Nursing Care of the Dysphagic Patient

• Dysphagia is the difficulty of swallowing foods or liquids, ranging from mild difficulty to severe. 
• The main objective when caring for the dysphagic patient is promoting safe swallowing and ensuring the patient has food and fluids that are the appropriate texture and thickness for their diet. 
• It is important interventions and dietary restrictions are followed to achieve positive outcomes for the patient and ensure proper nutrition and optimal health. 

Caring for the Dysphagic Patient

If you are a nurse working in long-term care, it is important for you to be aware of the factors that may make the elderly more vulnerable to dysphagia. It is vital to keep in mind the challenges of caring for dysphagic patients and to utilize simple techniques to improve outcomes for these patients.  

The main objective when caring for the dysphagic patient is promoting safe swallowing and ensuring the patient has food and fluids that are the appropriate texture and thickness for their diet.

Dietitians and Speech Language Pathologists help in the diagnosis and diet management of the patient with dysphagia, and it is important to follow their guidelines for each patient struggling with dysphagia.  

Why is Dysphagia?

Dysphagia is the difficulty of swallowing foods or liquids, ranging from mild difficulty to severe. 

What Causes Dysphagia?

Dysphagia can occur from changes to the esophagus due to aging or from conditions such as strokes, head injuries, multiple sclerosis, or dementia.  

What Are the Outcomes of Poorly Managed Dysphagia?

• Aspiration Pneumonia: Infection of the lungs when food or liquid is breathed into the lungs instead of being swallowed. 
• Malnutrition: Lack of proper nutrition caused by not having enough to eat or not eating enough of the right nutrients. 
• Dehydration: Dangerous loss of body fluid caused by illness, sweating, or inadequate liquid intake. 

How Can Nurses Assist in Management of Dysphagia?

Providing adequate rest periods prior to mealtime: Fatigue can further add to swallowing impairment so providing the patient with rest periods prior to eating will assist in being able to properly eat as they will be more alert.  

Eliminating distractions: Turning the television and radio off will help the patient focus on eating and promote swallowing.  

Providing oral care prior to eating: Research has shown evidence of oral care prior to meals aiding in appetite and feeding. It will help clear any debris in the mouth that may get in the way of eating and swallowing. 

Ensure the patient is sitting upright at ninety degrees: This will aid in choking and aspiration prevention. 

Stay near patient during mealtimes: Nursing homes and other long term care facilities usually require a nurse be present in the dining areas during the duration of the entire mealtime. This is important in case there is an emergency with a dysphagic patient or other health emergency with other patients; this will allow the nurse to assist the patient quickly.  

Observe for signs of aspiration and pneumonia: Listen to lung sounds after meals and note any new crackles or wheezes. Note the patient’s temperature and notify the physician as needed of any new concerns or changes in health status.  

Keeping suction equipment at the beside of dysphagic patients: Secretions can rapidly accumulate in the pharynx and upper trachea which increases aspiration risk. Keeping suction equipment at the bedside will aid in the faster clearing of these secretions and prevent the patient from aspirating.  

Educate family on the importance of following a patient’s diet: Dysphagic patients are usually on specialized diets to aid them in swallowing and getting the nutrients they need. If a family doesn’t understand the importance of diet restrictions, they may give them something they should not have; this increases their aspiration and choking risk.  

Barriers to Caring for the Dysphagic Patient

• Poor Familiarity with dysphagia and management of the condition.  
• Lack of knowledge regarding speech language pathologist terminology. 
• Disagreement with care management plan. 

What Are the Outcomes of Poorly Managed Dysphagia?

• Aspiration Pneumonia: Infection of the lungs when food or liquid is breathed into the lungs instead of being swallowed. 
• Malnutrition: Lack of proper nutrition caused by not having enough to eat or not eating enough of the right nutrients. 
• Dehydration: Dangerous loss of body fluid caused by illness, sweating, or inadequate liquid intake. 

How to Overcome These Barriers

• Nursing staff inclusion: Speech language pathologists should include the nurses in the decision-making process when recommendations are made for the patient struggling with dysphagia. If the nursing staff has concerns or questions regarding the recommendations, they should address these concerns prior to initiating the care plan. 

• Additional staff training: Dietitians and Speech Language Pathologists should ensure they are using clear and direct communication that nursing care staff can understand. It may also help to have visual aids available.

• Continuing nurse education: Nurses can enroll in online courses or in person conferences that discuss elderly care and care of the patient with dysphagia to get a better understanding of the condition to aid them in their job.  

The Bottom Line

In conclusion, dysphagia is a chronic condition that cannot be cured but there are several techniques and interventions that aid in management of the condition. It is important these interventions and dietary restrictions are followed to achieve positive outcomes for the patient and ensure proper nutrition and optimal health.  

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