Materiały źródłowe

• #1 Evaluating Dysphagia | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0615/p3639.html

  Dysphagia is a problem that commonly affects patients cared for by family physicians in the office, as hospital inpatients and as nursing home residents. […] Complaints of dysphagia (difficult swallowing) are common, especially in aging persons. Approximately 7 to 10 percent of adults older than 50 years have dysphagia, although this number may be artificially low because many patients with this problem may never seek medical care. Up to 25 percent of hospitalized patients and 30 to 40 percent of patients in nursing homes experience swallowing problems. […] Elderly patients are at the highest risk of dysphagia and its subsequent complications, especially silent aspiration. […] In oropharyngeal dysphagia, symptoms arise from the dysfunctional transfer of a food bolus in the pharynx past the upper esophageal sphincter into the esophagus. Oropharyngeal dysphagia is most common in elderly patients and frequently presents as part of a broader complex of signs and symptoms that lead the physician to a correct primary diagnosis.

• #2 End of Life Care in Frailty: Dysphagia | British Geriatrics Society

  https://www.bgs.org.uk/resources/end-of-life-care-in-frailty-dysphagia

  Dysphagia refers to difficulty swallowing. It can be temporary, or it can be a permanent condition that may or may not deteriorate over time, depending on the aetiology. […] Signs that an individual is experiencing dysphagia may include: Reported difficulty swallowing certain foods/liquids. Coughing or choking when eating and drinking. Wet sounding voice post eating and drinking. Persistent drooling of saliva. Recurrent chest infections/aspiration pneumonia (just over half of patients with dysphagia suffer from aspiration). […] A large proportion of those with a progressive neurological disease will develop oropharyngeal dysphagia as the condition progresses. Half to three-quarters of nursing home residents have some difficulty swallowing. The presence of dysphagia and associated risk of aspiration are indicators that prognosis is limited and should trigger a discussion of treatment goals in this context.

• #3 Dysphagia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK559174/

  Clinicians should be aware of the psychological impacts of dysphagia on patients, including depression, anxiety, frustration, fear, vulnerability, and embarrassment. […] A multidisciplinary approach must involve primary care and specialty clinicians, nurses, speech therapists, dieticians, and caregivers using compensatory and rehabilitative strategies to promote quality of life and regain physiologic swallowing, respectively. […] Dysphagia can significantly impair the quality of life of those affected. Patients with dysphagia may experience social isolation because of cough, embarrassment, and difficulties in swallowing. […] Patients should be educated about the underlying etiology of their dysphagia, including any etiology-specific needs.

• #4 Dysphagia (difficulty swallowing) – symptoms, causes and treatment | healthdirect

  https://www.healthdirect.gov.au/dysphagia

  Dysphagia is when you have trouble swallowing solids and liquids. […] Dysphagia can cause coughing, gagging or choking when you are eating or drinking, or the feeling of food getting stuck in your throat. […] There are many causes of dysphagia, and treatment depends on the cause. […] Dysphagia can lead to dehydration, weight loss and malnutrition if not treated. […] Eating and drinking is a vital part of life. Difficulty swallowing can limit what you can eat and drink. […] If you have dysphagia, it may lead to feelings of frustration, stress, and health problems. […] Dysphagia can be a sign of a serious medical condition. […] Your doctor can diagnose the cause of your dysphagia and help you access treatment. […] A range of health professionals can help with dysphagia, including doctors, speech pathologists, dietitians, and physiotherapists.

• #5 Dysphagia (swallowing problems)

  https://www.nhs.uk/conditions/swallowing-problems-dysphagia/

  Dysphagia is where you have problems swallowing. It’s usually caused by certain medicines or another condition, such as acid reflux or a stroke. […] Some people with dysphagia have problems swallowing certain foods or drinks, while others cannot swallow at all. […] Signs of dysphagia include: coughing or choking when eating or drinking, bringing food back up, sometimes through the nose, a feeling that food is stuck in your throat or chest, a gurgly, wet-sounding voice when eating or drinking. […] Over time, dysphagia can also cause symptoms such as weight loss, dehydration and repeated chest infections. […] Common causes of swallowing problems include: some medicines, such as antipsychotics, having a learning disability, a cleft lip and palate in babies, heartburn and acid reflux, especially in children or people who have gastro-oesophageal reflux disease, problems with your breathing caused by conditions like chronic obstructive pulmonary disease (COPD), a condition that affects the nervous system or brain, such as cerebral palsy, a stroke, dementia or multiple sclerosis, cancer, such as mouth cancer or oesophageal cancer.

