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A client with a history of stroke is being evaluated for dysphagia. Which of the following swallowing techniques would be MOST appropriate to teach this client to minimize aspiration risk?
A client with a history of stroke is being evaluated for dysphagia. Which of the following swallowing techniques would be MOST appropriate to teach this client to minimize aspiration risk?
- Alternating liquids and solids with each swallow.
- Rotating the head to the affected side while swallowing. (correct)
- Tilting the head to the affected side while swallowing.
- Extending the neck upwards during swallowing.
Which assessment finding is the MOST indicative of overt aspiration in a client who is eating?
Which assessment finding is the MOST indicative of overt aspiration in a client who is eating?
- Sudden onset of wheezing and coughing during swallowing. (correct)
- A weak cough.
- Increased clearing of the throat after consuming liquids.
- Complaining of mild heartburn after each meal.
A nurse is caring for a client receiving continuous tube feeding. Which intervention is MOST important to prevent aspiration pneumonia?
A nurse is caring for a client receiving continuous tube feeding. Which intervention is MOST important to prevent aspiration pneumonia?
- Confirming tube placement by auscultating for air insufflation.
- Maintaining the head of the bed elevated at least 30 to 45 degrees. (correct)
- Checking gastric residual volume every 8 hours.
- Administering metoclopramide to promote gastric emptying.
A client with dysphagia is prescribed honey-thick liquids. Which characteristic BEST describes the consistency the nurse should expect when preparing the liquids?
A client with dysphagia is prescribed honey-thick liquids. Which characteristic BEST describes the consistency the nurse should expect when preparing the liquids?
The nurse is preparing to administer insulin to a client with diabetes. Which action is MOST important for the nurse to take before administering the insulin?
The nurse is preparing to administer insulin to a client with diabetes. Which action is MOST important for the nurse to take before administering the insulin?
A client with diabetes is prescribed rapid-acting insulin before meals. The nurse should teach the client to administer this type of insulin:
A client with diabetes is prescribed rapid-acting insulin before meals. The nurse should teach the client to administer this type of insulin:
A nurse is teaching a client about the function of glucagon in the body. Which statement BEST describes glucagon's primary role?
A nurse is teaching a client about the function of glucagon in the body. Which statement BEST describes glucagon's primary role?
A nurse is caring for a client with hypoglycemia. After administering a rapid-acting carbohydrate source, how long should the nurse wait before rechecking the client’s blood glucose level?
A nurse is caring for a client with hypoglycemia. After administering a rapid-acting carbohydrate source, how long should the nurse wait before rechecking the client’s blood glucose level?
Which nursing intervention is MOST important when initiating enteral feeding via a nasogastric (NG) tube?
Which nursing intervention is MOST important when initiating enteral feeding via a nasogastric (NG) tube?
A nurse is caring for a client receiving continuous enteral feeding via a gastrostomy tube. The nurse notes the client has developed a fever, has increased respiratory rate, and is wheezing. What is the nurse's FIRST action?
A nurse is caring for a client receiving continuous enteral feeding via a gastrostomy tube. The nurse notes the client has developed a fever, has increased respiratory rate, and is wheezing. What is the nurse's FIRST action?
A client is scheduled for placement of a gastrostomy tube (G-tube). What preoperative instruction is MOST important for the nurse to provide?
A client is scheduled for placement of a gastrostomy tube (G-tube). What preoperative instruction is MOST important for the nurse to provide?
The provider prescribes total parenteral nutrition (TPN) for a client. What is the MOST important nursing action related to TPN administration?
The provider prescribes total parenteral nutrition (TPN) for a client. What is the MOST important nursing action related to TPN administration?
A nurse is caring for a client receiving total parenteral nutrition (TPN). Which assessment finding requires immediate intervention?
A nurse is caring for a client receiving total parenteral nutrition (TPN). Which assessment finding requires immediate intervention?
When assisting a client with eating, which intervention promotes independence?
When assisting a client with eating, which intervention promotes independence?
A nurse is preparing to insert a nasogastric (NG) tube in an adult client. Which action demonstrates appropriate technique?
A nurse is preparing to insert a nasogastric (NG) tube in an adult client. Which action demonstrates appropriate technique?
A nurse is caring for a client with a nasojejunal (NJ) tube. What is the PRIMARY advantage of using an NJ tube over a nasogastric (NG) tube for enteral feeding?
A nurse is caring for a client with a nasojejunal (NJ) tube. What is the PRIMARY advantage of using an NJ tube over a nasogastric (NG) tube for enteral feeding?
A client with dysphagia is learning the supraglottic swallow technique. Which statement BEST describes the steps of this technique?
