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By
Gil Wayne, RN
-
October 26, 2016
Risk for Aspiration: At risk for entry of gastrointestinal secretions, oropharyngeal secretion,
solids, or fluids into tracheobronchial passages.
Aspiration is breathing in a foreign object such as foods or liquids into the trachea and lungs and
happens when protective reflexes are reduced or jeopardized. An infection that develops after an
entry of food, liquid, or vomit into the lungs can result in aspiration pneumonia. Inhaling
chemical fumes or breathing in and choking on certain chemicals, even small amounts of gastric
acids can damage lung tissue, resulting in chemical pneumonitis. Many household and industrial
chemicals can produce both an acute and a chronic form of inflammation in the lungs which can
place patients at risk for aspiration. Acute conditions, like postanesthesia effects from surgery or
diagnostic tests, happen predominantly in the acute care setting. Chronic conditions, like altered
consciousness from head injury, spinal cord injury, neuromuscular weakness, hemiplegia, and
dysphagia from stroke, use of tube feedings for nutrition, and artificial airway devices such as
tracheostomies, may be experienced in the home, rehabilitative, or hospital setting.
Prevention is the main goal when caring for patients at risk for aspiration. Evidence shows that
one of the principal precautionary measures for aspiration is placing at-risk patients in a
semirecumbent position. Other measures include compensating for absent reflexes, assessing
feeding tube placement, identifying delayed stomach emptying, and managing effects of
prolonged intubation.
Contents [hide]
1 Risk Factors
2 Goals and Outcomes
3 Nursing Assessment
4 Nursing Interventions
5 See Also
6 Further Reading
Risk Factors
Here are some factors that may be related to Risk for Aspiration:
Advanced age
Anesthesia or medication administration
Decreased gastrointestinal motility
Delayed gastric emptying
Depressed cough or gag reflex
Drug or alcohol intoxication
Facial, oral, or neck surgery or trauma
Impaired swallowing
Increased gastric residual
Presence of gastrointestinal tubes
Presence of tracheostomy or endotracheal tube
Reduced level of consciousness
Seizure activity
Situations hindering elevation of upper body
Tube feedings
Wired jaws
The following are the common goals and expected outcomes for Risk for Aspiration:
Nursing Assessment
Assessment is required in order to distinguish possible problems that may have lead to aspiration
as well as name any episode that may occur during nursing care.
Assessment Rationales
The primary risk factor of aspiration is
Assess level of consciousness.
decreased level of consciousness.
Monitor respiratory rate, depth, and effort. Note Signs of aspiration should be identified as soon
any signs of aspiration such as dyspnea, cough, as possible to prevent further aspiration and to
cyanosis, wheezing, or fever. initiate treatment that can be life-saving.
Evaluate swallowing ability by assessing for the
following: Impaired swallowing increases the risk for
aspiration. There remains a need for valid and
Coughing, choking, throat clearing, easy-to-use methods to screen for aspiration
gurgling or “wet” voice during or after risk.
swallowing
Residual food in mouth after eating
Regurgitation of food or fluid through
the nares
Nursing Interventions
The following are the therapeutic nursing interventions for Risk for Aspiration:
Interventions Rationales
Keep suction machine available when feeding A patient with aspiration needs immediate
high-risk patients. If aspiration does occur, suctioning and will need further lifesaving
suction immediately. interventions such as intubation.
Early intervention protects the patient’s airway
Inform the physician or other health care and prevents aspiration. Anyone identified as
provider instantly of noted decrease in being at high risk for aspiration should be kept
cough/gag reflexes or difficulty in swallowing. NPO (nothing by mouth) until further
evaluation is completed.
Maintaining a sitting position after meals may
Keep head of bed elevated when feeding and
help decrease aspiration pneumonia in the
for at least a half hour afterward.
elderly.
This positioning (rescue positioning) decreases
the risk for aspiration by promoting the
Position patients with a decreased level of
drainage of secretions out of the mouth instead
consciousness on their side.
of down the pharynx, where they could be
aspirated.
Supervision helps identify abnormalities early
Supervise or aid the patient with oral intake. and allows implementation of strategies for safe
Never give oral fluids to a comatose patient. swallowing. Withholding fluids and foods as
needed prevents aspiration.
Thickened semisolid foods such as pudding and
Provide foods with consistency that the patient
hot cereal are most easily swallowed and less
can swallow. Use thickening agents if
likely to be aspirated. Liquids and thin foods
recommended by a speech pathologist or
(e.g., creamed soups) are most difficult for
dietician.
patients with dysphagia.
Allow the patient to chew thoroughly and eat Well-masticated food is easier to swallow, food
slowly during meals. cut into small pieces may also be easier to
swallow.
Abdominal distention or rigidity can be
Note new onset of abdominal distention or associated with paralytic or mechanical
increased rigidity of abdomen. obstruction and an increased likelihood of
vomiting and aspiration.
Concentration must be focused on chewing and
For patients with reduced cognitive abilities,
swallowing. There is a higher risk for the
eliminate distracting stimuli during mealtimes.
airway to be opened when talking and eating at
Tell the patient not to talk while eating.
the same time.
During enteral feedings, position patient with Keeping patient’s head elevated helps keep
head of bed elevated 30 to 40 degrees; maintain food in stomach and decreases incidence of
for 30 to 45 minutes after feeding. aspiration
Place medication and food on the strong side of
Careful food placement promotes chewing and
the mouth when unilateral weakness or paresis
successful swallowing.
is present.
Ingesting food and fluids together increases
Offer liquids after food is eaten.
swallowing difficulties.
Place whole or crushed pills in soft foods (e.g.,
Mixing pills with food helps reduce risk for
custard). Verify with a pharmacist which pills
aspiration.
should not be crushed.
When turning or moving a patient, it is difficult
Stop continual feeding temporarily when
to keep the head elevated to prevent
turning or moving patient.
regurgitation and possible aspiration.
Oral care before meals reduces bacterial counts
in the oral cavity. Oral care after eating removes
Provide oral care before and after meals.
residual food that could be aspirated at a later
time.
In patients with artificial airways:
Suctioning reduces the volume of
Perform oral suctioning as needed.
oropharyngeal secretions and reduces aspiration
risk.
Brush teeth twice a day, and swab Oral care reduces the risk for ventilator-
mouth with sponge applicators every 2 associated pneumonia by decreasing the number
to 4 hours between brushing. of microorganisms in aspirated oropharyngeal
secretions.
In patients with NG or gastrostomy tubes:
If ordered by physician, put several
drops of blue or green food coloring in
tube feeding to help indicate aspiration.
Colored secretions suctioned or coughed from
In addition, test the glucose in
the respiratory tract indicate aspiration.
tracheobronchial secretions to detect
aspiration of enteral feedings.
Elevate the head of bed to 30 to 45
degrees while feeding the patient and for
30 to 45 minutes afterward if feeding is
intermittent. Turn off the feeding before Upright positioning reduces aspiration by
lowering the head of bed. Patients with decreasing reflux of gastric contents.
continuous feedings should be in an
upright position.