Protocol of nursing care in hospitalized dysphagic patients

Dias, Suelem Frian Couto; Queluci, Gisella de Carvalho; Mendonça, Amanda Ribeiro; Souza, Vinicius Rodrigues de

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Original Article • CoDAS 32 (3) • 2020 • https://doi.org/10.1590/2317-1782/20202019060 copy

Protocol of nursing care in hospitalized dysphagic patients

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose:

To investigate nursing care for patients hospitalized with oropharyngeal dysphagia.

Method:

This is a descriptive study of a qualitative approach, developed during the year 2017, in a Public hospital in Rio de Janeiro that offers a nursing residency program. The sample consisted of 17 nursing residents who work in the care of dysphagic patients. Data collection was realized by applying the problem-based learning methodology and data were analyzed according to the content analysis technique.

Results:

The data analysis allowed for the identification of the main aspects of nursing care in the patient hospitalized with oropharyngeal dysphagia and the elaboration of a nursing care protocol for the patient, based on a discussion of thematic categories.

Conclusion:

This study allowed for the identification of the relevant nursing care for the patient hospitalized with oropharyngeal dysphagia, which could provide assistance for nurses, thereby improving the quality of care and safety of the service provided for hospitalized patients.

Keywords
Speech; Language and Hearing Science; Nursing; Deglutition Disorders; Problem-Based Learning; Teaching

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[1] Correspondence address: Suelem Frian Couto Dias, Escola de Enfermagem Aurora de Afonso Costa - Universidade Federal Fluminense Rua Dr. Celestino, 74, Niterói (RJ), Brasil. CEP: 24020-091. E-mail: suelemfrian@gmail.com

Assessment of oropharyngeal dysphagia
Action	Description
Anamnesis and physical examination	Obtain information such as: age, physical condition, medical history, neurological diagnosis, state of awareness, respiratory condition, eating habits, presence of xerostomia/sialorrhea, duration of the meal and vocal or speech disorders.
Assessment of acceptance of diet and medication	Investigate difficulties with swallowing food and medications.
Assessment of nutrition/hydration status	Analyze the amount of food and liquids ingested/day and the need for help with eating and/or drinking.
Observation of aspiration signs and symptoms	Observe coughing/choking, shortness of breath during feeding, fever etc.
Therapeutic planning for the patient with oropharyngeal dysphagia
Action	Description
Monitoring of the patient with oropharyngeal dysphagia	Observe and record the patient's swallowing process, due to the ease of continuous monitoring.
Reevaluation of the ability/inability to swallow, according to clinical evolution	It has the purpose of generating adequate monitoring, analyzing the occurrence of complications or improvements.
Preparation for discharge	Instruct the patient/caregiver/family about measures to adapt to dysphagia.
Adaptation measures for oropharyngeal dysphagia
Action	Description
Postural adjustment of the patient	Maintain a safe position: If the patient is seated, keep them in an upright position and, if they are restricted to the bed, keep the headboard at a 45 ° Fowler position, in order to avoid aspiration of food.
Assist the use of food thickener, oral hygiene.	Observe the use of the thickener in all prescribed consistencies, maintain strict mouth hygiene, privileging the hydration of the mucous membranes.
Care for the rate and speed of food supply.	Guide the placement of small amounts of food in the mouth and only introduce food when you are sure that the previous mouthful has been swallowed.
Indication of alternative feeding route	Indicate the alternative route for feeding after careful clinical evaluation, along with complementary exams. In situations where the dysphagia is total and/or permanent, the indication of a nasogastric tube or percutaneous gastrostomy tube may be necessary.
Nurse/patient/team communication
Action	Description
Communication to the team about the identification of patients with dysphagia and its evolution	Encourage/facilitate multidisciplinary interaction, emphasizing the quality of care for dysphagic patients.
Guide the patient and his caregivers about measures to adapt to dysphagia; train patients and their caregivers on safe feeding and swallowing techniques	Promote integration between nurse/patient, enabling the family to provide adequate care to the dysphagic patient.