• #5 Dysphagia (swallowing problems)

  https://www.nhs.uk/conditions/swallowing-problems-dysphagia/

  You, your child or someone you care for: has difficulty swallowing, coughs or chokes while eating or drinking, feels like something’s stuck in the throat after eating, keeps bringing food or milk back up, sometimes through the nose, cries a lot or arches their back when feeding, has a wet, gurgly voice after eating or drinking, is short of breath after eating or drinking, gets lots of chest infections. […] Treatment for dysphagia depends on what’s causing it and how severe it is. […] If your swallowing problems are being caused by a condition like acid reflux, the problem may get better on its own. […] But if the cause is longer term, you may need specialist treatment to make eating and drinking as safe as possible. […] This may include: medicines to treat acid reflux, swallowing therapy with a speech and language therapist, making changes to what you eat and drink, such as softer foods and using thickener in drinks, using special spoons, plates and cups, feeding tubes through your nose or a hole into your stomach, surgery to widen your oesophagus, injections to relax the muscles in your oesophagus and allow food and drink to reach the stomach.

• #6 Dysphagia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK559174/

  Patients subjectively define dysphagia as difficulty swallowing and objectively defined by clinicians as an impairment in swallowing that results in an abnormal delay in the transit of a liquid or solid bolus from the oral cavity to the stomach. […] The management of dysphagia is dependent on the cause of dysphagia and associated conditions. […] This activity reviews the evaluation and management of oropharyngeal and esophageal dysphagia and highlights the role of the interprofessional team in improving care for patients with dysphagia. […] The medical history and physical examination are critical to determining the etiology of dysphagia and will often point to a diagnosis. […] Comprehensive dysphagia management is essential, particularly in the geriatric population, patients with dementia, Alzheimer disease, stroke, and Parkinson disease.

• #7 Dysphagia – Health Management | Nestlé Health Science

  https://www.nestlehealthscience.com/health-management/dysphagia/dysphagia-hcp

  Dysphagia is a medical condition which describes the difficulty in swallowing solids or liquids. A care plan which adapts the way that food and drink is consumed is an important step in management of the condition. Despite the significant health risks linked to dysphagia, the condition still remains under-recognized and under-diagnosed. Evidence suggests that only 25% of individuals who have dysphagia are diagnosed with the disorder. Systematic screening of at-risk patients is justified for the early management of dysphagia. Screening at-risk patients is suggested as the first step in dysphagia care. Screening for dysphagia can effectively identify symptom severity in a quick and easy manner so the health risks may be avoided and proper intervention may be recommended earlier. The volume-viscosity swallow test (V-VST) is a sensitive clinical method to identify persons whose swallowing could be improved by intervention with liquids of specific volume and viscosity.

• #8 Dysphagia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/dysphagia/diagnosis-treatment/drc-20372033

  A member of your healthcare team will likely ask you for a description and history of your swallowing difficulties, perform a physical exam, and use various tests to find the cause of your swallowing problem. […] Our caring team of Mayo Clinic experts can help you with your dysphagia-related health concerns. […] For oropharyngeal dysphagia, you may be referred to a speech or swallowing therapist. Therapy might include: Learning exercises. Certain exercises might help coordinate your swallowing muscles or restimulate the nerves that trigger the swallowing reflex. […] If difficulty swallowing prevents you from eating and drinking enough and treatment doesn’t allow you to swallow safely, a feeding tube may be recommended. A feeding tube provides nutrients without the need to swallow. […] Surgery might be needed to relieve swallowing problems caused by throat narrowing or blockages. […] If you have trouble swallowing, be sure to see a healthcare professional. You also may try these approaches to help ease symptoms: Changing your eating habits. Try eating smaller, more frequent meals.

• #9 Evaluating Dysphagia | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0615/p3639.html

  Patients who have dysphagia may present with a variety of complaints, but they usually report coughing or choking, or the abnormal sensation of food sticking in the back of the throat or upper chest when they are trying to swallow. […] A carefully conducted patient history will enable the physician to identify 80 to 85 percent of the causes of dysphagia. […] A patient’s general health information should be reviewed, including long-term illnesses, current prescription medications, and alcohol and tobacco use. […] Neurologic evaluation should include assessments of the patient’s mental status, motor and sensory functioning, deep tendon reflexes and cranial nerves, and a cerebellar examination. […] A general physical examination and focused organ- or symptom-specific examinations based on the patient’s history often identify the etiology of dysphagia. […] Family physicians can reduce the symptoms and risks of complications by early and aggressive evaluation and management of stroke patients.

• #10 Older people in hospital – Swallowing problems | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/servicesandsupport/swallowing-problems-in-hospital

  Swallowing is a complex process. […] The medical term for swallowing problems is dysphagia. […] If you cough or choke when you are eating, or find that food or medication sticks in your mouth or throat, you may have a swallowing problem. […] It is important to find the cause of your swallowing problem, so that it can be treated or managed. […] A swallowing problem can affect your health and your recovery. […] Tell hospital staff if you have or think you may have a swallowing problem. […] Having trouble swallowing can cause much greater health problems if it is not addressed. […] If you have problems swallowing, it can be hard to get enough to eat and drink, and to take your medications, which can slow down your recovery. […] If you have a swallowing problem, ask for training for you and your family and carers in how to prepare food and fluids, brush and care for your teeth, take your medication, and minimise the risk of choking.

