Nursing Care Plan (NCP) for Aspiration
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Outline
Lesson Objectives for Aspiration
- Definition and Recognition:
- Define aspiration as the inhalation of foreign material (such as food, liquids, or gastric contents) into the airways, leading to potential respiratory complications.
- Risk Factors:
- Identify common risk factors for aspiration, including impaired swallowing function, altered consciousness, neurological disorders, and conditions affecting upper airway protection.
- Clinical Manifestations:
- Recognize the clinical manifestations associated with aspiration, such as coughing, choking, wheezing, dyspnea, and potential complications like pneumonia.
- Prevention Strategies:
- Understand preventive measures to minimize the risk of aspiration, including proper positioning during meals, modified diets, and interventions to improve swallowing safety.
- Immediate Response:
- Learn the immediate nursing response to aspiration events, including assessment, initiation of emergency protocols, and collaboration with the healthcare team to ensure prompt and appropriate interventions.
Pathophysiology of Aspiration
- Inhalation of Foreign Material:
- Aspiration occurs when foreign material, such as food particles, liquids, or gastric contents, is inhaled into the airways instead of being directed into the digestive system.
- Bronchial Entry:
- Aspirated material can enter the bronchi and lungs, leading to potential obstruction, inflammation, and infection in the respiratory system.
- Airway Irritation:
- Aspirated substances can irritate the delicate tissues of the airways, triggering a local inflammatory response. This irritation can contribute to coughing and increased secretions.
Etiology of Aspiration
- Impaired Swallowing Function:
- Conditions that affect swallowing function, such as dysphagia due to neurological disorders, stroke, or structural abnormalities, increase the risk of aspiration.
- Altered Consciousness:
- Individuals with altered levels of consciousness, such as those under the influence of sedatives, anesthetics, or alcohol, are more prone to aspiration due to reduced protective reflexes.
- Neurological Disorders:
- Neurological conditions, including Parkinson’s disease, dementia, and conditions affecting the cranial nerves or brainstem, can impair the coordination of swallowing and increase the risk of aspiration.
- Gastroesophageal Reflux Disease (GERD):
- GERD can contribute to aspiration by allowing gastric contents to flow back into the esophagus, increasing the likelihood of aspiration into the respiratory tract.
- Upper Airway Obstruction:
- Conditions that cause upper airway obstruction, such as tumors, foreign bodies, or anatomical abnormalities, can lead to difficulty in managing secretions and increase the risk of aspiration.
Desired Outcome for Aspiration
- Respiratory Stability:
- Maintain respiratory stability with clear breath sounds, absence of wheezing or stridor, and adequate oxygenation to prevent complications such as pneumonia.
- Effective Airway Clearance:
- Promote effective airway clearance to minimize the risk of respiratory distress, coughing, or further aspiration events.
- Improved Swallowing Safety:
- Enhance swallowing safety through interventions and strategies to reduce the risk of aspiration, especially in individuals with impaired swallowing function.
- Prevention of Complications:
- Prevent complications associated with aspiration, such as pneumonia or chronic respiratory conditions, through vigilant monitoring and prompt intervention.
- Patient Education:
- Educate the patient and caregivers on strategies to reduce the risk of aspiration, recognize early signs, and seek prompt medical attention when needed.
Nursing Care Plan (NCP) for Aspiration
Subjective Data:
- Shortness of breath
- Difficulty breathing
- Chest pain
Objective Data:
- Coughing
- Low oxygen saturation
- Tachypnea/dyspnea
- Blue lips/fingers
- Lung sounds (crackles and/or diminished
- Frothy sputum
Nursing Assessment for Aspiration
- Swallowing Assessment:
- Conduct a thorough swallowing assessment, including observation of the patient during meals, assessing the coordination of swallowing, and identifying any signs of difficulty or discomfort.
- Neurological Assessment:
- Perform a neurological assessment to identify conditions or impairments affecting consciousness, cranial nerves, and coordination, which may contribute to aspiration risk.
