Nursing Diagnosis - Impaired Swallowing related to Dysphagia

Dysphagia is difficulty in swallowing process and skip the food from the esophagus to the stomach. Causes of dysphagia can be various kinds. It is important to know the difference dysphagia due to oropharyngeal and esophageal disorders.

Dysphagia can be found on some of the causes that can cause the condition include:

• Stroke
• Progressive neurological disease
• The lapse trachestomy
• Paralise or absence of movement of the vocal cords
• Tumors in the mouth
• Head surgery

At regurgitation is often caused by acid that rises from the stomach (acid reflux). Regurgitation can also be caused by a narrowing (stricture) or blockage of the esophagus. Where blockage can occur due to several causes, including cancer of the esophagus, by impaired nerve control valve in the esophagus and the mouth of the stomach.

Impaired Swallowing Definition :
Abnormal functioning of the swallowing mechanism associated with deficits in oral, pharyngeal, or esophageal structure or function

Nursing Diagnosis for Dysphagia

Impaired swallowing related to weakness of the muscles due to paralise.

Expected results:
Patients can demonstrate the proper method of ingest food without causing despair

Intervention:

• Review the patient's ability to swallow, note the extent of facial paralysis.
• Increase efforts to be able to perform effective ingestion such as helping the patient hold his head.
• Place the patient in a sitting position / upright during and after eating.
• Stimulation lips to open and close the mouth manually by pressing lightly on the lips / under the chin.
• Place the food in the mouth is not sick / impaired.
• Most in touch with the cheeks spatel tongue to detect weaknesses.
• Give eat slowly in a quiet environment.
• Start by giving oral semi-liquid foods, soft foods when the patient can swallow water.
• Help the patient to choose foods that are small or do not need to chew and easy to swallow.
• Instruct the patient to use a straw to drink liquids.
• Encourage you to participate in an exercise program.

Nursing Diagnosis Intervention Read more »

NANDA Impaired Swallowing Nursing Diagnosis

NANDA Definition: Abnormal functioning of the swallowing mechanism associated with deficits in oral, pharyngeal, or esophageal structure or function

Defining Characteristics:

Oral phase impairment

• Lack of tongue action to form bolus; 
• weak suck resulting in inefficient nippling; 
• incomplete lip closure; 
• food pushed out of mouth; 
• slow bolus formation; 
• food falls from mouth; 
• premature entry of bolus; 
• nasal reflux; 
• inability to clear oral cavity;
• long meals with little consumption; 
• coughing, choking, or gagging before a swallow; 
• abnormality in oral phase of swallow study; 
• piecemeal deglutition; 
• lack of chewing; 
• pooling in lateral sulci; 
• sialorrhea or drooling

Pharyngeal phase impairment

• Altered head positions; 
• inadequate laryngeal elevation; 
• food refusal; 
• unexplained fevers; 
• delayed swallow; 
• recurrent pulmonary infections; 
• gurgly voice quality; 
• nasal reflux; 
• choking, coughing, or gagging;
• multiple swallows; 
• abnormality in pharyngeal phase by swallowing study

Esophageal phase impairment

• Heartburn or epigastric pain; 
• acidic smelling breath; 
• unexplained irritability surrounding mealtime; 
• vomitous on pillow; 
• repetitive swallowing or ruminating; 
• regurgitation of gastric contents or set burps; 
• bruxism; 
• nighttime coughing or awakening; 
• observed evidence of difficulty in swallowing (e.g., stasis of food in oral cavity, coughing, or choking); 
• hyperextension of head, arching during or after meals; 
• abnormality in esophageal phase by swallow study; 
• odynophagia; 
• food refusal or volume limiting; 
• complaints of "something stuck"; 
• hematemesis; 
• vomiting

Related Factors:

• Congenital deficits; 
• upper airway anomalies; 
• failure to thrive; 
• protein energy malnutrition; 
• conditions with significant hypotonia; 
• respiratory disorders; 
• history of tube feeding; 
• behavioral feeding problems; 
• self-injurious behavior; 
• neuromuscular impairment (e.g., decreased or absent gag reflex, decreased strength or excursion of muscles involved in mastication, perceptual impairment, or facial paralysis); 
• mechanical obstruction (e.g., edema, tracheotomy tube, or tumor); 
• congenital heart disease; 
• cranial nerve involvement; 
• neurological problems; 
• upper airway anomalies; 
• laryngeal abnormalities; 
• achalasia; 
• gastroesophageal reflux disease; 
• acquired anatomic defects; 
• cerebral palsy;
• internal or external traumas; tracheal, laryngeal, esophageal defects; 
• traumatic head injury; 
• developmental delay; 
• nasal or nasopharyngeal cavity defects; 
• oral cavity or oropharynx abnormalities; 
• premature infants

NOC Outcomes (Nursing Outcomes Classification)

Suggested NOC Labels

• Swallowing Status
• Swallowing Status: Esophageal Phase, Oral Phase, Pharyngeal Phase

Client Outcomes

• Demonstrates effective swallowing without choking or coughing
• Remains free from aspiration (e.g., lungs clear, temperature within normal range)

NIC Interventions (Nursing Interventions Classification)

Suggested NIC Labels

• Aspiration Precautions
• Swallowing Therapy

Read More : http://nanda-nic-noc.blogspot.com/2013/03/impaired-swallowing-nursing-diagnosis.html

Nursing Diagnosis Intervention Read more »