• #11 Dysphagia/Difficulty Swallowing | UK Healthcare

  https://ukhealthcare.uky.edu/ear-nose-throat/services/dysphagia-difficulty-swallowing

  Dysphagia is a term that describes difficulty swallowing both solid and liquid foods. The condition results from various medical conditions that cause weakness and structural problems in the coordination of the mouth and throat muscles that direct food and/or liquids to travel down the trachea (windpipe) instead of the esophagus (food pipe). […] Dysphagia specialists include otolaryngologists and speech language pathologists. […] If you have had difficulty swallowing and are experiencing any of the symptoms listed for more than one week, you should see a medical specialist for evaluation of the swallowing difficulty. […] Dysphagia is evaluated by a multidisciplinary team that involves an otolaryngologist, speech pathologist, nutritionist, radiologist, gastroenterologist, and primary care physician with specialization in swallowing disorders.

• #12 Impaired Swallowing (Dysphagia) Nursing Diagnosis & Care Plan – Nurseslabs

  https://nurseslabs.com/impaired-swallowing/

  Utilize this comprehensive nursing care plan and management guide to provide exceptional care for clients diagnosed with dysphagia or those with impairment in swallowing. This guide equips you with valuable insights into conducting thorough nursing assessments, implementing evidence-based interventions, establishing appropriate goals, and identifying nursing diagnoses related to dysphagia or impaired swallowing. […] Nursing care plans for clients with dysphagia involve a comprehensive assessment of the clients medical history, nutritional status, and the underlying cause of dysphagia. This information is important for developing individualized interventions that address the needs and risks associated with each client. These nursing care plans will aid the nurse in promoting safety and optimal nutritional status for the client.

• #12 Impaired Swallowing (Dysphagia) Nursing Diagnosis & Care Plan – Nurseslabs

  https://nurseslabs.com/impaired-swallowing/

  The following are nursing priorities for clients diagnosed with swallowing impairment or dysphagia: Airway protection. Ensuring the safety of the clients airway is of utmost priority. Nutritional support. Develop and implement a nutritionally balanced diet that addresses the clients specific needs. Client and family education. Educate the client and their family or caregivers on dysphagia management, aspiration precautions, and dietary restrictions and modifications. […] Assessment is necessary to determine potential problems that may have led to dysphagia as well as handle any difficulty that may appear during nursing care. […] Following a thorough assessment, a nursing diagnosis is formulated to specifically address the challenges associated with impaired swallowing (dysphagia) based on the nurses clinical judgement and understanding of the patients unique health condition.

• #12 Impaired Swallowing (Dysphagia) Nursing Diagnosis & Care Plan – Nurseslabs

  https://nurseslabs.com/impaired-swallowing/

  Dysphagia can reduce the quality of life, compromise nutrition, and may result in penetration or aspiration of oropharyngeal secretions or food contents into the airway, compromising ventilation. […] If the client has impaired swallowing, do not feed until an appropriate diagnostic workup is completed. Ensure proper nutrition by consulting with a for enteral feedings, preferably a PEG tube in most cases. Feeding a client who cannot sufficiently swallow results in aspiration and possibly death. […] Providing extensive education to both the client and their caregivers on dysphagia management strategies, including safe swallowing techniques, dietary modifications, and signs of complications can help them adapt to home care and improve their quality of life.

• #13 Dysphagia and swallowing disorders | Nursing in Practice

  https://www.nursinginpractice.com/clinical/dysphagia-and-swallowing-disorders/

  It is important for the clinical staff, part of the multidisciplinary teams, to recognise the importance of dysphagia and adhere to guidelines and informed management. […] Nursing staff play an important role in the management of the dysphagic patient, starting with the screening for suspected swallowing difficulties. […] It is important for the nursing staff to seek further information and training from professionals, including SLTs and dieticians, since all the aforementioned together with the rest of the multidisciplinary team, will have to deliver the best evidence-based practice in the NHS.

• #13 Dysphagia and swallowing disorders | Nursing in Practice

  https://www.nursinginpractice.com/clinical/dysphagia-and-swallowing-disorders/

  For individuals with dementia, there is a lack of evidence for the use of enteral feeding and complications usually faced by the medical care teams include tube displacements, leakage and blockage of the tube. […] Meanwhile, for those patients in need of oral medicinal administration, dysphagia poses a threat. […] Medication errors remain common. […] Although the correct administration remains challenging, an approach that includes direct communication with the pharmacy, in-service education for the staff, and a protocol for administering medication to the dysphagic patient seems to be the optimal solution at present. […] The management of dysphagia can be tailored to patients needs, nature of disease or disorder (progressive versus non-progressive disease), pre-morbid swallowing function (age-related swallowing problem versus swallowing problems of an aged patient with stroke lesion).

