Question

The nurse is caring for a client with dysphagia and is feeding her a pureed chicken diet when she begins to choke. What is the priority nursing intervention? a. Suction her mouth and throat. b. Turn her on her side. c. Put on oxygen at \(2 \mathrm{~L}\) nasal cannula. d. Stop feeding her.

Short answer

d. Stop feeding her.

Step-by-step solution

Assess the Situation

The nurse needs to quickly assess the client's level of distress and ability to breathe. If the client is choking, she cannot manage her secretions or the pureed food, which indicates her airway may be compromised.

Immediate Action

To respond to a choking client, the nurse should immediately stop feeding to prevent further aspiration of food into the airway.

Additional Interventions

After stopping the feeding, additional interventions can be considered based on the client's needs and response, such as repositioning the client, suctioning if appropriate, or administering oxygen if the choking is resolved but the client shows signs of respiratory distress.

Key concepts

Choking Management in Healthcare

When a patient begins to choke, as in the case of the client with dysphagia, immediate action is required to prevent an obstruction of the airway. In a healthcare setting, professionals are trained to follow a set of protocols to manage choking. The most critical step is to stop feeding the patient, as stated in the step-by-step solution.

After ensuring no more food is introduced, a quick assessment of the patient's ability to cough or breathe will determine the subsequent steps. If the patient is coughing vigorously and can breathe, this is a good sign, indicating that their airway is not completely blocked. However, if the cough is weak or they are unable to breathe or speak, this suggests a more serious blockage.

Heimlich Maneuver

When an obstruction is suspected, and the patient is conscious, staff may perform the Heimlich maneuver or abdominal thrusts. This technique applies pressure on the bottom of the diaphragm to expel the object causing the obstruction. In a healthcare setting, nurses and other staff must be adequately trained and certified to perform these life-saving techniques.

Advanced Support

If the patient becomes unconscious, or if initial attempts to clear the airway are unsuccessful, advanced airway management may be necessary, including the possible use of suction devices or emergency tracheal intubation. It's crucial for healthcare providers to work efficiently and effectively as a team during such emergencies to optimize patient outcomes.

Nursing Care for Aspiration

Aspiration occurs when something enters the airway or lungs by accident. In the context of dysphagia, there is an increased risk of food, liquids, or saliva getting aspirated. Nursing care for aspiration is about prevention, early recognition, and responding quickly to potential or actual aspiration events.

Positioning

Proper positioning can be a pivotal aspect of care, particularly during feeding. Elevating the head of the bed to at least 30 degrees during and after feeding can help prevent aspiration, enhancing the effect of gravity on the esophagus and lessening the likelihood of material entering the airway.

Feeding Techniques

Training on feeding techniques is also crucial. This includes techniques such as small bites, encouraging the patient to chew thoroughly, alternating solids and liquids, and monitoring the patient closely for signs of difficulty swallowing or aspiration during feeding.

Immediate intervention upon signs of choking includes stopping feeding, as previously discussed, but can also extend to suctioning. Suctioning the oral cavity helps to remove any aspirated material and prevent further aspiration into the lungs, a technique that can sometimes be the first course of action.

Airway Management in Nursing

Airway management is a fundamental component of nursing care, particularly in patients with conditions such as dysphagia that increase the risk of aspiration and choking. Nurses are trained to ensure that the patient's airway is clear and to take swift action if it becomes obstructed.

Early recognition of airway compromise is paramount, as highlighted when the client began to choke on pureed chicken. The cessation of feeding is the primary and most immediate intervention to prevent further compromise of the airway.

Oxygen Therapy

After attending to an obstruction, nurses often administer oxygen therapy if the patient exhibits signs of respiratory distress. This can help stabilize the patient's oxygen levels while additional assessments and interventions are carried out.

Post-Choking Monitoring

Once a choking emergency is resolved, continuous monitoring is vital to ensure the patient's airway remains clear, and there are no delayed complications. Respiratory sounds are assessed for any abnormalities, such as wheezing or gurgling, that may indicate remaining obstruction or aspiration. Additionally, nurses must remain vigilant for signs of respiratory infection, which can occur after aspiration of foreign material into the lungs.