Domain 2. Nutrition
Class 1. Ingestion
Diagnostic Code: 00103
Nanda label: Impaired swallowing
Diagnostic focus: Swallowing
Nursing diagnosis refers to a clinical judgment about a patient’s capacity for health and functioning. In the case of impaired swallowing, this particular nursing diagnosis is used to profile the patient’s present condition as well as their capacity for successful treatment, prevention and management of the disorder. It takes into account ethnicity, geographical factors, age, living situation and medical history. This particular diagnosis can have a range of causes which is why it's important for healthcare professionals to properly diagnose individual patients in order to take any necessary steps for optimal care.
NANDA Nursing Diagnosis Definition
According to NANDA International, the official definition of the nursing diagnosis “impaired swallowing” is an “inability to swallow, or dysphagia, which may be related to disrupted control or coordination of swallows, absent or underdeveloped swallowing reflex or structural defects”. Impairments of this nature can range from mild to serious and can compromise a patient’s capacity to eat and drink safely and gain adequate nutrition and hydration.
Defining Characteristics
Subjective: Patient reports feeling of food sticking in throat, coughing while swallowing and pain while swallowing.
Objective: Difficulty in handling saliva, difficulty in propelling food or liquids to swallow, coughing of food or liquids, recurrent aspiration, laryngeal penetration, and/or rapid reduction in food textures.
There are several possible contributing factors that can cause impaired swallowing. These include neurological disorders (e.g. stroke), neuromuscular illnesses (e.g. muscular dystrophy), use of medications, post-surgical restrictions, brain tumor, head or neck deformities, gastroesophageal reflux, scoliosis, temporomandibular joint disorders, arthritis and dental problems.
At Risk Populations
Patients at risk of impaired swallowing include those with following primary or secondary conditions: Parkinson’s disease, dementia, stroke, head and neck cancer, esophageal cancer, chronic lung disease, cerebral palsy, multiple sclerosis and traumatic brain injury. Additionally, those who are not adequately nourished, dehydrated, bedbound or intubated patients may also be at risk.
Associated Conditions
Aspiration pneumonia and dehydration are two secondary conditions that can occur if left untreated. Swallowing disorders can lead to malnutrition which causes weakened immune systems, problems with wound healing, impaired memory and cognitive abilities, muscle deterioration and poor recovery from diseases or other medical conditions.
Suggestions of Use
Nursing diagnosis for impaired swallowing should be performed in conjunction with full assessment of the patient’s physical, neurological and psychological condition. Evaluation should include dietary history, nutritional status, symptoms and signs of aspiration, methods of oral administration, ability to clear oral secretions, and evaluation of protective reflexes.
Suggested Alternative NANDA Nursing Diagnosis
Alternative diagnoses that can assist in determining patient care plans include: Imbalanced Nutrition (less than body requirements), Risk for Aspiration and Activity Intolerance. Imbalanced Nutrition (less than body requirements) may be applicable if patient cannot or will not orally ingest the necessary nutrients while Risk for Aspiration and Activity Intolerance may be applicable if patient has difficulty breathing or communicating when suffering from decreased glandular or systemic strength
Usage Tips
It is important to create a detailed nursing care plan based on the nursing diagnosis. Practices that can enable efficient execution of patient careplans include taking into account environmental factors, providing regular checks for aspiration, creating small amounts of food for intake, always having a gravity feed set ready for use and adapted utensils when necessary.
NOC Outcomes
Nursing Outcome Classification (NOC) consists of thirteen outcomes that should be observed under nursing diagnosis impaired swallowing. This list infers the patient’s ability to swallow and rate of swallowing, ability to tolerate oral diet and fluid intake, frequency of coughing and choking during meals, details of notifying feeding specialists, ability to communicate hunger and satisfaction of food, ability to maintain a safe diet, ability to manage elimination, development of infection and degree of safety when able to consume foods by mouth.
Evaluation Objectives and Criteria
The main objective when evaluating a patient’s swallowing impairment is assessing its severity. Criteria should include the quantity of food and liquids that can be safely consumed in a timely manner and the quality of items that can be ingested with little to no choking or stage-two homogenous diet.
NIC Interventions
When treating a patient with nursing diagnosis impaired swallowing, there are several Nursing Intervention Classification (NIC) practices to consider. These include alleviating discomfort and airway obstruction, providing nutrition education, providing emotional support, preventing further complications, managing oral hygiene and promoting safety measures.
Nursing Activities
Once an appropriate nursing intervention has been determined and implemented, it is important to monitor the patient’s response in order to make necessary adjustments. The most appropriate activities to carry out during nursing diagnosis impaired swallowing include suctioning, administering medications and therapies, assisting with mealtime needs, performing a swallowing evaluation and providing psychosocial interventions.
Conclusion
People suffering from impaired swallowing need the help of nurses, in order to ensure their safety and to prevent further harm. Nursing diagnosis for impaired swallowing should focus on properly diagnosis patients, monitoring their progress and taking the best course of action for efficient management of the condition.
FAQs
- What is nursing diagnosis? Nursing diagnosis is a clinical judgment about a patient's capacity for health and functioning, based on the patient's ethnicity, geographical region, age, living situation, and medical history.
- What are the defining characteristics of impaired swallowing? Defining characteristics include difficulty propelling food or liquids to swallow, coughing or choking while swallowing, recurrent aspiration, and rapid reduction in food texture.
- What are the primary and secondary conditions that cause impaired swallowing? Possible primary conditions include neurological disorders (e.g. stroke), neuromuscular illnesses (e.g. muscular dystrophy), and post-surgical restrictions. Secondary conditions can include aspiration pneumonia and dehydration.
- What are the suggested alternative NANDA nursing diagnoses? Suggested alternatives include Imbalanced Nutrition (Less than Body Requirements), Risk for Aspiration, and Activity Intolerance.
- What are some nursing activities used to treat impaired swallowing? Common activities include providing nutrition education, performing a swallowing evaluation, and providing psychosocial interventions.