A client with dysphagia is learning the supraglottic swallow technique. Which statement BEST describes the steps of this technique?
A client with diabetes is prescribed intermediate-acting insulin. The nurse should teach the client that the peak effect of this insulin occurs in:
A client with diabetes is prescribed intermediate-acting insulin. The nurse should teach the client that the peak effect of this insulin occurs in:
A nurse is preparing to administer insulin to a client who is overweight. At what angle should the nurse insert the needle?
A nurse is preparing to administer insulin to a client who is overweight. At what angle should the nurse insert the needle?
Which of the following actions should the nurse include in the plan of care for a client at risk for aspiration?
Which of the following actions should the nurse include in the plan of care for a client at risk for aspiration?
A client is receiving nutrition through a nasogastric tube due to difficulty swallowing after a stroke. Which of the following could indicate that the client has developed aspiration pneumonia?
A client is receiving nutrition through a nasogastric tube due to difficulty swallowing after a stroke. Which of the following could indicate that the client has developed aspiration pneumonia?
When caring for a client with dysphagia you should immediately collaborate with:
When caring for a client with dysphagia you should immediately collaborate with:
Which of the following instructions would be appropriate to give to assistive personnel regarding assisting patients with eating?
Which of the following instructions would be appropriate to give to assistive personnel regarding assisting patients with eating?
While obtaining a capillary blood sample for glucose testing, which of the following steps is essential to ensure accuracy of the result?
While obtaining a capillary blood sample for glucose testing, which of the following steps is essential to ensure accuracy of the result?
Why is it important to rotate insulin injection sites?
Why is it important to rotate insulin injection sites?
A nurse plans to administer a bolus feeding via nasogastric tube. Which of the following actions best promotes patient safety during this procedure?
A nurse plans to administer a bolus feeding via nasogastric tube. Which of the following actions best promotes patient safety during this procedure?
For a patient prescribed parenteral nutrition, which laboratory value is most important for the nurse to monitor regularly?
For a patient prescribed parenteral nutrition, which laboratory value is most important for the nurse to monitor regularly?
What safety measure should the nurse prioritize when administering total parenteral nutrition (TPN) through a central venous catheter?
What safety measure should the nurse prioritize when administering total parenteral nutrition (TPN) through a central venous catheter?
In providing nutritional support for clients, when is enteral nutrition preferred over parenteral nutrition?
In providing nutritional support for clients, when is enteral nutrition preferred over parenteral nutrition?
A nurse is caring for a client who is receiving continuous enteral feedings through a gastrostomy tube. Which action is most appropriate to assess the client's tolerance to the feeding?
A nurse is caring for a client who is receiving continuous enteral feedings through a gastrostomy tube. Which action is most appropriate to assess the client's tolerance to the feeding?
To reduce the risk of aspiration during enteral feedings, the nurse should ensure that the patient is in what position?
To reduce the risk of aspiration during enteral feedings, the nurse should ensure that the patient is in what position?
Which of the following is a contraindication for the use of enteral nutrition?
Which of the following is a contraindication for the use of enteral nutrition?
A client is experiencing difficulty swallowing medications. What is the MOST appropriate intervention the nurse can implement in collaboration with the provider?
A client is experiencing difficulty swallowing medications. What is the MOST appropriate intervention the nurse can implement in collaboration with the provider?
Which action is MOST important for the nurse to take before delegating the task of feeding a client with a history of aspiration to assistive personnel?
Which action is MOST important for the nurse to take before delegating the task of feeding a client with a history of aspiration to assistive personnel?
Which action should a nurse take to verify the correct placement of a newly inserted nasogastric tube prior to initiating feedings?
Which action should a nurse take to verify the correct placement of a newly inserted nasogastric tube prior to initiating feedings?
Which assistive device is MOST appropriate for a client who has weakness on one side of their body and is having difficulty feeding themselves?
Which assistive device is MOST appropriate for a client who has weakness on one side of their body and is having difficulty feeding themselves?
A nurse is providing education to a client with diabetes about foot care. Which of the following statements by the client indicates a need for further teaching?
A nurse is providing education to a client with diabetes about foot care. Which of the following statements by the client indicates a need for further teaching?
What should the nurse do if, while preparing to administer insulin, the client states they feel lightheaded and sweaty?
What should the nurse do if, while preparing to administer insulin, the client states they feel lightheaded and sweaty?
During mealtime, a client suddenly starts coughing forcefully and demonstrates signs of respiratory distress after taking a sip of water. Which of the following is the nurse's priority action?
