Running head: ASPIRATION CARE PLAN 1

Aspiration Care Plan

Delaware Technical Community College

NUR 320

Christine E. Davis

April 20, 2018

ASPIRATION CARE PLAN 2

Care planning is an effective tool to assist in care coordination and managing patients

with special health care needs. Care plans provide direction for individualized care of the client.

A care plan flows from each patient’s unique list of diagnoses and should be organized by the

individual’s specific needs (RN Central, 2018).

I chose aspiration for my care plan. There is a high risk for aspiration when the patient

has a stroke, has a tube feeding, they are critically ill, getting older or has dysphagia. Aspiration

is when fluid is not properly swallowed and enters the lungs. The signs of aspiration is coughing,

having wet speech after drinking or eating, tearing of the eyes, having difficulty catching their

breath, looking like they are choking. Aspiration pneumonia is when contents back up in the

esophagus and enters the lungs, if the patient is in poor health the chances of the fluid becoming

bacterial infected is high. The treatment for pneumonia aspiration is antibiotic and respiratory

supportive care.

Aspiration can be avoided if you know the signs and symptoms, and know what patients

are at risk. The preventive measures are keeping the head of bed at 30 to 45 degrees; it will

provide the proper route for fluids and food. Be sure to place them on a correct diet, do they need

thicken fluids? This helps fluids not to enter the airway and prevent choking. How is the food to

be prepared? Pureed foods prevent saliva and don’t need to be chewed. Both of these will allow

the patient to swallow correctly, not aspirate and provide basic needs. “ Evidence indicates that a

sustained supine position (0º head-of-bed elevation) increases gastroesophageal reflux and the

probability of aspiration; for example, in a study that used a radioactive-labeled formula,

endobronchial counts were higher when patients were lying flat in bed (0º) than when they were

semirecumbent (45º elevation). Thus, elevating the head of the bed to an angle of 30º to 45º,

unless contraindicated, is recommended for patients at high risk for aspiration pneumonia (eg, a
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patient receiving mechanical ventilation and/or anyone who has a feeding tube in place)”

(Methany, 2016).

Knowing the patient also helps provide safety to the patient, as care managers, nurses,

doctors and family members, as we provide care we will be able to notice changes in the person.

If we notice excessive drooling, choking and/or coughing while eating or drinking, and a change

in their diet habits we will be able to assess that person and order a swallow test. The

videofluorographic swallowing study (VFSS)* is the gold standard for evaluating the mechanism

of swallowing. For this study, the patient is seated comfortably and given foods mixed with

barium to make them radiopaque. The patient eats and drinks these foods while radiographic

images are observed on a video monitor and recorded on videotape. Ideally, the VFSS is

performed jointly by a physician (typically a radiologist or physiatrist) and a speech-language

pathologist (Palmer et al, 2018).

Aspiration is avoidable, and knowing what signs to look for will provide proper care to

that person. Aspiration can occur at any age and at any time. Everyone on the care team of a

patient needs to keep this in mind. It is especially important if the patient is a tube feed. As a

nurse you have to be sure that everyone knows to pause the feeding and wait before you lay the

patient flat before you do care. Unfortunately I have heard horror stories of this happening. I

have also caught many patients with thin liquids in their rooms; families feel good about giving

their loved ones something to drink without realizing what can occur with the patient. As a nurse

I am always making sure that the team is all on the same page. I feel education is very important

for aspiration not to happen. Non-compliance is very big with aspiration, not many like pureed

foods or thickened liquids, and I always keep that in mind. Nutrition for that patient can decline

without realizing it. Knowing the signs and symptoms of aspiration can save the person from
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getting pneumonia aspiration, knowing this can save the patient from being very ill, staying in

the hospital longer and relieve them of the burdens of being on an antibiotic.

References

Metheny, N. (February 1, 2016). Prevention of Aspiration in Adults. American

Association of Critical-Care Nursing. CriticalCareNurse. Vol 36, No. 1.

Retrieved from https://www.aacn.org/clinical-resources/practice-

alerts/prevention-of-aspiration

PALMER, J., DRENNAN, J., and BABA, M. (2018). Evaluation and Treatment of Swallowing

Impairments. American Family Physician. Retrieved from

https://www.aafp.org/afp/2000/0415/p2453.html

RN Central. (2018). What Is A Nursing Care Plan and Why One is Needed. Retrieved from

http://www.rncentral.com/nursing-library/careplans/