patient’s nutritional status and recommend food options that will supplement the patient’s nutritional gaps.
Refer to speech and language therapy.Speech and language therapists assess the patient’s ability to swallow safely and can recommend food and food texture that is safe for the patient to eat/drink. 
Weigh the patient regularly and document readings.The patient’s weight will help in the evaluation of the patient’s progress.
Explain nutrition and the patient’s personal nutritional needs. Understanding the importance of maintaining proper nutrition will encourage the patient to become proactive in adhering to the treatment plan.
Discuss the nutritional recommendation of the team, nutritionist, and dietitian to the patient. Follow the recommended type of diet and thickness of fluids.An explanation of the new food choices and the recommended type of diet and fluids to support the patient’s nutritional requirements will promote compliance to treatment. 

Nursing Care Plan 3

Ineffective Airway Clearance related to dysphagia and aspiration as evidenced by difficulty of swallowing and shortness of breath

Desired Outcome: The patient will be able to establish improved airway patency and airway clearance as evidenced by respiratory rates between 12 to 20 breaths per minutes, oxygen saturation within the target range (as set by the physician), and verbalize ease of breathing.

InterventionRationale
Assess the patient’s vital signs and characteristics of respirations at least every 4 hours. Assess for signs of hypoxia.To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment.  Early signs of hypoxia include irritability, confusion, headache, restlessness, and pallor.
Place the patient on a side-lying position.To promote drainage of saliva from the mouth through gravity, while preventing aspiration, especially in children.
Ask the patient to cough.To facilitate removal of food, liquid or foreign object from the airways.
Suction as needed.To help clear liquid that the patient has aspirated.
Elevate the head of the bed and assist the patient to assume semi-Fowler’s position.Head elevation and proper positioning help improve the expansion of the lungs, enabling the patient to breathe more effectively.

Other possible nursing diagnoses:

  • Risk for Dehydration
  • Risk for Failure to Thrive (in infants and children)
  • Anxiety
  • Fatigue

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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