During mealtime, a client suddenly starts coughing forcefully and demonstrates signs of respiratory distress after taking a sip of water. Which of the following is the nurse's priority action?
A nurse is preparing to administer thickened liquids to a client with dysphagia. Which of the following best describes 'honey-thick' consistency?
A nurse is preparing to administer thickened liquids to a client with dysphagia. Which of the following best describes 'honey-thick' consistency?
A nurse is reviewing the residual volume for a client receiving continuous enteral feeding via a gastrostomy tube. The residual volume is 300 mL. Which of the following actions is MOST appropriate based on this finding?
A nurse is reviewing the residual volume for a client receiving continuous enteral feeding via a gastrostomy tube. The residual volume is 300 mL. Which of the following actions is MOST appropriate based on this finding?
A client who had a stroke is being assessed for dysphagia. Which of the following observations during the oral feeding trial would MOST strongly suggest silent aspiration?
A client who had a stroke is being assessed for dysphagia. Which of the following observations during the oral feeding trial would MOST strongly suggest silent aspiration?
For a client with gastroesophageal reflux disease (GERD) and nocturnal aspiration risk, which of the following positions is MOST appropriate to maintain during and immediately following meals?
For a client with gastroesophageal reflux disease (GERD) and nocturnal aspiration risk, which of the following positions is MOST appropriate to maintain during and immediately following meals?
A speech therapist recommends the 'chin-tuck' swallowing technique for a client with dysphagia. Which statement BEST explains the physiological benefit of this technique?
A speech therapist recommends the 'chin-tuck' swallowing technique for a client with dysphagia. Which statement BEST explains the physiological benefit of this technique?
A client's blood glucose reading before breakfast is 65 mg/dL. The client is alert and oriented but reports feeling shaky and hungry. Which of the following is the nurse's MOST appropriate initial action?
A client's blood glucose reading before breakfast is 65 mg/dL. The client is alert and oriented but reports feeling shaky and hungry. Which of the following is the nurse's MOST appropriate initial action?
A nurse is caring for a client with type 1 diabetes who is prescribed insulin lispro (Humalog) and insulin detemir (Levemir). Which statement accurately compares these two types of insulin?
A nurse is caring for a client with type 1 diabetes who is prescribed insulin lispro (Humalog) and insulin detemir (Levemir). Which statement accurately compares these two types of insulin?
Before delegating the task of feeding a client with dysphagia to assistive personnel (AP), which factor is MOST critical for the nurse to assess and communicate to the AP?
Before delegating the task of feeding a client with dysphagia to assistive personnel (AP), which factor is MOST critical for the nurse to assess and communicate to the AP?
In which clinical scenario would enteral nutrition be MOST appropriate compared to parenteral nutrition for a client requiring nutritional support?
In which clinical scenario would enteral nutrition be MOST appropriate compared to parenteral nutrition for a client requiring nutritional support?
A client receiving total parenteral nutrition (TPN) via a central venous catheter develops a sudden onset of shortness of breath, chest pain, and anxiety. Which TPN-related complication should the nurse suspect FIRST?
A client receiving total parenteral nutrition (TPN) via a central venous catheter develops a sudden onset of shortness of breath, chest pain, and anxiety. Which TPN-related complication should the nurse suspect FIRST?
A nurse is providing discharge teaching to a client with dysphagia and a history of aspiration pneumonia. Which of the following home care instructions is MOST crucial for preventing future aspiration events?
A nurse is providing discharge teaching to a client with dysphagia and a history of aspiration pneumonia. Which of the following home care instructions is MOST crucial for preventing future aspiration events?
Which of the following conditions is a CONTRAINDICATION for initiating enteral nutrition via a nasogastric tube?
Which of the following conditions is a CONTRAINDICATION for initiating enteral nutrition via a nasogastric tube?
A nurse is prioritizing care for four clients receiving enteral nutrition. Which client is at HIGHEST risk for aspiration pneumonia?
A nurse is prioritizing care for four clients receiving enteral nutrition. Which client is at HIGHEST risk for aspiration pneumonia?
A client with rheumatoid arthritis has limited hand and wrist mobility, making self-feeding difficult. Which assistive device would be MOST beneficial to promote independence during mealtimes?
A client with rheumatoid arthritis has limited hand and wrist mobility, making self-feeding difficult. Which assistive device would be MOST beneficial to promote independence during mealtimes?
Flashcards
Overt aspiration
Overt aspiration
Noticeable symptoms of aspiration, like coughing or wheezing, as the body tries to clear the airway.
Silent aspiration
Silent aspiration
Aspiration without obvious symptoms.
