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FON exam 3
aspiration
| Question | Answer |
|---|---|
| aspiration | the entry of food, fluid, or foreign material into the trachea and lungs |
| what types of things can be aspirated | oropharyngeal secretions, food/drink/medications, gastric contents/vomit |
| what is the informal wording for aspiration | down the wrong pipe |
| dysphagia | difficulty swallowing, the inability to swallow |
| what can cause dysphagia | poor dental health - missing teeth, mouth pain cancer - due to treatment neurologic disease (CVA, Parkinson's, dementia, stroke) |
| dysphagia puts you at risk for | aspiration |
| what is your reflex when something other than air is inhaled/aspirated into the lungs via the trachea | cough! |
| when does aspiration happen | when protective reflexes are reduced or impaired |
| silent aspiration | don't show signs, in respiratory distress |
| aspiration is bad because can cause | infection, inflammation, impaired oxygenation/diffusion, |
| infection due to aspiration | aspiration pneumonia results in high mortality, morbidity, increases LOS and ICU admission |
| aspiration pneumonia occurs when | stuff gets into the trachea which is supposed to be sterile |
| infection due to aspiration causes irritation and leads to | inflammation |
| inflammation due to aspiration | aspiration pneumonitis |
| aspiration pneumonitis is | the inflammatory responses within lungs, trachea and bronchiole tree |
| oxygenation/diffusion can be impaired | capillaries and alveoli can be blocked which makes pt hypoxemic |
| what happens if alveoli get blocked | alveoli can fill with contents and O2/CO2 can't get through |
| what is the main goal when caring for patients at risk for aspiration | prevention! |
| prevention of aspiration | HOB elevated, identify pts early who may be at risk for aspiration through a general survey - LOC, speech, health Hx risk factors |
| elevated HOB | high fowlers - 60 to 90 degrees if pt will tolerate, in chairs for meals if possible |
| assessment | assess LOC - primary risk factor for aspiration is decreased LOC note any signs of aspiration |
| what sounds can be indicative of aspiration | coughing, choking, throat clearing, gurgling or "wet voice" during or after swallowing |
| interventions | elevate HOB during and 30 min after feeding inform HCP instantly if noted decrease in cough/gag reflexes or difficulty in swallowing supervised feeding foods w/ consistency that pt can swallow - thick it pills in soft foods - make sure can be crushed |
| interventions for tube fed pts | bolus feeding |
| how should you position pts with a decrease LOC | on their side!! |
| what should you never give to a comatose pt | oral fluids and avoid straws |
| what kind of consult to assess and recommend changes in diet | ST, SLP, RD consult |
| dysphagia/aspiration risk factors following stroke | age over 65, Hx pneumonia, severe dysarthria, more than 2 chronic diseases, brain injury |
| does having a stroke always mean dysphagia | no! |
| risk factors not specific to stroke | older adults! changes in airway protective mechanisms/swallowing processes underlying pulmonary disease musculoskeletal disorders immunosuppression - IS can't protect trachea when food touches |
| things that should get your attention | Hx, choking, immediate or delayed cough, drooling, altered voice quality, throat clearing, absent swallow, decreased O2 sats |
| what kind of pneumonia is more common | RUL because much more direct path |
| who is at risk | altered or declined mental status, Hx of dysphagia/aspiration/aspiration pneumonia, residual food in mouth after swallowing, neurologic disorders such as TBI/stroke/parkinsons/MS/dementia, trach, bad dental hygiene, etc |
| bedside swallow screen tools | tools are available for RN to assess pt swallowing ability at the bedside, used for pts determined at risk for aspiration |
| many tools available but are | facility dependent, so validity and reliability of these tools vary, no one specific tool is superior to others |
| use of interprofessional teams | consult SLP! |
| how is aspiration diagnosed/treated? | SLP/RD consult, CXR, swallowing studies, may need bronch or abx (C&S - collect junk and test it) |
| RD consult | if a pt only eats 1/4 of their meal, that's not good so RD create meals high in protein |
| gold standard testing | chest xray (CXR) |
| aspiration precautions | HOB elevated (at least 30 deg if can) NPO until cleared supervised feeding avoid straws thickened liquids monitoring oral care!! educating pts! - small bites, swallow twice, etc. |
Created by:
leh195