- Respiratory Assessment:
- Monitor respiratory status, including breath sounds, respiratory rate, and oxygen saturation, to detect signs of respiratory distress or compromise.
- Gastrointestinal Assessment:
- Assess for conditions such as GERD that may increase the risk of gastric contents entering the esophagus, contributing to aspiration risk.
- Cough Assessment:
- Evaluate the presence and characteristics of cough, as persistent or ineffective coughing may indicate a potential aspiration event.
- Nutritional Status:
- Assess the patient’s nutritional status and ability to tolerate oral intake, considering factors such as weight loss, dehydration, or signs of malnutrition.
- Speech and Language Assessment:
- Collaborate with speech and language therapists to assess speech and language function, as impairments in these areas may contribute to swallowing difficulties.
- Medication Review:
- Review the patient’s medication list to identify drugs that may affect consciousness, coordination, or increase the risk of aspiration.
Implementation for Aspiration
- Positioning:
- Position the patient upright during and after meals to facilitate gravity-assisted swallowing and reduce the risk of aspiration. Consider the use of specialized seating or positioning devices as needed.
- Modified Diet:
- Implement a modified diet based on the individual’s swallowing capabilities, including texture modifications (e.g., pureed, soft) and fluid consistency adjustments. Collaborate with a dietitian for personalized dietary plans.
- Swallowing Rehabilitation:
- Initiate swallowing rehabilitation exercises, working closely with speech and language therapists to improve swallowing coordination and strength. Encourage adherence to recommended exercises.
- Respiratory Support:
- Provide respiratory support as needed, including oxygen therapy and nebulization, to maintain adequate oxygenation and address respiratory symptoms. Monitor respiratory status closely.
- Education and Caregiver Training:
- Educate the patient and caregivers on strategies to reduce the risk of aspiration, proper swallowing techniques, and the importance of adhering to dietary modifications. Provide training on recognizing signs of aspiration and when to seek medical attention.
Nursing Interventions and Rationales
| Nursing Intervention (ADPIE) | Rationale |
| Assess respiratory function -lung sounds, O2 Sats, skin color, chest symmetry | will assess baseline for patient and whether their respiratory function is getting better or worse with interventions |
| maintain patent airway- NPO, HOB>30 Degrees, oral hygiene, suction equipment in room, O2 in case | Keep the airway protected. Maintain proper ventilation/oxygenation |
| Perform a swallow screen test | should be performed with thin liquids at bedside (if not NPO status) checks patients swallowing ability. If fails, patient goes to NPO status, and notify physician
Note: swallow study is done in radiology if they fail the screening test |
| Acquire a chest x-ray | this will see if a patient has aspirated, whether they have acquired pneumonia or not |
| Lab testing/ABG/sputum-blood cultures | blood gas- monitors PaCO2/PCO2 & PaO2/PO2
CBC- Monitors WBC count Sputum/Blood Cultures-may be needed an able to make sure the patient is receiving the right antibiotic therapy if needed |
| Antibiotic therapy-
Clindamycin & Metronidazole |
may be prophylaxis, or because patient developed pneumonia. Clindamycin is most commonly used for aspiration pneumonia. Metronidazole can be used in conjunction with Clindamycin for further coverage |
Evaluation for Aspiration
- Airway Patency:
- Evaluate airway patency by assessing breath sounds, monitoring for signs of airway obstruction, and ensuring effective coughing and airway clearance.
- Swallowing Function:
- Assess improvements in swallowing function through regular swallowing assessments, observing the patient’s ability to manage oral intake and identifying any ongoing difficulties.
- Respiratory Status:
- Monitor respiratory status for improvements or stabilization, including the absence of respiratory distress, decreased coughing, and improved oxygen saturation levels.
- Dietary Tolerance:
- Evaluate the patient’s tolerance of modified diets and adjustments, assessing weight stability, nutritional intake, and signs of dehydration or malnutrition.