Thickened liquids
Thickened liquids
Liquids thickened to different consistencies (nectar, honey, pudding) to reduce aspiration risk for clients with dysphagia.
Manifestations of Tube Feeding Aspiration
Manifestations of Tube Feeding Aspiration
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Assistive devices
Assistive devices
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Chin-tuck position
Chin-tuck position
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Rotation of the head to the affected side
Rotation of the head to the affected side
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Tilting of the head to the strong side
Tilting of the head to the strong side
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Supraglottic swallow
Supraglottic swallow
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Mendelsohn maneuver
Mendelsohn maneuver
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Glucose
Glucose
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Fasting blood glucose
Fasting blood glucose
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Hypoglycemia
Hypoglycemia
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Gastrostomy tube (G-tube)
Gastrostomy tube (G-tube)
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Nasogastric (NG) tube
Nasogastric (NG) tube
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Nasoduodenal tube
Nasoduodenal tube
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Nasojejunal (NJ) tube
Nasojejunal (NJ) tube
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Enteral nutrition
Enteral nutrition
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Parenteral nutrition
Parenteral nutrition
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Study Notes
Preventing Aspiration
- Aspiration happens when food, liquid, or other materials enter the lungs instead of air.
- Clients with dysphagia or poor swallowing reflexes are prone to aspiration.
- Medical conditions like stroke, acid reflux, mouth sores, and dental issues increase aspiration risk.
- Overt aspiration symptoms include sudden cough, wheezing, trouble breathing, congestion, heartburn, throat clearing, or chest discomfort.
- Silent aspiration has no obvious symptoms
Diet Modifications for Dysphagia
- Thickening liquids with gels or powders is prescribed for clients with dysphagia.
- Thinner liquids are usually easier to aspirate.
- Thickened liquid consistencies: mildly thick (nectar), moderately thick (honey), and extremely thick (pudding).
- Verify the liquid's consistency after adding thickener to ensure it has reached the expected thickness before consumption.
- Liquids that can be thickened include milk, tea, water, coffee, soup, juice, and nutritional supplements.
Nursing Assessment and Interventions
- Nurses should assess clients at risk for dysphagia.
- Place clients on NPO status and notify the provider immediately if manifestations of aspiration are noted.
Tube Feeding Aspiration Prevention
- Initial tube placement should be verified with an x-ray before initial use.
- Check tube placement every 4 hours by checking the pH of the gastric contents to help prevent aspiration .
- Check the client’s tube feeding tolerance every 4 hours by measuring the residual.
- Follow facility policy for residuals greater than 250 mL.
- Maintain the head of the bed at 30° to 45° during and for at least 1 hour following bolus feedings.
- Manifestations of tube feeding aspiration include difficulty or painful breathing, wheezing, a productive cough, or a fever of 38°C (100.4°F).
- Stop the tube feeding and immediately notify the provider if any manifestations occur.
Assisting with Eating and Feeding
- Ensure clients receive necessary assistance with eating or drinking.
- Assistance ranges from textural modification of food to posture manipulation.
- The goal is to provide nutritional support and prevent complications.
- RNs must assess clients’ ability to swallow safely before delegating feeding responsibilities.
- The nurse’s role includes providing assistance in making food choices based on diet and preferences, assessing chewing and swallowing abilities, and determining the support needed for feeding.
- Encourage clients to feed themselves to promote independence, if able.
- Position the client upright in a chair or raise the head of the bed to 90° to prevent aspiration.
Pre-Meal Considerations
- Ensure the client's needs are addressed that include restroom use, hand washing, dentures in place, hearing aids in place and surroundings free of clutter.
- Note if clients have all the necessary items within reach.
- Cut food into bite-sized pieces.
Swallowing Techniques
- Should be taught by a speech therapist.
- Clients with dysphagia or at risk for aspiration should receive a referral for a swallowing evaluation.
Swallowing Techniques - How to perform
- Chin-tuck position: Client holds the chin down to the chest while swallowing, narrowing the airway’s entrance to decrease aspiration.
- Rotation of the head to the affected side: Client turns the head to the affected side, which directs the food to the strong side.
- Tilting of the head to the strong side: Client tilts the head to the strong side to push food down that side.
- Supraglottic swallow: Client swallows food/liquid while holding the breath, protects the airway, and then coughs immediately after to remove any residual food.
- Mendelsohn maneuver: Client swallows, holds the swallow for 2–3 seconds, completes the swallow, and then relaxes.
Glucose Monitoring
- Glucose is the body’s major source of energy obtained from food.
- Blood glucose monitoring is performed to determine a client’s glucose level.
