Research demonstrates that a program of diagnosis and treatment ofĭysphagia in acute stroke management decreases the incidence ofĦ. Shortened recovery time, and reduced overall health costs (Scott, 1998). Nutritional support, results in decreased length of hospital stay, Of CVA clients to a speech pathologist, along with early initiation of Speech pathologists specialize in impaired swallowing. Speech pathologist within 72 hours after admission if client has had a If client has impaired swallowing, refer to a speech pathologist forīedside evaluation as soon as possible. These are all signs of swallowing impairment (Baker, 1993 Lugger, 1994).ĥ. Move food to the back of the pharynx, slow or scanning speech). Tongue and lips, decreased mastication of food, decreased ability to Secretions, double swallowing or major delay in swallowing, wateringĮyes, nasal discharge, wet or gurgly voice, decreased ability to move Observe for signs associated with swallowing problems (e.g.,Ĭoughing, choking, spitting of food, drooling, difficulty handling oral Have an intact gag reflex (Baker, 1993 Lugger, 1994).Ĥ. Have a greatly increased chance of developing aspiration pneumonia Cardiovascular accident (CVA)Ĭlients with prolonged pharyngeal transit times (prolonged swallowing) The reflex is triggered to the esophageal entry (pharyngeal transit Normally the time taken for the bolus to move from the point at which Not rely on presence of gag reflex to determine when to feed. Of posterior pharyngeal wall (lingual surface) with a tongue blade. Ask client to cough test for a gag reflex on both sides Assess ability to swallow by positioning examiner's thumb and indexįinger on client's laryngeal protuberance. There are multiple causes of swallowing impairment, some of which are treatable (Schechter, 1998).ģ. If new onset of swallowing impairment, ensure that client receives a diagnostic workup. Swallow adequately (Poertner, Coleman, 1998).Ģ.
Cognitive deficits can result in aspiration even if able to Oral feeding and use enteral feeding for nourishment (McHale et al,ġ998). If one of these factors is missing, it may be advisable to withhold To follow instructions, hold head erect, and able to move tongue in NIC Interventions (Nursing Interventions Classification)ġ.
IMPAIRED SKIN INTEGRITY FREE
Remains free from aspiration (e.g., lungs clear, temperature within normal range).Demonstrates effective swallowing without choking or coughing.Swallowing Status: Esophageal Phase, Oral Phase, Pharyngeal Phase.NOC Outcomes (Nursing Outcomes Classification) oral cavity or oropharynx abnormalities.nasal or nasopharyngeal cavity defects.internal or external traumas tracheal, laryngeal, esophageal defects.mechanical obstruction (e.g., edema, tracheotomy tube, or tumor).Perceptual impairment, or facial paralysis) neuromuscular impairment (e.g., decreased or absent gag reflex,ĭecreased strength or excursion of muscles involved in mastication,.abnormality in esophageal phase by swallow study.hyperextension of head, arching during or after meals.observed evidence of difficulty in swallowing (e.g., stasis of food in oral cavity, coughing, or choking).
regurgitation of gastric contents or set burps.unexplained irritability surrounding mealtime.
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