Dysphagia (difficulty swallowing) is a serious condition that affects a patient’s ability to safely transfer food and liquids from the mouth to the stomach. This nursing diagnosis focuses on identifying and managing swallowing difficulties, preventing complications, and ensuring adequate nutrition and hydration.
Causes (Related to)
Dysphagia can affect patients in various ways, with several factors contributing to its severity and progression:
- Neurological conditions
- Stroke
- Multiple sclerosis
- Parkinson’s disease
- Cerebral palsy
- Alzheimer’s disease
- Structural abnormalities such as:
- Tumors
- Strictures
- Zenker’s diverticulum
- Radiation-induced changes
- Head and neck surgery
- Medical conditions including:
- GERD
- Muscular dystrophy
- Myasthenia gravis
- Scleroderma
- Post-intubation trauma
Signs and Symptoms (As evidenced by)
Dysphagia presents with distinctive signs and symptoms that nurses must recognize for proper diagnosis and treatment.
Subjective: (Patient reports)
- Difficulty initiating swallowing
- Coughing or choking while eating
- Food sticking sensation
- Pain while swallowing
- Extended time needed for meals
- Fear of eating
- Weight loss
- Regurgitation
Objective: (Nurse assesses)
- Weak cough reflex
- Delayed swallowing reflex
- Drooling
- Gurgling voice
- Poor tongue control
- Pocketing of food in cheeks
- Weight loss
- Decreased oxygen saturation during meals
- Signs of aspiration
Expected Outcomes
The following outcomes indicate successful management of dysphagia:
- The patient will maintain adequate nutrition and hydration
- The patient will demonstrate safe swallowing techniques
- The patient will avoid aspiration
- Patient will maintain or improve weight status
- Patient will report increased comfort while eating
- The patient will demonstrate proper positioning during meals
- The patient will verbalize understanding of dietary modifications
Nursing Assessment
Swallowing Evaluation
- Observe meal consumption
- Assess swallowing phases
- Monitor for signs of aspiration
- Document choking episodes
- Evaluate oral motor function
Nutritional Status
- Monitor weight trends
- Track food and fluid intake
- Assess for signs of malnutrition
- Document meal completion
- Evaluate the need for alternative feeding
Respiratory Status
- Monitor oxygen saturation during meals
- Assess breathing patterns while eating
- Document coughing episodes
- Check lung sounds
- Evaluate respiratory effort
Mental Status
- Assess the level of consciousness
- Evaluate cognitive function
- Monitor anxiety levels
- Check attention span
- Document cooperation level
Physical Assessment
- Evaluate muscle strength
- Check posture control
- Assess head/neck range of motion
- Document facial symmetry
- Monitor hand-eye coordination
Nursing Care Plans
Nursing Care Plan 1: Impaired Swallowing
Nursing Diagnosis Statement:
Impaired Swallowing related to neuromuscular impairment as evidenced by coughing and choking during meals, prolonged chewing time, and food retention in oral cavity.
Related Factors:
- Neurological impairment
- Decreased muscle strength
- Impaired cognition
- Structural abnormalities
- Poor positioning
Nursing Interventions and Rationales:
- Perform bedside swallow evaluation
Rationale: Identifies specific swallowing difficulties and guides interventions - Position the patient upright at 90 degrees
Rationale: Promotes optimal swallowing mechanics and reduces aspiration risk - Implement dietary modifications
Rationale: Ensures safe food consistency and reduces choking risk
Desired Outcomes:
- The patient will demonstrate improved swallowing ability.
- The patient will maintain airway clearance during meals
- The patient will complete meals without aspiration
Nursing Care Plan 2: Risk for Aspiration
Nursing Diagnosis Statement:
Risk for Aspiration related to impaired swallowing mechanism as evidenced by delayed swallowing reflex and weak cough.
Related Factors:
- Impaired swallowing
- Decreased level of consciousness
- Tube feedings
- Poor oral hygiene
- Gastric reflux
Nursing Interventions and Rationales:
- Monitor oxygen saturation during meals
Rationale: Early detection of aspiration risk - Teach proper swallowing techniques
Rationale: Reduces risk of aspiration through proper mechanics - Maintain proper positioning
Rationale: Minimizes risk of aspiration during and after meals
Desired Outcomes:
- The patient will remain free from aspiration
- The patient will demonstrate proper swallowing techniques
- The patient will maintain adequate oxygenation during meals
Nursing Care Plan 3: Imbalanced Nutrition: Less Than Body Requirements
Nursing Diagnosis Statement:
Imbalanced Nutrition: Less Than Body Requirements related to difficulty swallowing as evidenced by weight loss and inadequate food intake.
Related Factors:
- Dysphagia
- Poor appetite
- Fatigue during meals
- Fear of choking
- Extended meal times
Nursing Interventions and Rationales:
- Monitor daily caloric intake
Rationale: Ensures nutritional needs are met - Provide nutrient-dense foods
Rationale: Maximizes nutritional intake with smaller portions - Consider alternative feeding methods
Rationale: Ensures adequate nutrition when oral intake is insufficient
Desired Outcomes:
- The patient will maintain or improve weight status
- The patient will meet daily nutritional requirements
- The patient will demonstrate improved oral intake
Nursing Care Plan 4: Anxiety
Nursing Diagnosis Statement:
Anxiety related to fear of choking and social isolation during meals as evidenced by expressed concerns and reluctance to eat.
Related Factors:
- Fear of choking
- Social embarrassment
- Previous negative experiences
- Loss of independence
- Altered body image
Nursing Interventions and Rationales:
- Provide emotional support
Rationale: Reduces anxiety and builds confidence - Teach coping strategies
Rationale: Helps manage fear during meals - Encourage social interaction
Rationale: Reduces isolation and improves quality of life
Desired Outcomes:
- The patient will report decreased anxiety during meals
- The patient will demonstrate improved confidence while eating
- The patient will participate in social dining when appropriate
Nursing Care Plan 5: Self-Care Deficit: Feeding
Nursing Diagnosis Statement:
Self-Care Deficit: Feeding related to neuromuscular impairment as evidenced by the inability to safely prepare and consume meals independently.
Related Factors:
- Physical limitations
- Cognitive impairment
- Fatigue
- Visual deficits
- Poor coordination
Nursing Interventions and Rationales:
- Assess feeding ability
Rationale: Determines the level of assistance needed - Provide adaptive equipment
Rationale: Promotes independence in feeding - Teach compensatory techniques
Rationale: Enhances self-feeding abilities
Desired Outcomes:
- The patient will demonstrate increased independence in feeding
- The patient will use adaptive equipment properly
- The patient will maintain adequate nutrition with modified independence
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Irwin, G. M., & Leatherman, J. (2024). Dysphagia. Primary Care: Clinics in Office Practice. https://doi.org/10.1016/j.pop.2024.09.016
- McCarty EB, Chao TN. Dysphagia and Swallowing Disorders. Med Clin North Am. 2021 Sep;105(5):939-954. doi: 10.1016/j.mcna.2021.05.013. PMID: 34391544.
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
- Wilkinson JM, Codipilly DC, Wilfahrt RP. Dysphagia: Evaluation and Collaborative Management. Am Fam Physician. 2021 Jan 15;103(2):97-106. PMID: 33448766.
