You know difficulty in
swallowing or impaired swallowing is very disturbing. You can't do your work
properly, you can't speak properly, and especially, you can't eat properly.
There are different reasons why people experience difficulty of swallowing and
most of them are mild cases and non-life-threatening. However, a patient having
like this kind of discomfort is eager to have a nursing care. Like Mr. Hans who
recently undergone radiotherapy and experiencing esophagitis. Since he is a
radio announcer, having impaired swallowing is very disturbing for him. Below
is a sample of nursing care plan of impaired swallowing of Mr. Hans.
Assessment:
Subjective: *slurred speech (we are unable to understand Mr. Hans clearly).
Objective:
- Nasal-sounding voice.
- Drooling (unintentional flowing of saliva outside the mouth).
- Irritated
- Uncomfortable
- Pain scale 8/10 when swallowing
- Nausea (wanting to vomit)
Diagnosis:
Impaired swallowing
related to esophagitis secondary to radiotherapy.
Planning:
After 4 hours of nursing
intervention, the patient will report improved ability to swallow, as evidenced
by describing the cause of impaired swallowing and describe procedures for
treatment and its rationale.
Interventions:
- Assess Mr. Hans, the
patient, for causative factors. Other nurses must know that the patient has
impaired swallowing so you need to notify all the staff.
- Help Mr. Hans about proper way of eating while having impaired swallowing.
Assist the patient with his moving bolus of food from the area to back part of
mouth. Tell Mr. Hans to place food in the back mouth where his swallowing can
be ensured. You can use a syringe with short piece of tubing attached or a
glossectomy spoon, a spoon that can transport bolus of food to the oropharynx
to help Mr. Hans swallow his food. Prepare soft, moist food of a
consistency that can be manipulated by the tongue against the pharynx, such as
gelatin, custard, or mashed potatoes. You can use artificial saliva papain tablets;
these can decrease the patient's thick secretions, just tell Mr. Hans, the
patient, to dissolve in mouth for 10 minutes before eating. Apply
meat tenderizer made from papaya enzyme applied to oral cavity 10 minutes
before eating. Unless contraindicated to him, increase fluid intake to 8
glasses of liquid. Check medications for potential side effects of dry
mouth or decreased salivation.
- Since Mr. Hans have difficulty in communication, establish a visual method to
communicate to him with staff at bedside.
- Plan meals when Mr. Hans is well rested and ensure that there is reliable
suction equipment on hand during meals. Discontinue feeding if the patient is
tired. If indicated to him, use modified supraglottic swallow technique.
Teach Mr. Hans to hold his breath before and during swallowing in order to
close his vocal folds and prevent food to enter in the airway. Position
the head of the bed in semi- or high Fowler's position. Make Mr. Hans' neck
flexed forward slightly and his chin tilted down. Remember that when you tilted
down a patients' chin, it closes airway and preventing food to enter the lungs.
- Instruct the patient to be able to eat effectively, take bolus of food and
hold it in his strongest side of mouth for 1-2 seconds, then immediately flex
his neck with chin tucked against chest. Without breathing, instruct Mr. Hans
to swallow as many times as needed. When mouth is emptied, raise chin and clear
throat. Tell the patient to avoid overloading the mouth because this decreases
his swallowing effectiveness. Note the consistency of food that is
problematic and select consistencies that are easier to swallow like mashed
bananas, potatoes, gelatin, and gravy which are highly viscous. Select thick
liquids such as milkshakes, slushes, nectar, and cream soups. If bolus of food
is pocketed in the affected side, teach Mr. Hans, the patient, how to use
tongue to transfer food or apply external finger pressure to cheek to help
remove the trapped bolus.
- Drooling is present to Mr. Hans so use a quick-stretch stimulation just before
and toward the end of each meal. Digitally apply short, rapid, downward strokes
to the edge of his bottom lip, mostly on the affected side. Use a cold
washcloth over finger for added stimulation.
- Minimize extraneous stimuli while eating such as television or radio and no
verbal stimuli unless directed at task. Have Mr. Hans to concentrate on
his task of swallowing to reduce the possibility of aspiration. If you need
nursing care plan for aspiration you can check it in risk for aspiration.
Before beginning of Mr. Hans feeding, assess that the he is adequately alert
and responsive and can control the mouth, which he has gag reflex and he can
swallow saliva. Always have suction equipment available and functioning
properly. Position the patient sitting upright 60 to 90 degrees in his chair or
dangle his feet at side of the bed if possible. Mr. Hans should assume
position 10 to 15 minutes before eating and maintain it for 10 to 15 minutes
after finishing eating. Flex the patient's head forward on the midline about 45
degrees to keep esophagus patent.
- If above strategies are unsuccessful to Mr. Hans, consultation with a
physician may be necessary for alternative feeding techniques such as tube
feedings or parenteral nutrition.
Evaluation:
After 4 hours of nursing intervention, the
patient reported improved ability to swallow, as evidenced by describing the
cause of impaired swallowing and described procedures for treatment and its
rationale.
Related nursing care plan is Imbalanced Nutrition: Less than Body Requirements.
For
more samples of nursing care plan you are free to check it out in our NCP LIST page.
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