NURSING DIAGNOSIS: Impaired swallowing

related to weakness or paralysis of the swallowing muscles on the affected side and diminished or absent swallowing reflex.

Desired Outcome
The client will experience an improvement in swallowing as evidenced by:
  1. communication of same
  2. absence of food in oral cavity after swallowing
  3. absence of coughing and choking when eating and drinking.
Nursing Actions and Selected Purposes/Rationales
  1. Assess for signs and symptoms of impaired swallowing (e.g. communication of difficulty swallowing, stasis of food in oral cavity, coughing or choking when eating or drinking, abnormal results of swallow study).
  2. Implement measures to improve ability to swallow:
    1. place client in high Fowler's position for meals and snacks; head and neck should be tilted forward slightly to facilitate elevation of the larynx and posterior movement of the tongue
    2. provide oral care before meals and snacks (oral care stimulates sensory awareness and salivation, which facilitates swallowing)
    3. assist client to select foods that require little or no chewing and are easily swallowed (e.g. custard, eggs, canned fruit, mashed potatoes)
    4. instruct client to avoid mixing foods of different texture in his/her mouth at the same time
    5. avoid serving foods that are sticky (e.g. peanut butter, soft bread, honey)
    6. avoid foods that tend to fall apart in mouth (e.g. cake, muffins) and those that consist of small food particles (e.g. rice, peas, corn) if client has impaired tongue control
    7. serve foods/fluids that are hot or cold instead of room temperature (the more extreme temperatures stimulate the sensory receptors and swallowing reflex)
    8. serve thick rather than thin fluids or add a thickening agent (e.g. "Thick-it," gelatin, baby cereal) to thin fluids
    9. moisten dry foods with gravy or sauces (e.g. catsup, salad dressing, sour cream)
    10. utilize assistive devices (e.g. long-handled spoon) to place food that does not need to be chewed (e.g. gelatin, mashed potatoes, custard) in the back of mouth on unaffected side if tongue movement is impaired
    11. instruct client to avoid putting too much food/fluid in mouth at one time
    12. encourage client to concentrate on the act of swallowing; provide verbal cueing as needed
    13. if client has decreased lip control, instruct him/her to gently hold lips closed with fingers after putting food in mouth
    14. gently stroke client's throat when he/she is swallowing if indicated
    15. consult speech pathologist or therapist about methods for dealing with impaired swallowing; reinforce recommended exercises and techniques.
  3. Consult appropriate health care provider (e.g. speech pathologist, physician) if swallowing difficulties persist or worsen.