• #13 Dysphagia and swallowing disorders | Nursing in Practice

  https://www.nursinginpractice.com/clinical/dysphagia-and-swallowing-disorders/

  The SLT provides the training for those responsible for providing nutrition and mealtime support. […] Modification of food and fluids and feeding strategies are frequently the first line of support for the dysphagic patients. […] Of importance, an oral health hygiene program should be always implemented and adhered to by all trained and informed staff working with the dysphagic patient, even though currently there seems to be inadequate knowledge amongst clinicians. […] Living with swallowing difficulties can be challenging. […] Dysphagia affects social interaction, the ability to work and the overall quality of life. […] The dysphagic patient has limited choices of food, increased meal times, and may frequently experience anxiety and panic in fear of a choking incidence. […] The current evidence for the risk factors of dysphagia and the consequences on health status of the patients were reviewed here, together with the current management and treatments.

• #14 Adult Dysphagia

  https://www.asha.org/practice-portal/clinical-topics/adult-dysphagia/?srsltid=AfmBOoqPXtkJitFxgTDOojDpc0p8a_S9TIXxQWnHWc3aeK2PdqYcf1lM

  Dysphagia is a swallowing disorder involving the oral cavity, pharynx, esophagus, or gastroesophageal junction. […] Dysphagia intervention may concentrate on swallowing exercises, compensatory swallowing strategies (including posture considerations), bolus consistency modification, and caregiver/patient education. […] SLPs play a central role in the assessment and management of individuals with swallowing disorders. An SLPs roles include identifying signs and symptoms of dysphagia; identifying normal and abnormal swallowing anatomy and physiology supported by imaging; providing treatment for swallowing disorders, documenting progress, adapting and adjusting treatment plans based on patient performance, and determining appropriate discharge criteria. […] The primary goals of dysphagia intervention are to support adequate nutrition and hydration and return to oral intake (including incorporating the patients dietary preferences and consulting with family members/caregivers to ensure that the patients daily living activities are being considered); determine the optimum supports (e.g., posture, or assistance) to reduce patient and caregiver burden while maximizing the patients quality of life; and develop a treatment plan to improve the safety and efficiency of the swallow. […] Management of individuals with dysphagia should be based on results of comprehensive assessment, including both instrumental and non-instrumental assessments as applicable. […] The decision to recommend use of a feeding tube is made in collaboration with the medical team.

• #15 Detecting dysphagia

  https://www.myamericannurse.com/detecting-dysphagia/

  Use the PASS acronym to determine your patients risk for dysphagia. Start by asking if its probable that the patient will have difficulty swallowing. For example, intubated patients and those with feeding tubes are at risk for dysphagia. Next, ask for an account or history of previous swallowing problems, which may indicate future problems and the need for additional or immediate intervention. […] Any of the following signs or symptoms may indicate the need for an immediate referral to a speech-language pathologist (SLP) for dysphagia assessment: coughing or throat clearing before, during, or after swallowing; wet, gurgling voice before, during, or after swallowing; shortness of breath after swallowing; drooling or loss of liquid from the mouth; holding food or liquid in mouth for extended time without swallowing; complaining of food or liquid feeling stuck.

• #16 The Dysphagic Patient: Nursing Care Tips and Interventions

  https://nursingcecentral.com/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. […] 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. […] 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.

• #16 The Dysphagic Patient: Nursing Care Tips and Interventions

  https://nursingcecentral.com/dysphagic-patient/

  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.

• #16 The Dysphagic Patient: Nursing Care Tips and Interventions

  https://nursingcecentral.com/dysphagic-patient/

  Observe for signs of aspiration and pneumonia: Listen to lung sounds after meals and note any new crackles or wheezes. Note the patients 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 patients diet: Dysphagic patients are usually on specialized diets to aid them in swallowing and getting the nutrients they need. If a family doesnt understand the importance of diet restrictions, they may give them something they should not have; this increases their aspiration and choking risk.

• #17 Preventing Aspiration in Older Adults with Dysphagia | HIGN

  https://hign.org/consultgeri/try-this-series/preventing-aspiration-older-adults-dysphagia

  PREVENTION OF ASPIRATION DURING HAND FEEDING: The following actions may be of some benefit during hand feeding: Provide a 30-minute rest period prior to feeding time; a rested person will likely have less difficulty swallowing. Sit the person upright in a chair; if confined to bed, elevate the backrest to a 90-degree angle. Implement postural changes that improve swallowing. For example, a chin-down posture is helpful for patients with a tongue base swallowing disorder (Aslam Vaesi, 2013). Adjust rate of feeding and size of bites to the persons tolerance; avoid rushed or forced feeding. Alternate solid and liquid boluses. Vary placement of food in the persons mouth according to the type of deficit. For example, food may be placed on the right side of the mouth if left facial weakness is present. Determine the food viscosity that is best tolerated by the individual. Ideally a trained dysphagia clinician (such as a speech therapist) is available to assist with this assessment. Be aware that thickened liquids are commonly used to promote safer bolus transit and better airway protection (Joyce et al., 2015). However, they may not be appropriate for all patients. Some patients may find thickened liquids unpalatable and thus drink insufficient fluids (Murray et al., 2013). Monitor and record the amount of fluids consumed. Encourage fluid intake by offering fluids between meals as well as during meals. Minimize the use of sedatives and hypnotics since these agents may impair the cough reflex and swallowing.

