This NPR is on risk for aspiration. I passed it and was told it's perfect, but i passed it with the easiest instuctor ever.

Dysphagia
CVA
Pure/ thickened fluid diet
Dementia
Unable to elevate upper body
Poor oral care
Depressed gag reflex

Risk for aspiration related to depressed laryngeal and glottic reflexes secondary to CVA

Cerebral vascular infarction results when an area of the brain loses blood supply because of vascular occlusion. One of the signs of CVA is inability to swallow due to depresses laryngeal and glottis reflexes. (#7, 530) Depressed laryngeal and glottic reflexes places person at risk for aspiration. Risk for aspiration in the sate in which a person is at risk for entry of secretions, solids, or fluids into the tracheobronchial passages (#1, 247)
Ms. CR has a history of CVA and has dysphagia, this places her at risk for aspiration.
Patient will not aspirate while in my care as evidence by absent adventitious breath sounds.

1.assess level of consciousness.
2. Position patient in a high Fowler’s position (head of the bead elevated at least 45degrees)
3. Provide pureed and thick liquid diet
4. Provide oral care following each meal
5. Auscultate the lungs
6. place suctioning equipment at the bedside
7. Assess vital signs
7a. Assess blood pressure
7b. Assess respiration.
7c. Assess pulse
7d. Assess temperature.
8. Educate patient/ family about aspiration precautions.
9. Obtain WBC count
10. Assess oxygen saturation.
11. Assess mental status
12. Assess skin color

1.A decreased level of consciousness is a prime risk factor for aspiration
2. Patients with neuro-muscular dysfunction may not be able to change position most congruent to maintaining their airway.
3. Pureed and thick liquids are easy to swallow. This diet is often ordered for patients who have difficulty swallowing. Thick fluids have a slower transit time and allow more time to trigger the swallowing reflex(#6, 522)
4. it is important to remove residual from the mouth of the patient who is suffering from dysphasia as it can cause them to aspirate. Pocketed food can be easily aspirated at a later time (#9, 1298)
5. Stridor can be an indication of lower airway obstruction. (#3, 1298)
6. Suctioning may be necessary to clear the airway passage. (#3, 1318)
7a. Unusual increase in blood pressure may be a sign of hypoxia (#7, 724)
7b. tachypnea/dyspnea are signs of hypoxia.(#9, 724)
7c. Dysrhythmia is a sign of hypoxemia. Hypoxemia usually leads to hypoxia, which is life threatening. Tachycardia is a sign of hypoxia. (#9, 724)
7d. Patients with certain types of pneumonia (aspiration pneumonia) usually have a sudden onset of chills and rapidly rising fever (38.5 to 40.5 C or 101 to 105 F) (#7, 636)
8. Aspiration of gastric contents causes a chemical burn of the tracheobronchial tree and pulmonary parenchyma. An inflammatory response occurs. This results in the destruction of alveolar–capillary endothelial cells, with a consequent outpouring of protein-rich fluids into the interstitial and intra-alveolar spaces. As a result, surfactant is lost, which in turn causes the airways to close and the alveoli to collapse. Finally, the impaired exchange of oxygen and carbon dioxide causes respiratory failure. (#9, 681)
9. WBC's protect the body from invasion by foreign objects. WBC count is often elevated if infection is present. Pneumonia can be caused by aspirated food (#9, 872)
10. Pulse oximetry is performed to determine the need for oxygen and to evaluate the effectiveness of the therapy. Pulse oximetry can help to determine the need for oxygen therapy. Decreased oxygen saturation is a sign of hypoxia which could be caused by blockage of airway(#9, 638)
11. Changes in mental status, such as impaired judgment, agitation, disorientation, confusion, lethargy, and coma are signs of hypoxia. If hypoxia is not identified and treated early many complications and even death may occur. (#9, 724)
12. cyanotic nail beds are demonstrating central cyanosis (A late sign of hypoxia) (#7, 636)

1. I assessed patient to be alert. She responded to her name by opening her eyes.
2. I elevated the head of the bed 45 degrees when patient was at rest and 90 degrees during meals.
3. I attempted to feed patient on 4/23 with puree food and thickened liquids, however she pretended to sleep as soon as she hear me saying I was going to feed her. She ate breakfast on 4/24. Her meal was pureed and liquids thickened.
4. I provided oral are after breakfast. There was no residual left in the mouth
5. I auscultated lung sounds. Pt. had clear lung sounds
6. Suctioning equipment was kept at a bedside.
7a. I assessed blood pressure to be 132/72 on 4/23 and 128/65 on 4/24
7b. I assessed respirations to be 18 regular, non labored , deep on 4/23 and 20 on 4/24
7c. I assessed pulse to be 83 on 4/23 and 88 on 4/24
7d. I assessed temperature to be 98.9 on 4/23 and 99.2 on 4/24
8. I was unable to teach the patient about aspiration precaution due to dementia. I explained to pt’s daughter that she shouldn’t feed her mother by her self, since she cannot use suctioning equipment in case the pt. aspirates.
9. WBC count was 11.6H on 4/22, 12.3H on 4/23, 13.9H on 4/24
10. I assessed pulse oximetry to be 96% on
4/23 and 97% on 4/24
11. Patient is alert and responds to her name. I was unable to establish orientation to time and place due to patient’s inability to communicate.
12. I assessed patient’s skin to be pink

1. Pt. is alert and therefore this factor is not contributing to risk for aspiration.
2. Patient did not aspirate during meals and there was no stomach content in the lungs by the evidence of clear lung sounds.
3. Patient tolerated food well and didn’t aspirate.
4. patient did not aspirate residual left from the meal
5. Pt. doesn’t have airway obstruction caused by aspiration.
6. Patient did not aspirate while in my care, therefore suctioning equipment was not used. However if patient would’ve aspirated, suctioning would’ve cleared airway.
7a. patient’s blood pressure is slightly elevated; however it is not unusual for this patient since she has a history of HTN. Other assessments are needed to determine presence of hypoxia
7b. respirations are within a normal range which shows that pt. is not experiencing hypoxia.
7c. pulse is within a normal range, therefore pt. is not experiencing hypoxia and have not aspirated.
7d. temperature is slightly elevated, therefore an infections process is suspected. Thee is a possibility of aspiration pneumonia. To determine cause of temperature elevation more assessments are needed.
8. Daughter stated she will not feed her mother unless appropriate personnel is in the room.
9. elevated WBC count is an evidence of infection. This result is consistent with other findings (elevated temperature). Although there is a possibility of aspiration pneumonia, due to clear lung sounds, I believe this infection is of other origin
10. Patient is not experiencing hypoxia, therefore she did not aspirate
11. I was unable to determine orientation, however due to dementia; patient might not be oriented to time and place. Other assessments are needed to determine hypoxia
12. patient is not experiencing hypoxia