Preventing Aspiration in a Patient with Dysphagia

Scenario

You are caring for a stroke patient with new-onset dysphagia who begins coughing during breakfast and has a wet, gurgling voice afterward.
O₂ saturation drops to 90% on room air.

Question: What are your immediate nursing actions, and how do you prevent aspiration-related complications?

Best Practice Answer

1. Recognize Aspiration and Stop Oral Intake Immediately:

   • Coughing, choking, or voice changes after swallowing indicate possible aspiration.
   • Stop feeding at once and do not offer fluids or meds orally until cleared.
   • Position the patient upright (≥ 45°) and maintain head elevation even after the episode.

2. Immediate Actions:

   • Assess airway: If patient is coughing effectively, encourage continued coughing to clear airway.
   • Check SpO₂: If SpO₂ < 92%, apply supplemental oxygen and monitor closely.
   • Suction oropharynx if secretions are audible or patient cannot clear effectively.
   • Notify provider of possible aspiration event.

3. Collaborate and Evaluate:

   • Request a speech-language pathology (SLP) evaluation for formal swallow assessment.
   • Anticipate orders for NPO status until safe swallowing confirmed.
   • Administer meds via IV or alternative route if necessary.
   • Monitor for delayed complications — fever, crackles, increased sputum, or infiltrates (early signs of aspiration pneumonia).

4. Preventive Strategies Going Forward:

   • Maintain upright position (≥ 90°) during feeding and for 30–45 minutes afterward.
   • Chin-tuck technique or thickened liquids as recommended by SLP.
   • Provide small bites, slow pace, and frequent oral care.
   • Avoid straws unless specifically cleared.
   • Supervise all meals for high-risk patients.

5. Documentation:

   • Record event details (time, symptoms, O₂ saturation, interventions).
   • Document provider notification, orders received, and patient response.
   • Note SLP referral and diet changes.

Real-World Application

Aspiration is a common and preventable hospital-acquired complication, especially in neuro and geriatric units.
This scenario evaluates your ability to:

• Identify aspiration early
• Act immediately to protect the airway
• Coordinate interdisciplinary care (RN–SLP–MD)

Preventing aspiration directly impacts patient safety metrics and hospital readmission rates.

Tip: In interviews, summarize clearly —
“At the first sign of aspiration, I stop feeding, position the patient upright, assess airway, apply oxygen, notify the provider, and request a swallow evaluation before resuming any oral intake.”
That concise structure reflects clinical vigilance, safety-first reasoning, and interdisciplinary collaboration.