• #17 Preventing Aspiration in Older Adults with Dysphagia | HIGN

  https://hign.org/consultgeri/try-this-series/preventing-aspiration-older-adults-dysphagia

  PREVENTION OF ASPIRATION DURING TUBE FEEDING: Tube feeding is not necessary for all patients who aspirate. However, in the early weeks of acute stroke, nasogastric (NG) feedings are appropriate for patients with severe dysphagia (Moran OMahony, 2015). Percutaneous gastrostomy (PEG) feedings are generally reserved for stroke patients who have persisting dysphagia at two to three weeks after the stroke (Moran OMahony, 2015). Fortunately, the removal of a feeding tube may be possible for some stroke patients due to spontaneous and/or treatment induced recovery (Wilmskoetter et al., 2017). […] For patients with tube feedings, the following considerations are important: Keep the beds backrest elevated to at least 30o during continuous feedings. Keep the beds backrest elevated to at least 30 o during intermittent feedings and for at least an hour afterward. When the tube-fed person is able to communicate, ask if any of the following signs of gastrointestinal intolerance are present: nausea, feeling of fullness, abdominal pain or cramping. These signs are indicative of slowed gastric emptying that may, in turn, increase the probability for regurgitation and aspiration of gastric contents. Monitor tube location every 4 hours or per institutional policy (Boullata et al., 2017). A feeding tube inadvertently displaced into the esophagus greatly increases risk for aspiration. Observe for signs of intolerance to feedings, such as abdominal distention and large gastric residual volumes (Boullata et al., 2017). These observations are especially important for patients unable to communicate their discomfort. Percutaneous gastrostomy offers no significant protection against aspiration pneumonia; in fact, it is the commonest cause of death in PEG fed patients (Onur et al., 2013). However, a PEG tube is more comfortable for patients than is a NG tube. Also, nutritional intake is likely to be higher in patients with PEG tubes than in those with NG tubes, since the latter type of tubes have more mechanical problems.

• #17 Preventing Aspiration in Older Adults with Dysphagia | HIGN

  https://hign.org/consultgeri/try-this-series/preventing-aspiration-older-adults-dysphagia

  Preventing Aspiration in Older Adults with Dysphagia […] WHY: Aspiration (the misdirection of oropharyngeal secretions or gastric contents into the larynx and lower respiratory tract) is common in older adults with dysphagia and can lead to aspiration pneumonia. In fact, the risk of pneumonia is three times higher in patients with dysphagia (Hebert et al., 2016). Other harmful sequelae of dysphagia include malnutrition and dehydration (Wilmskoetter et al., 2017). Dysphagia is a significant predictor of worse clinical outcomes in hospitalized patients with dementia (Paranji et al., 2017). […] TARGET POPULATION: Dysphagia is common in persons with neurologic diseases such as stroke, Parkinsons disease, and dementia. The older adult with one of these conditions is at even greater risk for aspiration because the dysphagia is superimposed on the slowed swallowing rate associated with normal aging. Conditions that suppress the cough reflex (such as sedation) further increase the risk for aspiration.

• #17 Preventing Aspiration in Older Adults with Dysphagia | HIGN

  https://hign.org/consultgeri/try-this-series/preventing-aspiration-older-adults-dysphagia

  BEST PRACTICES: ASSESSMENT AND PREVENTION ASSESSMENT: A multidisciplinary approach to identify dysphagic patients is important (Aoki et al., 2016). While dysphagia screening by nurses does not replace assessment by other health professionals, it enhances the provision of care to at-risk patients by allowing for early recognition and intervention (Hines et al., 2016; Palli et al., 2017). Assessment may begin at the bedside, using a variety of tools. Most swallow screens use varying volumes of water to assess the ability to swallow (Smithard, 2016). For more specific swallowing assessments, fiberoptic endoscopy of swallowing (FEES) or videofluoroscopy (VFS) may be used (Gallegos et al., 2017). […] BEST PRACTICES: PREVENTION The primary methods used to prevent aspiration during oral intake in dysphagic stroke patients include texture modification of food/liquids and positional swallowing maneuvers, such as chin-tuck or head rotation (Smithard, 2016). Thickened liquids are easier for many patients to control intra-orally, thus preventing premature spillage into the pharynx (Murray et al., 2013). The positional swallowing maneuver prescribed for dysphagic patients varies with the type of swallowing disorder.