- Patient and Caregiver Adherence:
- Assess patient and caregiver adherence to prescribed interventions, dietary modifications, and rehabilitation exercises. Identify any challenges or barriers to compliance and provide additional support or education as needed.
References
https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/dysphagia-what-happens-during-a-bedside-swallow-exam
https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/aspiration-pneumonia
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Transcript
Hey everyone. Today, we are going to be putting together a nursing care plan for aspiration. So, let’s get started. So we’re going to go over the pathophysiology. So aspiration occurs when something enters into the lungs that is not air. If this ventilation progresses to infection, aspiration pneumonia can develop. Some nursing considerations. We want to make sure we’re doing a full respiratory assessment, maintaining a patent airway, performing a swallow screen test, doing some labs, ABGs, and administering medications. Desired outcomes. We want to make sure that the patient has a patent airway, oxygenation maintenance, and prevention of further complications, such as pneumonia.
So we’re going to go ahead and get started on the care plan. We’re going to have some subjective data and we’re going to have some objective data. So what are we going to see with the patients that are aspirating? They may have some shortness of breath and they may have some chest pain. Some objective data: coughing, maybe blue lips if they’re aspirating or some frothy sputum. Some other things: they may have difficulty breathing, some low oxygen saturation, adventitious lung sounds. You might hear some crackles or some diminished sounds.
So with our interventions, we’re going to assess their respiratory function. We’re going to look for their skin color. Is it blue? Is it pink? Are they oxygenating enough? You’re going to be looking for chest symmetry. So you want to make sure we’re assessing the entirety of the respiratory function. See what their baseline is. See when we do some interventions, if it’s improving or not. Another intervention we’re going to be doing is to make sure we’re maintaining their airway. So maintaining the patient’s airway. So we’re going to keep them NPO. Make sure they’re doing oral hygiene. Make sure we have suction equipment in the room. Always, always make sure we have suction equipment because you never know if you’re going to need it to help try to clear their airway if the patient’s not able to clear it themself. Also, any O2, in case you may need O2 for your patient. Another intervention we’re going to be doing, we’re going to perform a swallow screen test. Now the swallow screen test is done at the bedside. So this is going to be performed with thin liquids at the bedside. We’re going to check the patient’s swallowing ability. If the patient fails this test, the patient will go to NPO status and you’ll notify the physician. I do want to note a swallow study is done in radiology if they fail the screening test. Another intervention we’re going to be doing is acquiring a chest X-ray to see if the patient may have aspirated and whether they have acquired any sort of pneumonia. Another intervention we’re going to be doing are labs, ABGs, or sputum culture. So the blood gases, we’re going to monitor the PaCO2 and PaO2 levels. For the labs, we’re going to be looking for CBC, which is going to monitor their white blood cell counts. And for the sputum, we’re going to be checking to see if there’s any sort of pneumonias, the type of bacteria that we’re going to be treating, and making sure that the patient’s going to be on the right antibiotic therapy. So then we’re also going to be given the patient medication. So antibiotic therapy, such as clindamycin and metronidazole. So it may be prophylactic measures, or if the patient had developed pneumonia, clindamycin is commonly used for aspiration pneumonia, and metronidazole can be used in conjunction with the clindamycin for any further coverage that the patient needs.
Alright, so now we’re going to look at some of the key points for the care plan. So aspiration occurs when something enters into the lungs, that’s not air likely caused by someone losing their gag reflex, or the inability to clear secretions on their own. Some subjective and objective data. They’ll have some shortness of breath, chest pain, difficulty breathing, some coughing, low oxygen saturation, blue lips, or fingers, frothy sputum. You want to do a full respiratory assessment and perform a swallow screen test bedside. We’re going to give meds. We’re going to do labs. Make sure they have a patent airway. So we’ll be giving those meds, doing the labs, checking the white blood cells and ABGs. X-ray just to see if they have pneumonia. And once again, maintaining that airway is very, very important.
Alright, you guys did awesome. We love you guys out. Be your best self today, and as always happy nursing.
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