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PERFORMING A BEDSIDE swallowing screen can help you to quickly identify patients with dysphagia and aspiration risk until further studies can be done by a speech-language pathologist. Patients may need a swallow screen if they have a neurologic disease, such as acute stroke, Parkinson's disease, or dementia, or a history of prolonged or multiple endotracheal intubations or tracheostomy.
* Review the patient's medical record for risk factors for dysphagia and aspiration.
* If he's tired, your patient may have more difficulty swallowing. Wait 30 minutes, then reassess his alertness before performing the test.
* Have suction equipment immediately available.
* Minimize environmental distractions and position him upright in a chair or elevate the head of the bed 60 to 90 degrees.
* Assess his mental status and make sure he can voluntarily cough, clear his throat, and swallow saliva before proceeding with the test.
If he's managing his oral secretions, offer him small bites of ice chips or sips of water from a cup or a teaspoon. Observe him carefully before, during, and after each offering for cough, drooling, voice change (especially a wet or gurgling quality), and swallowing difficulty. Stop the test immediately if any of these occur and notify his health care provider.
* If he can swallow without his voice or breathing sounding wet, and without choking or coughing, proceed with a soft diet, then if tolerated to a regular diet as ordered.
* If he has difficulty tolerating water, try giving him thickened liquid (the consistency of honey) by spoon and try pureed semisolids. Observe him for choking or coughing. If tolerated, proceed with a pureed or thickened liquid diet as ordered until he's formally evaluated by a speech-language pathologist or place him on N.P.O. status based on your observations.
* Provide diligent oral care to all patients with dysphagia, including those who are N.P.O.
* Notify the patient's health care provider of the results of the swallow screen so she can order an appropriate diet and additional testing, as indicated. Document the test results and subsequent actions in the patient's medical record.
* Don't offer semisolids, liquids, or solids (including oral medications) to a patient who can't swallow saliva or voluntarily cough and clear his throat.
* Don't leave the patient unattended during the test.
* Don't administer sedatives and hypnotics, if possible, because they can impair the cough reflex and swallowing.
American Speech-Language-Hearing Association. Swallowing Disorders in Adults. http://www.asha.org/public/speech/swallowing/SwallowingAdults.htm.
Metheny NA. Preventing aspiration in older adults with dysphagia. Try This: Best Practices in Nursing Care to Older Adults. Issue 20, revised 2007. http://www.hartfordign.org/publications/trythis/issue_20.pdf. Accessed May 8, 2008.
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