Nursing Care Plan (NCP) for Aspiration

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Outline

Pathophysiology

Aspiration occurs when something enters into the lungs that is not air. If this inhalation progresses to infection, aspiration pneumonia can develop.

This is likely caused by someone losing their gag reflex but can also be caused by inability to clear secretions/emesis, as well as from a position or medication (such as a sedative medication). Someone with dysphagia, no matter the cause is at high risk for aspiration.

Etiology

This is likely caused by someone losing their gag reflex but can also be caused by inability to clear secretions/emesis, as well as from a position or medication (such as a sedative medication). Someone with dysphagia, no matter the cause is at high risk for aspiration.

Desired Outcome

Patent airway, oxygenation maintenance, prevention of further complications such as pneumonia.

Subjective Data:

  • Shortness of breath 
  • Difficulty breathing 
  • Chest pain

Objective Data:

  • Coughing 
  • Low oxygen saturation 
  • Tachypnea/dyspnea 
  • Blue lips/fingers 
  • Lung sounds (crackles and/or diminished
  • Frothy sputum

Nursing Interventions and Rationales

Nursing Intervention (ADPIE) Rationale
Assess respiratory function -lung sounds, O2 Sats, skin color, chest symmetry  will assess baseline for patient and whether their respiratory function is getting better or worse with interventions 
maintain patent airway- NPO, HOB>30 Degrees, oral hygiene, suction equipment in room, O2 in case Keep the airway protected. Maintain proper ventilation/oxygenation
Perform a swallow screen test should be performed with thin liquids at bedside (if not NPO status) checks patients swallowing ability. If fails, patient goes to NPO status, and notify physician 

Note: swallow study is done in radiology if they fail the screening test

Acquire a chest x-ray this will see if a patient has aspirated, whether they have acquired pneumonia or not
Lab testing/ABG/sputum-blood cultures  blood gas- monitors PaCO2/PCO2 & PaO2/PO2

CBC- Monitors WBC count 

Sputum/Blood Cultures-may be needed an able to make sure the patient is receiving the right antibiotic therapy if needed

Antibiotic therapy-

Clindamycin & Metronidazole

may be prophylaxis, or because patient developed pneumonia. Clindamycin is most commonly used for aspiration pneumonia. Metronidazole can be used in conjunction with Clindamycin for further coverage 

Writing a Nursing Care Plan (NCP) for Aspiration

A Nursing Care Plan (NCP) for Aspiration starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/dysphagia-what-happens-during-a-bedside-swallow-exam

Aspiration

https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/aspiration-pneumonia

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Transcript

Hey everyone. Today, we are going to be putting together a nursing care plan for aspiration. So, let’s get started. So we’re going to go over the pathophysiology. So aspiration occurs when something enters into the lungs that is not air. If this ventilation progresses to infection, aspiration pneumonia can develop. Some nursing considerations. We want to make sure we’re doing a full respiratory assessment, maintaining a patent airway, performing a swallow screen test, doing some labs, ABGs, and administering medications. Desired outcomes. We want to make sure that the patient has a patent airway, oxygenation maintenance, and prevention of further complications, such as pneumonia. 

So we’re going to go ahead and get started on the care plan. We’re going to have some subjective data and we’re going to have some objective data. So what are we going to see with the patients that are aspirating? They may have some shortness of breath and they may have some chest pain. Some objective data: coughing, maybe blue lips if they’re aspirating or some frothy sputum. Some other things: they may have difficulty breathing, some low oxygen saturation, adventitious lung sounds. You might hear some crackles or some diminished sounds. 

So with our interventions, we’re going to assess their respiratory function. We’re going to look for their skin color. Is it blue? Is it pink? Are they oxygenating enough? You’re going to be looking for chest symmetry. So you want to make sure we’re assessing the entirety of the respiratory function. See what their baseline is. See when we do some interventions, if it’s improving or not. Another intervention we’re going to be doing is to make sure we’re maintaining their airway. So maintaining the patient’s airway. So we’re going to keep them NPO. Make sure they’re doing oral hygiene. Make sure we have suction equipment in the room. Always, always make sure we have suction equipment because you never know if you’re going to need it to help try to clear their airway if the patient’s not able to clear it themself. Also, any O2, in case you may need O2 for your patient. Another intervention we’re going to be doing, we’re going to perform a swallow screen test. Now the swallow screen test is done at the bedside. So this is going to be performed with thin liquids at the bedside. We’re going to check the patient’s swallowing ability. If the patient fails this test, the patient will go to NPO status and you’ll notify the physician. I do want to note a swallow study is done in radiology if they fail the screening test. Another intervention we’re going to be doing is acquiring a chest X-ray to see if the patient may have aspirated and whether they have acquired any sort of pneumonia. Another intervention we’re going to be doing are labs, ABGs, or sputum culture. So the blood gases, we’re going to monitor the PaCO2 and PaO2 levels. For the labs, we’re going to be looking for CBC, which is going to monitor their white blood cell counts. And for the sputum, we’re going to be checking to see if there’s any sort of pneumonias, the type of bacteria that we’re going to be treating, and making sure that the patient’s going to be on the right antibiotic therapy. So then we’re also going to be given the patient medication. So antibiotic therapy, such as clindamycin and metronidazole. So it may be prophylactic measures, or if the patient had developed pneumonia, clindamycin is commonly used for aspiration pneumonia, and metronidazole can be used in conjunction with the clindamycin for any further coverage that the patient needs. 

Alright, so now we’re going to look at some of the key points for the care plan. So aspiration occurs when something enters into the lungs, that’s not air likely caused by someone losing their gag reflex, or the inability to clear secretions on their own. Some subjective and objective data. They’ll have some shortness of breath, chest pain, difficulty breathing, some coughing, low oxygen saturation, blue lips, or fingers, frothy sputum. You want to do a full respiratory assessment and perform a swallow screen test bedside. We’re going to give meds. We’re going to do labs. Make sure they have a patent airway. So we’ll be giving those meds, doing the labs, checking the white blood cells and ABGs. X-ray just to see if they have pneumonia. And once again, maintaining that airway is very, very important. 

Alright, you guys did awesome. We love you guys out. Be your best self today, and as always happy nursing.

 

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