Killing me softly: Aspiration
Like all other dreams, nursing involves a step by step process. With each step being fulfilled, you learn more and you get closer and closer to achieving your dreams. Ria, a student nurse is a believer of this thought. One step at a time, she tells herself. Someday, she’ll get there. But for now, she still needs to graduate from nursing school and learn as much as she can.
Today is just like any other day for her, a day spent in the four walls of the hospital. She was roaming around the wards when she sees a patient’s folk approach and talk to the staff nurse on duty.
“Nurse, my patient wants to have her meal,” the folk says.
“Okay, Mrs. X. I’ll go there,” the staff nurse responds.
Wait, what? Why can’t the staff nurse just say “Okay, go on. She may have her meal?” Why does she have to go to patient? Why? While asking these questions, she observes as the nurse adjusts the bed and positions the patient on a high fowler’s position and gave an okay signal to the patient.
Why? She asks herself. What was that for?
Everybody loves to eat. Happy, or sad. Excited or depressed. In love or heartbroken. Yep, admit it, eating is one of the most favorite things people do. Maybe it’s because when we eat, it brings out a happy feeling, like it can suit all moods. However, not at all times does food bring out a pleasant effect. Sometimes, when someone isn’t careful enough, what one thought would make a person’s tummy happy might end up as the one causing a person’s life to end.
Aspiration: An overview
Aspiration is the inhaling of a liquid or object into the lungs, it may involve food, any type of liquid, and even stomach contents such as vomit and stomach acids. When such things go into the lungs, damage may occur as well as serious complications such as lung infection (pneumonia) and lung abscess or the collection of pus in the lungs. It is usually common in older patients who have dysphagia.
Aspiration may be caused by certain cases such as a decreased level of consciousness or awareness brought about by certain conditions like stroke, neurological diseases, brain injury and seizure. It may also be caused by a patient’s decreased or absent gag reflex, conditions that affect swallowing, conditions that affect the esophagus like esophageal stricture, Gastroesophageal reflux disease, any surgery that puts a patient under sedation or general anesthesia, drinking large amounts of alcohol, having a feeding tube such as an NGT and many more.
Preventing Aspiration: Role of Nurses
As they care for the sick, nurses play a role in preventing aspiration from happening in the clinical setting.
- If the nurse is caring for a patient who is conscious and able, he/she may position the patient properly by placing them on an upright position, either on a chair (if allowed), or positioning them on the bed like they are sitting upright before they eat food and/or drink fluids.
- Provide a 30-minute rest period before feeding, a well-rested person is more unlikely to have difficulty swallowing.
- For those patients with cognitive problems, never distract them. After eating, check the person’s mouth for leftovers and keep them upright for about 30 to 45 minutes more. Also, do not serve food for at least 2 hours before bedtime.
- For unconscious patients, never put objects, fluids or food in the mouth.
- Do not force feed a patient. Only feed him/her in small amounts unless indicated. Adjust the feedings and amounts of food given according to the patient’s tolerance.
- Watch out for signs of choking, soughing, throat clearing or struggle during eating.
- For patients with feeding tubes, keep the patient in an upright position as much as possible. If in cases wherein you need to place the patient on a flat position, turn the feeding pump off. Also, check for feeding residuals every 4-6 hours. Usually, 200-250 ml warrant medical attention.
- Provide oral care and regular cleaning of patient’s mouth. Studies show that regular dental care after each meal lowers the risk of aspiration pneumonia.
In clinical setting, even the smallest of things make the most difference. Yes, we do have a heavy workload, however, that must not interfere with us nurses caring for our patients holistically. So before you proceed with what you were doing, take some time and check your patient if all is still well. After all, it is what nurses must do, care for patients. Save not only you license, but help save lives as well.
Sources:
- http://www.sw.org/misc/health/Aspiration%20Precautions.html
- http://www.ucdmc.ucdavis.edu/otolaryngology/Health%20Information/ASPIRATION_PRECAUTIONS.pdf
- http://consultgerirn.org/uploads/File/trythis/try_this_20.pdf
Liane Clores, RN MAN
Currently an Intensive Care Unit nurse, pursuing a degree in Master of Arts in Nursing Major in Nursing Service Administration. Has been a contributor of Student Nurses Quarterly, Vox Populi, The Hillside Echo and the Voice of Nightingale publications. Other experience include: Medical-Surgical, Pediatric, Obstetric, Emergency and Recovery Room Nursing.