• #17 Preventing Aspiration in Older Adults with Dysphagia | HIGN

  https://hign.org/consultgeri/try-this-series/preventing-aspiration-older-adults-dysphagia

  PREVENTION OF ASPIRATION PNEUMONIA BY ORAL CARE: The oral cavity may constitute a reservoir of pathogenic organisms that could conceivably be aspirated and lead to aspiration pneumonia (Maeda Akagi, 2014). Good dental hygiene is important to minimize risk for aspiration pneumonia for several reasons: Missing teeth and poorly fitted dentures predispose to aspiration by interfering with chewing and swallowing. Infected teeth and poor oral hygiene predispose to pneumonia following the aspiration of contaminated oral secretions. Suggestions for mouth care are as follow (Sarin et al., 2008): Use a soft or electric toothbrush with fluoride toothpaste to clean all surfaces of the teeth and gums twice a day. For edentulous patients, gently brush the gums with a soft pediatric toothbrush. Use an electric suction apparatus, if necessary, during mouth care to prevent aspiration of the oral content.

• #18

  https://bluereo.com/blogs/weekly-blog/nursing-care-for-dysphagia-simple-strategies-for-a-better-life?srsltid=AfmBOooT0rQiinxAdjezML_0Bv2lnLIViZBe79oxA4BHdiA08S-IHE2l

  Creating a safe eating environment is one of the best ways to reduce risks. Follow these tips: Ensure the patient sits upright during meals and for 30 minutes afterward. Serve small bites and encourage slow chewing. Use adaptive tools, like special cups and spoons, to make eating easier. […] Aspiration is one of the most dangerous complications of dysphagia. Caregivers should monitor for signs of aspiration, such as coughing or changes in breathing. Adjust food and liquid textures as needed. Provide proper training on safe swallowing techniques. […] The Bluereo G100 suction toothbrush is an excellent choice for oral care. Its suction feature removes debris without requiring patients to rinse or spit, which can be difficult for those with swallowing problems. This toothbrush helps prevent aspiration pneumonia and ensures thorough cleaning.

• #19 End of Life Care in Frailty: Dysphagia | British Geriatrics Society

  https://www.bgs.org.uk/resources/end-of-life-care-in-frailty-dysphagia

  In the frail and ageing population, the experience of swallowing difficulty is common. Up to 50% of this group are affected by sarcopenia (loss of muscle mass). Dysphagia can occur as a result of loss of swallowing muscle mass and function. […] A multidisciplinary approach is beneficial in order to implement holistic management of dysphagia. This may include speech and language therapists, dietitians, occupational therapists, physiotherapists, carers, nurses and doctors as well as the individual and their family. […] Management strategies may consist of: Changing the consistency of fluids to make swallowing safer, such as thickening drinks. Modified texture diets (see IDDSI framework). Positions, techniques and specific equipment to enable independent feeding. […] Where possible it is advisable that individuals consider planning for the future in order to make their wishes known regarding feeding decisions should their swallow function deteriorate.

• #19 End of Life Care in Frailty: Dysphagia | British Geriatrics Society

  https://www.bgs.org.uk/resources/end-of-life-care-in-frailty-dysphagia

  Poor oral hygiene is common in hospitalised and nursing home patients. The number of decayed teeth, frequency of brushing and dependency on others for oral care are associated with incidences of aspiration pneumonia. Good mouth care should be maintained to make sure the mouth is clean and moist ensuring the individual is comfortable, especially if not eating or drinking or if approaching the end of life.

• #20 Dysphagia (swallowing problems) | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/dysphagia-swallowing-problems/

  If this occurs frequently, you may avoid eating and drinking because you fear choking, which can lead to malnutrition and dehydration. […] Dysphagia can also affect your quality of life as it may prevent you enjoying meals and social occasions. […] Most swallowing problems can be treated, although the treatment you receive will depend on the type of dysphagia you have. […] Treatment will depend on whether your swallowing problem is in the mouth or throat (oropharyngeal, or high dysphagia), or in the oesophagus (oesophageal, or low dysphagia). […] Treatment for dysphagia may be managed by a group of specialists known as a multidisciplinary team (MDT). […] You may be referred to a speech and language therapist (SLT) for swallowing therapy if you have high dysphagia. […] Feeding tubes can be used to provide nutrition while youre recovering your ability to swallow.

• #20 Dysphagia (swallowing problems) | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/dysphagia-swallowing-problems/

  Dysphagia is the medical term for swallowing difficulties. […] Some people with dysphagia have problems swallowing certain foods or liquids, while others cant swallow at all. […] You should see your GP if you have swallowing difficulties. […] Treatment usually depends on the cause and type of dysphagia. […] Many cases of dysphagia can be improved with treatment, but a cure isnt always possible. […] Treatments for dysphagia include: speech and language therapy to learn new swallowing techniques, changing the consistency of food and liquids to make them safer to swallow, alternative forms of feeding, such as tube feeding through the nose or stomach, surgery to widen the narrowing of the oesophagus by stretching it or inserting a plastic or metal tube (known as a stent). […] Dysphagia can sometimes lead to further problems.

