Assessment of oropharyngeal dysphagia
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Action
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Description
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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
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Action
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Description
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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
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Action
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Description
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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
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Action
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Description
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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. |