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Relevant Cues/ Findings (Assessment), Nursing Actions: What should be…

- - - - Discharge: medical and nursing outcomes/resources needed
        
        Patient should have a consult with speech therapy. Speech therapy can provide a through assessment of the patient's risk of aspiration before discharge. They help to decide the proper diet for patient's with impaired swallowing. They can assess and decide if it is safe for the patient to discharge home and eat independent of a nurses observation.
        
        The nurse should educate the patient on foods they should stick to post-discharge. The nurse can provide pantalets for the patient to take home and meal plans to follow. The nurse can contact dietitian to create a meal plan for the patient if required.
        
        The nurse should educate family members on what to do if the patient aspirates at home. The nurse should ensure there is a family member that could preform the Heimlich maneuver. Nurse should educate the family on signs of aspiration and to call 911 in the case of the patient aspirating.
        
        Any PO medications that the patient has to take home, the nurse should contact the provider to see if ER medications could be switched to pill that could be crushed into applesauce/pudding or chewed. Swallowing pills can be diffucult for patients with impaired swallowing. This would just be another measure to put in place to decrease risk of aspiration.
      - The patient is able to display the ability to eat without any aspiration or coughing. The patient will eat a meal independently and the nurse is able to assess that there are no safety risks regarding meal time alone.
        
        The patient's lung sounds are clear during respiratory assessment. The patient does not display any signs of labored breathing. The patient has adequate oxygenation saturation and does not display any signs of hypoxia such as cyanosis, rapid HR, shortness of breath, etc.
    - - Suction and airway equipment should be easily accessible and ready in the patients room. In the case of the patient aspirating, the nurse can quickly clear the airway and prevent any respiratory distress or hypoxia.
        
        Patient should be sitting in a semi fowler position or higher when eating. Eating while laying down increases the risk of aspiration. If able, the nurse should help the patient ambulate to the chair or raise the head of the bed during meal times.
        
        The nurse should observe to aid the patient during meal time. If the patient is independent, the nurse should just sit with the patient while they eat. This allows the nurse to assess swallowing and be close in case of aspiration. If the patient is dependent, the nurse can help the patient eat. The nurse should go slow with meal times to ensure the patient has time to fully swallow in-between bites.