• Provide at least a 30-minute rest period prior to mealtime. A rested person will likely have less difficulty swallowing.
• Sit the patient upright, preferably in a chair. If bed rest is mandatory, elevate the head of the bed to a 90-degree angle. Maintain upright position for 30 minutes after the meal.
• Provide mouth care immediately before meals to enhance the sense of taste.
• Avoid rushed or forced feeding. Adjust the rate of feeding and size of bites to the patient's tolerance. Allow patient to control the eating process if possible.
• Collaborate to obtain a speech therapy consult for swallowing evaluation.
• Initiate a nutrition consult for appropriate diet modification such as chopping, mincing, or pureeing of foods and liquid consistency (thin, nectar-thick, honeylike, spoon-thick).
• Keep in mind that some patients may find thickened liquids unpalatable and thus drink insufficient fluids.
• Reduce or eliminate distractions at mealtime so that the patient can focus attention on swallowing; discourage chatting during the meal.
• Alternate solids and liquids.
• Assess for signs of aspiration during eating: sudden appearance of severe coughing; choking; cyanosis; voice change, hoarseness, and/or gurgling after swallowing; frequent throat clearing after meals; or regurgitation through the nose or mouth.
• Inspect oral cavity for retained food.
• Avoid or minimize the use of sedatives and hypnotics since these agents may impair the cough reflex and swallowing.

Source: Adapted from Dudek, S. (2022). Nutrition essentials for nursing practice (9th ed.). Wolters Kluwer; Holdoway, A., & Smith, A. (2020). Meeting nutritional need and managing patients with dysphagia. Journal of Community Nursing, 34(2), 52-59; Metheny, N. (n.d.). Issue #20. General assessment series. Preventing aspiration in older adults with dysphagia. Retrieved September 26, 2020, from https://hign.org/consultgeri/try-this-series/preventing-aspiration-older-adults-dysphagia; and Nazarko, L. (2020). Dysphagia: A guide for nurses in general practice. Practice Nursing, 31(4), 162-168. https://doi.org/10.12968/pnur.2020.31.4.162