• #21 Dysphagia (Difficulty Swallowing): What It Is, Causes & Treatment

  https://my.clevelandclinic.org/health/symptoms/21195-dysphagia-difficulty-swallowing

  Many people find rehabilitation helpful. An SLP can teach you exercises to strengthen your swallowing muscles. […] Dysphagia can lead to serious health issues and even be fatal without treatment. Risks include: […] Schedule an appointment with your healthcare provider as soon as you notice that your dysphagia isnt a one-time thing. Recurring dysphagia likely has a cause that your provider can diagnose and treat. […] If youre regularly struggling to swallow, its time for a visit with your healthcare provider. If youre a stroke survivor or someone considered high risk for a swallowing disorder, your provider will check for swallowing problems. If theres an issue, an SLP can often provide resources you can use to eat or drink safely, so you get the nourishment you need.

• #22 Nursing Care Plan For Dysphagia – Made For Medical

  https://www.madeformedical.com/nursing-care-plan-for-dysphagia/

  The primary objective of the nursing care plan for dysphagia is to prevent aspiration, ensure adequate nutritional intake, and promote safe and enjoyable eating experiences. By identifying the level of swallowing impairment, nurses can tailor the care plan to address specific challenges, such as difficulty chewing, swallowing, or coordinating breathing during eating. […] Nursing interventions for dysphagia may include modifying food textures and consistencies, providing thickened liquids, and encouraging adaptive feeding techniques to enhance oral intake safety. […] Patient education and involvement are essential components of the care plan, empowering individuals and their families to understand dysphagia management, recognize signs of aspiration, and adhere to prescribed dietary recommendations.

• #22 Nursing Care Plan For Dysphagia – Made For Medical

  https://www.madeformedical.com/nursing-care-plan-for-dysphagia/

  The nursing care plan for dysphagia, a swallowing disorder, is a crucial and comprehensive approach aimed at addressing the challenges associated with impaired swallowing. Dysphagia can result from various underlying medical conditions or neurological deficits, affecting individuals of all ages. It poses significant health risks, including malnutrition, dehydration, and aspiration pneumonia, making a prompt and patient-centered nursing care plan essential to optimize patient outcomes and improve their quality of life. […] This nursing care plan for dysphagia focuses on assessing the patients swallowing function, identifying the cause and severity of the swallowing impairment, and implementing evidence-based interventions to ensure safe and efficient oral intake. Nurses play a pivotal role in the management of dysphagia, providing individualized care, monitoring for complications, and collaborating with other healthcare professionals to address the diverse needs of the patient.

• #22 Nursing Care Plan For Dysphagia – Made For Medical

  https://www.madeformedical.com/nursing-care-plan-for-dysphagia/

  By monitoring the patients nutritional status, promoting a calm mealtime environment, and offering emotional support, nurses aim to optimize swallowing function, prevent complications such as aspiration, and enhance the patients overall well-being. Through their expertise, compassion, and dedication, nurses play a vital role in empowering individuals with dysphagia to manage their condition effectively and improve their quality of life.

• #23 Risk for Aspiration Nursing Diagnosis & Care Plans | NurseTogether

  https://www.nursetogether.com/risk-for-aspiration-nursing-diagnosis-care-plan/

  Aspiration occurs when food, secretions, fluids, or other substances enter the airways of the lungs. […] People who have dysphagia, which is difficulty swallowing, are at the highest risk for aspiration. […] Aspiration can cause choking, respiratory complications, infections, and can be fatal if not quickly recognized and treated. […] For people with known dysphagia, aspiration precautions should be implemented. […] Patients with impaired swallowing (dysphagia) from a stroke, Parkinsons disease, spinal cord injury or neurological damage with the inability to clear secretions require assessment and monitoring when providing anything by mouth. […] Patients who are sedated either intentionally or unintentionally are at risk for aspiration. […] The nurse should first assess the patients speech and any difficulty in speaking which may signal risk for aspiration.

• #24 Swallowing disorders and aspiration in palliative care: Assessment and strategies for management – UpToDate

  https://www.uptodate.com/contents/swallowing-disorders-and-aspiration-in-palliative-care-assessment-and-strategies-for-management/print

  Dysphagia, or difficulty swallowing, occurs in many patients with serious life-limiting illnesses. […] Difficulty swallowing can impact the quality of life of the patient as well as of caregivers, whose natural instinct to nurture and comfort with food is curtailed. […] Dysphagia is a poor prognostic sign in patients nearing the end of life, and for many patients with a life-limiting illness, difficulty swallowing may represent a pivotal symptom that prompts the decision to consider end-of-life or hospice care. […] In addition to inefficient swallowing, dysphagia is a major predisposing condition for aspiration, or entry of secretions, liquids, or foods into the lungs, which can lead to pneumonia and can contribute to malnutrition, dehydration, and, in some cases, death. […] Management of swallowing disorders is especially challenging in this unique patient population, and the risk for aspiration often persists even with therapeutic intervention. […] Providers, patients, family, and caregivers would be well served in recognizing the signs of dysphagia, and determining appropriate ways to provide nutrition and hydration and to administer medications.