- Common times to check glucose levels include before or after meals or exercise, prior to going to bed, during times of illness, with the start of new medications, or when the client’s daily routine changes.
Fasting Blood Glucose
- Taken after a client has been NPO for at least 8 hours.
- The expected reference range for a client who does not have diabetes is 70 to 110 mg/dL.
- A blood glucose level of less than 140 mg/dL after eating 2 hours prior is considered within the expected reference range.
Hypoglycemia
- Occurs when the blood glucose level is less than 70 mg/dL.
- Treatment involves giving 15 g of carbohydrates, such as glucose tablets or gel, 4 ounces of regular soda or juice, 1 tablespoon of honey, or hard candy.
- Recheck blood glucose 15 minutes later and repeat until at least 70 mg/dL.
- Once normal, eat a snack or meal.
- Children usually need less than 15 grams of carbohydrates to fix a low blood glucose level; with infants needing 6 g, toddlers 8 g, and small children 10 g.
Insulin
- Prescribed for some clients with diabetes and is made in beta cells in the islets of Langerhans in the pancreas.
- Lowers blood glucose by using sugar to energize cells or storing it.
- Alpha cells in the islets of Langerhans make glucagon, which raises blood glucose.
- Administered via subcutaneous injection.
- Dosed by units (U), commonly U-100 (100 units/mL).
- Types vary by onset, peak, and duration: rapid-acting, regular/short-acting, intermediate-acting, long-acting, and ultra long acting.
Insulin Administration
- Check blood glucose levels before injection.
- Ensure correct insulin type and dose; gather equipment.
- Avoid injecting into scars or within 2 inches of the navel.
- Do not administer in bruised, tender, or swollen areas.
- Inject at a 45° angle for emaciated clients or a 90° angle for others.
- Hand hygiene and monitor client tolerance of medication.
Gastrostomy Tube (G-tube)
- Delivers nutrition directly into the stomach through the abdomen for clients unable to consume enough nutrition on their own.
- Placement performed by a surgeon.
- Client remains NPO for at least 8 hours prior to the procedure.
- Three insertion methods: percutaneous endoscopic gastrostomy (PEG), laparoscopic, and open surgery.
- PEG is the most common technique.
- Can provide total or supplemental dietary intake.
Nasogastric (NG) Tube
- A thin plastic tube inserted into the nostril down the esophagus to the stomach.
- Used to provide nutrition and medication or remove stomach contents, facilitated by suction.
- Requires a provider's prescription and insertion by a trained RN or PN.
- Placement must be verified by x-ray prior to use.
- Taped to the client’s nose to secure it.
Nasoduodenal Tube
- Inserted into the nasal passage, with the tip placed past the stomach and in the duodenum.
- Used primarily for feedings for clients needing long-term enteral feedings or who require total or supplementary feedings and for whom gastric feeding is not appropriate.
- Fluoroscopic assistance can aid in achieving appropriate positioning of this tube during insertion.
- An abdominal x-ray can confirm placement before the tube is used.
Nasojejunal (NJ) Tube
- A thin, soft tube that is inserted through the nostril and stomach, ending in the jejunum of the small intestine.
- Used for clients unable to consume enough nutrition, cannot tolerate foods and liquids in their stomach, or have delayed gastric emptying.
- Placed by a provider using guided radiology and verified by x-ray.
- Taped to the client’s cheek to secure it.
Enteral Nutrition
- Dietary intake via a medical device like a feeding tube.
- Prescribed for clients with inadequate oral intake to meet metabolic needs.
- Often used for clients who cannot eat safely due to swallowing impairments or dysphagia.
- Can provide total sustenance or supplement the diet.
- Associated with improved nutrition, a lower incidence of infection, and decreased days in the hospital.
- Contraindications include gastrointestinal bleeding, small or large bowel obstruction, and bowel ischemia.
Parenteral Nutrition
- Dietary intake administered intravenously (IV).
- Can prevent malnutrition by replacing missing nutrients.
- Provides liquid nutrients: proteins, fats, carbohydrates, minerals, electrolytes, and vitamins.
- Used for clients with a digestive system that cannot absorb or tolerate adequate food intake.
- Administered into a large vein through a venous access device.
- Nutrition can be customized per individual requirements and lab results.
Partial vs. Total Parenteral Nutrition
- Partial parenteral nutrition supplies part of the nutritional requirements, allowing for supplemental oral intake.
- Total parenteral nutrition gives the client their total daily nutritional requirements.
- For clients without a functioning GI tract, total parenteral nutrition may be the only option.
- A complication of total parenteral nutrition is abnormalities in glucose, including high blood glucose, which should be monitored.
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