Assessment

Diagnosis

Background Knowledge

Planning

Intervention

Rationale

Evaluation

Subjective: Nahihirapan akong lumunok as verbalized by the patient

Objective: Trouble swallowing food and large pill Coughing after each attempt to swallow food and prescribed medications Took a long time to chew and swallow food and continued to pocket food in cheeks even after attempting to swallow.

Impaired swallowing related to neurological impairment and muscle weakness as manifested by difficulty of swallowing food and prescribed medications.

Obstruction Interruption in the cerebral blood flow Lack of oxygen delivery to the cells Brain cell death Loss of function Hemiparesis Difficulty of swallowing

After 1 hour of nursing intervention the patient will demonstrate effective swallowing techniques and he will be able to swallow without much difficulty.

Independent: Assess for signs and symptoms of impaired swallowing (e.g. communication of difficulty swallowing, stasis of food in oral cavity, coughing or choking when eating or drinking, abnormal results of swallow study). Provide diet modification as indicated: small frequent feeding with snacks, mechanical soft or blenderized feeding, soft/ liquid diet. Ascertain understanding of individual nutritional needs. These are the factors that can affect ingestion and/or digestion of nutrients

After 1 hour of nursing intervention the patient had demonstrated effective swallowing techniques and he had able to swallow without much difficulty.

Soft diet is easily chewed and digested. It is often ordered for clients who have difficulty chewing and swallowing.

To determine what information to provide the client/SO.

 Needs assistance to chew food and took about 5 minutes to chew and swallow each small bite of food provided for him.

Place client in an upright position during and after feeding, as appropriate. Provide oral care before meals and snacks.

Uses gravity to facilitate swallowing and reduces risk for aspiration.

Oral care stimulates sensory awareness and salivation, which facilitates swallowing. To facilitate elevation of the larynx and posterior movement of the tongue allowing food to go into esophagus rather than the trachea. Increases salivation, improving bolus formation and swallowing effort.

Instruct the client to tilt head and neck slightly forward when attempting to swallow.

Season food with herbs, spices and lemon juices according to clients preference, within dietary restrictions. Serve foods/fluids that are hot or cold instead of room temperature.

Extreme temperatures stimulate the sensory receptors and swallowing reflex.

 Feed slowly, allowing 30 to 45 minutes for meal.

Feeling rushed can increase stress and level of frustration, may increase risk for aspiration, and may result in clients terminating meal early.

Collaborative: Consult speech pathologist or therapist about methods for dealing with impaired swallowing; reinforce recommended exercises and techniques. Muscle strengthening exercises may improve swallowing if done regularly.

Care of a client who had an Acute Ischemic stroke (Cardio Vascular Accident)

SCENARIO Mr. Lewis a 68 years old male was admitted at Fatima University Medical Center with a chief complaint of difficulty of swallowing. 3 days prior to admission the patient had experienced left-side paresis. He demonstrated left sided facial droop, left arm and leg weakness and slurred speech, with confusion and decrease in level of alertness. He was diagnosed to have an Acute Ischemic stroke (CVA).