As nurses know, one of the common residual effects of a stroke for a patient is dysphagia. Dysphagia requires a thorough medical evaluation and nursing assessment of the patient to avoid additional complications such as aspiration, choking, pneumonia and death.
Upon admission, one of a nurses responsibilities is a thorough nursing assessment and evaluation of the extent of a patients dysphagia. The evaluation process, called a nursing swallow screen, involves the use of one or several techniques or tests. Based on the outcome of the screen, the patient then is placed on a special diet, a regular diet or remains NPO until he or she is evaluated by a speech pathologist.
Once the patients swallowing abilities are documented, a diet that fits the patients strengths and weaknesses is established in consultation with the speech pathologist. However, once the diet is ascertained, it becomes a nursing responsibility to ensure the diet is one the patient can handle successfully.
Monitoring the patient
Regular scrutiny of a patients meals is vital. The dysphagic patient should not be given food that requires extensive chewing or that may be difficult to swallow. A patient with difficulty swallowing may need clear liquids only or may do better with pureed foods.
Ensuring the ordered diet is the correct one for the patient also requires careful observation of the patient when he or she eats or drinks the first meal. In reality, observation may need to be ongoing, and depending on the patients condition, he or she may require assisted feeding during the initial phases of hospitalization. If difficulties arise with the diet prescribed for the patient, nurses should notify members of the care team. The patient may be placed on IV fluids for a time until further evaluation is completed. A speech pathologist usually is available for ongoing consult and help throughout the patients hospitalization.
Delegation of care
It may be necessary to delegate the observation and assessment of the patients swallowing abilities during meals. Delegation is a nursing responsibility that requires nursing judgment and critical thinking. Therefore, it cannot be passed on to just anyone on the nursing team. Delegating assistance with feeding for a dysphagic patient is a crucial nursing role. The Five Rights of Delegation reflect your standard of care in this role.
If you decide to delegate the monitoring of the dysphagic patient during meals, or you are a nurse manager whose staff is delegating patient care, be certain that these delegation principles are followed. The patients very life may be at risk if not carefully assisted and observed during food intake. In addition, you may face liability for improperly delegating or for failure to properly manage your staff when they delegate this important nursing responsibility.
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