Weakened or damaged process of moving substances from the mouth to the stomach

• Behavioral feeding problem
• Decreased attention
• Protein-energy malnutrition
• Self-injurious behavior

• Individuals with history of enteral nutrition
• Older adults
• Premature infants

• History of neuromuscular, cerebral, or respiratory disease
• Age
• Gender
• Nutritional status, including appetite, dietary intake, hydration, current weight, and change from normal weight
• Neurologic status, including barium swallow; chest X-ray; cognition; esophageal video fluoroscopy; gag reflex; level of consciousness; memory; motor ability; orientation; symmetry of face, mouth, and neck; sensory function; and tongue movement

• Patient won't show evidence of aspiration pneumonia.
• Patient will achieve adequate nutritional intake.
• Patient will maintain weight.
• Patient will maintain oral hygiene.
• Patient and caregiver will demonstrate correct feeding techniques to maximize swallowing.
• Patient and caregiver will list strategies to prevent aspiration.

Suggested NOC Outcomes

• Elevate the head of the bed 90 degrees during mealtimes and for 30 minutes after the completion of a meal to decrease the risk of aspiration.
• Position patient on the side when recumbent to decrease the risk of aspiration.
• Keep suction apparatus at the bedside; observe and report instances of cyanosis, dyspnea, or choking. Symptoms indicate the presence of material in the lungs.
• Monitor intake and output and weight daily until stabilized. Establish an intake goal—for example, “Patient consumes ____mL of fluid and ____ % of solid food.” Record and report any deviation from this. Evaluating calorie and protein intake daily allows any necessary modifications to begin quickly.
• Consult with a dietitian to modify patient's diet and conduct a calorie count as needed to establish nutritional requirements.
• Consult with a dysphagia rehabilitation team, if available, to obtain expert advice.
• Provide mouth care three times daily to promote comfort and enhance appetite.
• Keep the oral mucous membrane moist by frequent rinses; use a bulb syringe or suction if necessary to promote comfort.
• Lubricate patient's lips to prevent cracking and blisters.
• Encourage patient to wear properly fitted dentures to enhance chewing ability.
• Serve food in attractive surroundings; encourage patient to smell and look at food. Remove soiled equipment, control smells, and provide a quiet atmosphere for eating. A pleasant atmosphere stimulates appetite; food aroma stimulates salivation.
• Teach patient and family members about positioning, dietary requirements, and specific feeding techniques, including facial exercises (such as whistling), using a short straw to provide sensory stimulation to patient's lips, tipping the head forward to decrease aspiration, applying pressure above the lip to stimulate mouth closure and the swallowing reflex, and checking the oral cavity frequently for food particles (remove if present). These measures allow patient to take an active role in maintaining health.

Suggested NIC Interventions

• Patient shows no evidence of aspiration pneumonia. Breath sounds remain bilaterally clear; fever, chills, purulent sputum, and rapid shallow respirations are absent.
• Patient's fluid and dietary intake remains within established daily limits.
• Patient's weight remains stable.
• Patient demonstrates appropriate oral hygiene practices.
• Patient and caregiver demonstrate feeding techniques to maximize swallowing and minimize risk of complications.
• Patient and caregiver list strategies to prevent aspiration.

• Patient's expressions of feelings about current situation
• Observations of weight, swallowing ability, intake and output, and oral hygiene
• Patient's response to nursing interventions
• Instructions about diet monitoring and feeding techniques
• Evaluations for expected outcomes

• Govender, R., Smith, C. H., Taylor, S. A., Barratt, H., & Gardner, B. (2017). Swallowing interventions for the treatment of dysphagia after head and neck cancer: A systematic review of behavioural strategies used to promote patient adherence to swallowing exercises. BMC Cancer, 17, 1-15. doi:10.1186/s12885-016-2990-x
• Martin-Harris, B., Garand, K. L. (Focht), & McFarland, D. (2017). Optimizing respiratory-swallowing coordination in patients with oropharyngeal head and neck cancer. Perspectives of the ASHA Special Interest Groups, 2(13), 103-110. doi:10.1044/persp2.SIG13.103
• Masilamoney, M., & Dowse, R. (2018). Knowledge and practice of healthcare professionals relating to oral medicine use in swallowing-impaired patients: A scoping review. International Journal of Pharmacy Practice, 26(3), 199-209. doi:10.1111/ijpp.12447
• Wakasugi, Y., Yamamoto, T., Oda, C., Murata, M., Tohara, H., & Minakuchi, S. (2017). Effect of an impaired oral stage on swallowing in patients with Parkinson's disease. Journal of Oral Rehabilitation, 44(10), 756-762. doi:10.1111/joor.12536