Susceptible to entry of gastrointestinal secretions, oropharyngeal secretions, solids, or fluids to the tracheobronchial passages

• Barrier to elevating upper body
• Decreased gastrointestinal motility
• Difficulty clearing airway
• Difficulty swallowing
• Enteral nutrition tube displacement
• Inadequate knowledge of modifiable factors
• Increased gastric residual

• Chronic obstructive pulmonary disease
• Critical illness
• Decreased level of consciousness
• Delayed gastric emptying
• Depressed gag reflex
• Enteral nutrition
• Facial surgery
• Facial trauma
• Head and neck neoplasms
• Incompetent lower esophageal sphincter
• Increased intragastric pressure
• Jaw fixation techniques
• Medical devices
• Neck surgery
• Neck trauma
• Neurological diseases
• Oral surgical procedures
• Oral trauma
• Pharmaceutical preparations
• Pneumonia
• Stroke
• Treatment regimen

• Patient's ability to cough
• Neurologic status, including level of consciousness (LOC), orientation, and mental status
• Gastrointestinal (GI) status, including gag and swallow reflexes, inspection of abdomen, abdominal girth, auscultation of bowel sounds, palpation for masses and tenderness, percussion of abdomen, and medications
• Nutritional status, including continuous and intermittent tube feeding
• Respiratory status, including skin color, rate and depth of respiration, cough (productive or nonproductive), auscultation of breath sounds, palpation for fremitus, sputum characteristics (color, consistency, amount, and odor), arterial blood gas values, and chest x-ray
• Vital signs
• Laboratory studies, such as white blood cell (WBC) count and sputum culture

• Patient's temperature and WBC count will remain normal.
• No pathogens will appear in sputum cultures.
• Respiratory secretions will be clear and odorless.
• Auscultation will reveal no adventitious breath sounds.
• Respiratory rate will remain within normal limits.
• Auscultation will reveal normal bowel sounds.
• Patient and caregiver will apply measures to prevent aspiration.

Suggested NOC Outcomes

• Assess respiratory status at least every 4 hours for signs of possible aspiration (increased respiratory rate, cough, sputum production, or diminished breath sounds), which should be treated as early as possible.
• Monitor and record neurologic status to detect altered LOC, which could affect ability to swallow food or saliva.
• Monitor and record vital signs to detect signs of aspiration or impaired gas exchange due to aspiration.
• Keep suction equipment available at all times, especially when feeding the patient, to ensure ability to keep airway clear.
• Assess patient for gag and swallow reflexes. Decreased gag or swallow reflex may cause aspiration.
• Encourage patient to cough and expectorate sputum to mobilize secretions. Provide tissues and paper bags for hygienic sputum disposal to prevent spreading infection.
• Hold infant with head elevated during feeding and position in an infant seat after feeding. Such positioning uses gravity to prevent regurgitation of stomach contents and promotes lung expansion.
• Auscultate for bowel sounds every shift and report changes. Delayed gastric emptying and elevated intragastric pressure may promote regurgitation of stomach contents.
• If patient is receiving tube feedings:
  • Assess cuff inflation for patient with artificial airway and adjust appropriately to protect lower airways from oropharyngeal secretions.
  • Add food coloring to tube feeding if patient has altered state of consciousness, diminished gag reflex, or history of aspiration to help monitor gastric secretions for aspiration.
  • Begin regimen with a small, diluted amount, as tolerated and ordered, to allow adjustment to formula osmolality and avoid nausea, vomiting, and diarrhea.
  • Elevate head of bed during and after feedings unless contraindicated to prevent aspiration.
  • Check for residual tube feeding every shift and record amount. If more than 50 mL remains, withhold feeding to prevent vomiting and aspiration. Report findings to physician.
  • Place tube properly before feeding or giving medication to protect airway.
  • Stop feeding immediately if aspiration is suspected; then apply suction as needed and turn patient on side to avoid further aspiration.
• Assess need for antiemetic drug to reduce nausea and vomiting. Administer, if ordered, and monitor for effectiveness.
• Review test results to identify signs of infection; report abnormalities.
• Explain treatment to patient and caregivers to encourage compliance.

Suggested NIC Interventions

• Patient's temperature and WBC count remain within normal parameters.
• No pathogens appear in patient's cultures.
• Patient's respiratory secretions remain clear and odorless.
• Auscultation of lungs reveals no adventitious breath sounds.
• Auscultation of abdomen reveals normal bowel sounds.
• Patient and caregiver discuss measures necessary to prevent aspiration.

• Verification of tube placement
• Residuals of tube feedings
• Vomiting or aspiration
• Breath sounds
• Patient's indication of situations that may lead to aspiration
• Observations of physical findings
• Interventions performed to prevent aspiration
• Evaluations for expected outcomes

• Miller, S. (2017). Assessment of airway defenses in the neurologically impaired patient. MEDSURG Nursing, 26(2), 113-118.
• Prevention of Aspiration in Adults. (2017). Critical Care Nurse, 37(3), 88.
• Sakai, K., Hirano, H., Watanabe, Y., Tohara, H., Sato, E., Sato, K., & Katakura, A. (2016). An examination of factors related to aspiration and silent aspiration in older adults requiring long-term care in rural Japan. Journal of Oral Rehabilitation, 43(2), 103-110.
• Takenoshita, S., Kondo, K., Okazaki, K., Hirao, A., Takayama, K., Hirayama, K., … Terada, S. (2017). Tube feeding decreases pneumonia rate in patients with severe dementia: Comparison between pre- and post-intervention. BMC Geriatrics, 17, 267.
• Yagi, N., Nagami, S., Lin, M., Yabe, T., Itoda, M., Imai, T., & Oku, Y. (2017). A noninvasive swallowing measurement system using a combination of respiratory flow, swallowing sound, and laryngeal motion. Medical & Biological Engineering & Computing, 55(6), 1001-1017.