Care Plan for High Risk of Recurrent Lung Aspiration

Category / Primary Body System

• Respiratory System

Problem

• High risk of recurrent lung aspiration.

Goal

• Patient will not exhibit signs or symptoms of lung aspiration for the next 90 days.

Plan/Approach

1. Aspiration Precautions

   • Maintain aspiration precautions per facility policy to minimize the risk of aspiration.

2. Positioning and Meal Management

   • Keep the patient in an upright position during meals and for 45 minutes following meals.
   • Encourage correct body alignment and a low-distraction environment during meal times.
   • Cue the patient to eat slowly and clear the oral cavity before taking another bite.
   • Encourage the patient to tuck their chin to their chest before swallowing.
   • Encourage alternating liquids with solids and frequent swallowing.

3. Monitoring and Assessment

   • Monitor for signs and symptoms of lung aspiration, including coughing, choking during meals, decreased oxygen saturation, increased or changed color of respiratory secretions, coarse lung sounds or pulmonary crackles, elevated temperature, and respiratory distress.
   • Notify the physician immediately if any of these symptoms are observed.

4. Speech Therapy

   • Arrange for speech-language pathology visits as needed to assess and manage swallowing difficulties.

5. Family Support and Education

   • Provide support and explanation to the family about why these strategies are necessary to prevent aspiration.

6. Dietary Management

   • Provide diet as ordered and keep the dietician informed of diet tolerance and any issues.
   • Ensure the patient has adequate time for meal intake and is not rushed.

7. Emergency Preparedness

   • Ensure licensed nurses are CPR/Heimlich certified.
   • Ensure a code cart is provided in the main dining room and/or lounges.

Rationale

1. Aspiration Precautions

   • Following aspiration precautions helps prevent food or liquid from entering the lungs, which can lead to pneumonia or other complications.

2. Positioning and Meal Management

   • Proper positioning and meal management reduce the risk of aspiration during and after eating.

3. Monitoring and Assessment

   • Regular monitoring allows for early detection of aspiration symptoms, enabling prompt intervention.

4. Speech Therapy

   • Speech therapy provides specialized assessment and strategies to improve swallowing function and reduce aspiration risk.

5. Family Support and Education

   • Educating the family helps them understand and support the necessary precautions to prevent aspiration.

6. Dietary Management

   • Ensuring the patient receives the appropriate diet and adequate time for meals helps maintain nutrition and reduce aspiration risk.

7. Emergency Preparedness

   • Having trained staff and accessible emergency equipment ensures quick response in case of an aspiration emergency.

Actions

1. Aspiration Precautions

   • Follow facility policy for aspiration precautions during all patient interactions.

2. Positioning and Meal Management

   • Assist the patient into an upright position during meals and ensure they remain upright for 45 minutes post-meal.
   • Encourage correct body alignment and minimize distractions during meals.
   • Cue the patient to eat slowly and clear the oral cavity before taking another bite.
   • Instruct the patient to tuck their chin to their chest before swallowing.
   • Encourage alternating liquids with solids and frequent swallowing.

3. Monitoring and Assessment

   • Monitor for signs of aspiration such as coughing, choking, decreased oxygen saturation, changes in respiratory secretions, coarse lung sounds, elevated temperature, and respiratory distress.
   • Document and report any signs of aspiration to the physician immediately.

4. Speech Therapy

   • Schedule speech-language pathology assessments as ordered.
   • Implement recommendations from the speech therapist to manage swallowing difficulties.

5. Family Support and Education

   • Explain aspiration precautions and the rationale to the family.
   • Provide educational materials and answer any questions from the family.

6. Dietary Management

   • Follow the prescribed diet and monitor the patient’s tolerance.
   • Communicate with the dietician regarding any issues or changes in diet tolerance.
   • Ensure meals are unhurried, allowing the patient adequate time to eat.

7. Emergency Preparedness

   • Ensure all licensed nurses maintain CPR/Heimlich certification.
   • Check the availability and condition of the code cart in the main dining room and lounges regularly.