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Nursing Care Plan for Dysphagia : Impaired Swallowing

Nursing Diagnosis for Dysphagia -Impaired Swallowing


Swallowing is a complex process that allows the movement of food and liquids from the mouth to the stomach. This process involves structures in the mouth, pharynx, larynx and esophagus.

Complaints of difficulty in swallowing (dysphagia) is one of the symptoms of the disorder or disease in the oropharynx and esophagus. These complaints will arise when there is interference with the movement of the muscles of swallowing and impaired transport of food from the mouth to the stomach. Types of foods that cause dysphagia can provide information regarding disorders that occur.


Purpose

1. General Purpose
  • Knowing nursing care in patients with Dysphagia.
2. Special Purpose
To know the nursing care for patients who experience such as :
  • Definition of Dysphagia.
  • Etiology of Disphagya.
  • Pathophysiology of Disphagya.
  • Diagnosis and treatment Disphagya.
  • Disphagya nursing care to patients.



Nursing Care Plan for Dysphagia


Definition

Disphagya is difficulty in swallowing and getting food from the esophagus into the stomach. Dysphagia can cause all sorts. Important to know the difference dysphagia, because orofaring and esophageal disorders. If not carefully observed, the symptoms are very similar.

On the problems of the esophagus, dysphagia sometimes there is, in the event of esophagitis or esophageal obstruction. Problems of the esophagus is usually also accompanied by regurgitation. Hypersalivation never or rarely occurs and when there is usually a result of a foreign object is actually a pseudo - hypersalivation.


Etiology

Disphagya can be found on some of the causes that can cause the condition include:
  • Stroke.
  • Progressive neurological disease.
  • The tube on trachestomy.
  • Paralise or absence of movement of the vocal cords.
  • Tumors in the mouth.
  • Surgery of the head.


Pathophysiology

Normally people swallow solid food or drinking liquids and swallow saliva or mucus produced by the body hundreds of times every day. The swallowing process has four stages : the first stage of preparation in the mouth, where food or solids mobilized / manipulated and chewed in preparation for swallowing. During the oral stage, the tongue pushing food or solids into the back of the mouth, and began to swallow response. Pharyngeal phase began immediately after food or liquid pass through the pharynx (the tube that connects the mouth to the esophagus) into the esophagus or gastrointestinal tract. The last stage is the stage of esophageal, food or liquid pass through the esophagus into the stomach. Although the first and second stages have some control voluntair, stages three and four occur by itself without realizing it. If the swallowing process stalled due to various reasons, will result in difficulty swallowing.





Nursing Assessment

Nursing assessment needs to be done in patients with swallowing disorders or disphagya include :
  • History of the disease.
  • History of stroke.
  • History of the use of medical devices : tracheostomy, nasogastric tube, mayo tube, ETT, post endoscopy examination.
  • History surgery laryx blood, pharynx, esophagus, thyroid.
  • Postoperative mouth area.

Physical examination :
  • Mouth shape is not symmetrical.
  • Looks an inflammation of the pharynx.
  • The presence of Candida in the oral / mouth.
  • Edema of the pharynx.


Nursing Diagnosis and Nursing Interventions

1. Impaired swallowing related to muscle weakness due to swallowing paralise

Outcomes :
Patients can demonstrate the proper method of swallowing food without causing despair.


Intervention :
a. Review the patient's ability to swallow , note the extent of facial paralysis.
b. Increase efforts to be able to perform effective ingestion such as helping the patient hold his head.
c. Place the patient in a sitting position / upright during and after eating.
d. Stimulation lips to open and close the mouth manually by pressing lightly on the lips / under the chin.
e. Place the food in the mouth is not ill / disturbed.
f. Tap the deepest part of the cheek with a spatula to know the weakness of the tongue.
g. Give eat slowly in a quiet environment.
h. Start by giving a semi-liquid food orally , soft foods when patients can not swallow water.
i. Help the patient to choose foods that are small or do not need to chew and easy to swallow.
j. Instruct the patient to use a straw to drink liquids.
k. Suggest to participate in the exercise program.


2. Imbalanced Nutrition Less than Body Requirements related to lack of adequate food intake.

Outcomes :
Adequate nutritional intake.

Intervention :
a. Instruct the patient to eat slowly and chew food thoroughly.
b. Feeding little and often with foods that are not irritating.
c. Serve food in interesting ways.
d. Avoid eating or drinking foods that contain irritant substances.
e. Measure body weight each day and record the increase.
f. Observation of the patient's intake of nutrients and review the things that hinder / complicate the swallowing.

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