• #25 Swallowing disorders and aspiration in palliative care: Assessment and strategies for management – UpToDate

  https://www.uptodate.com/contents/swallowing-disorders-and-aspiration-in-palliative-care-assessment-and-strategies-for-management

  Dysphagia, or difficulty swallowing, occurs in many patients with serious life-limiting illnesses. In fact, swallowing disorders, distinct from diminished appetite, are part of the natural process at the end of life, irrespective of the etiology. […] Difficulty swallowing can impact the quality of life of the patient as well as of caregivers, whose natural instinct to nurture and comfort with food is curtailed. Dysphagia is a poor prognostic sign in patients nearing the end of life, and for many patients with a life-limiting illness, difficulty swallowing may represent a pivotal symptom that prompts the decision to consider end-of-life or hospice care. […] Swallowing disorders occur frequently in patients with malignancies of the upper aerodigestive tract and brain as well as with progressive degenerative neurologic disorders, including dementia or as a result of the general debility that develops in patients with multisystem diseases.

• #25 Swallowing disorders and aspiration in palliative care: Assessment and strategies for management – UpToDate

  https://www.uptodate.com/contents/swallowing-disorders-and-aspiration-in-palliative-care-assessment-and-strategies-for-management

  Muscle wasting, cachexia, and asthenia affect the coordination and muscle strength needed for swallowing, which in turn, can lead to poor appetite and inefficient oral intake. […] In addition to inefficient swallowing, dysphagia is a major predisposing condition for aspiration, or entry of secretions, liquids, or foods into the lungs, which can lead to pneumonia and can contribute to malnutrition, dehydration, and, in some cases, death. […] Management of swallowing disorders is especially challenging in this unique patient population, and the risk for aspiration often persists even with therapeutic intervention. […] Providers, patients, family, and caregivers would be well served in recognizing the signs of dysphagia, and determining appropriate ways to provide nutrition and hydration and to administer medications.

• #26 Dysphagia: Evaluation and Collaborative Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/0115/p97.html

  Although hospitalized patients are routinely assessed for dysphagia, particularly after a stroke, impairments in community-dwelling older adults may not be recognized. All patients with chronic illness or recent pneumonia should be periodically screened for dysphagia. […] In older patients with progressive chronic illness, a diagnosis of oropharyngeal dysphagia should prompt a discussion about goals of care. The family physician is well-suited to provide anticipatory guidance about the potential consequences of dysphagia, as well as a realistic assessment of the patient’s overall condition and long-term prospects. […] Interventions for oropharyngeal dysphagia have limited benefit because of the inevitable decline in most patients. Nasogastric tube feeding does not result in any survival benefit or reduce rates of aspiration pneumonia, and it is associated with significant harms. Hand feeding is as effective and is generally recommended; caregivers and care settings must promote choice and respect the preferences of patients and their surrogates.

• #27 Identification and nursing management of dysphagia in individuals with neurological impairment – Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK68033/

  The evidence suggested that early detection and appropriate management by nurses may prevent untoward outcomes and that nurses have an important role to play in the recognition and management of dysphagia in a variety of settings. […] It is clear from this review that the nurse has an important role in the recognition and management of dysphagia in a variety of settings. This is of particular importance as the evidence suggests that early detection and appropriate management by nurses may prevent untoward outcomes. […] For adult patients, the authors state that nurses have a significant role to play in the early detection and assessment of dysphagia and that the study reports list specific knowledge that should be used by nurses. […] For juvenile patients, the authors state that 'nurses should be skilled in implementation of therapeutic strategies for children with dysphagia and monitoring their nutritional and hydration status’.

• #28 Interventions for Nursing Home Residents with Dysphagia—A Scoping Review

  https://www.mdpi.com/2308-3417/6/2/55

  The role of nurses in providing oral care seems of importance for resident safety, i.e., for protection against aspiration. […] Thus, the role of nurses in using evidence-based guidelines is of utmost importance for resident safety, i.e., in avoiding aspiration. […] Based on the evidence identified, this scoping review demonstrates sparse knowledge about which interventions affect nursing home residents’ dysphagia. […] Modified textures, oral hygiene, mobilization of the spine and an evidence-based nursing care algorithm seem to improve the swallowing capacity, reduce the risk of aspiration, and improve the quality of life in nursing home residents. […] Future research should strive for stronger evidence, for example, a randomized, controlled study design with larger sample sizes and multi-component interventions.

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