Risk for Aspiration Nursing Diagnosis & Care Plans

Aspiration occurs when food, secretions, fluids, or other substances enter the airways of the lungs. When swallowing, the epiglottis should close over the trachea which prevents food or fluids from entering the trachea (often called the windpipe). If this mechanism fails, substances can end up in the lungs, which can cause complications such as aspiration pneumonia. Sometimes gastric contents can also reflux, which causes stomach contents to regurgitate into the esophagus.

People who have dysphagia, which is difficulty swallowing, are at the highest risk for aspiration. Older adults, those with a compromised airway or impaired gag reflexes, or the presence of oral, nasal, or gastric tubes are at an increased risk. Aspiration can cause choking, respiratory complications, infections, and can be fatal if not quickly recognized and treated. Prevention is the first step, and the nurse should assess risk factors before feeding the patient or providing oral medications to patients. For people with known dysphagia, aspiration precautions should be implemented.

In this article:

Risk Factors (Related to)

The following are common risk factors for aspiration:

Note: A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred. Nursing interventions are aimed at prevention.

Expected Outcomes

The following are common nursing care planning goals and expected outcomes for risk for aspiration:

Nursing Assessment

The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. In the following section, we will cover subjective and objective data related to risk for aspiration.

1. Identify patients at an increased risk for aspiration.
Patients with impaired swallowing (dysphagia) from a stroke, Parkinson’s disease, spinal cord injury or neurological damage with the inability to clear secretions require assessment and monitoring when providing anything by mouth.

2. Determine the level of consciousness.
Patients who are sedated either intentionally or unintentionally are at risk for aspiration. Patients with reduced consciousness may not be able to clear secretions themselves.

3. Assess gag reflex and ability to safely swallow.
The nurse should first assess the patient’s speech and any difficulty in speaking which may signal risk for aspiration. Assess dentition and the patient’s ability to close the lips, control tongue movement, the presence of facial symmetry, and the ability to cough. The nurse can assess the gag reflex by touching the back of the patient’s throat with a tongue blade or cotton swab. The patient may cough or initiate swallowing as a positive response. If not, do not provide anything by mouth and request further evaluation. It may also be useful to have a speech-language pathologist do a formal assessment of the patient’s swallowing ability.

4. Monitor for signs of aspiration after oral intake.
If a patient is pocketing food in the mouth/cheeks, clearing the throat or coughing while eating, drooling, or displaying any difficulty breathing while eating or drinking, these may be indicators of aspiration.

5. Monitor for tubes that increase aspiration risk.
An overinflated or underinflated tracheostomy or endotracheal cuff can increase the risk of aspiration. A nasogastric tube dislodged from the stomach can cause aspiration if gastric contents get into the lungs. Tube feedings with a large residual signal ineffective digestion and increase the risk of reflux and aspiration.

6. Auscultate lung sounds and assess respiratory status.
Adventitious lung sounds such as crackles or rhonchi may be heard with aspiration pneumonia. Any change in respiratory status such as an increased rate, effort, or declining SaO2 level needs immediate attention.

Nursing Interventions

Nursing interventions and care are essential for the patients recovery. In the following section, you will learn more about possible nursing interventions for a patient with a risk for aspiration.

1. Keep suctioning equipment at the bedside.
Patients at an increased risk for aspirating should have functioning suctioning equipment at the bedside for immediate use.

2. Performing suctioning as necessary.
Patients with a large amount of secretions or who cannot clear the secretion themselves may require frequent suctioning.

3. Keep the head of the bed elevated after feeding.
Whether self-feeding, assisting with feeding, administering medications or tube feedings, the head of the bed should remain elevated for 30 minutes to one hour after oral intake.

4. Implement other feeding techniques.
Patients who require assistance with feeding should be fed small bites slowly. Some patients may require coaching to remind them to chew and swallow. Allow rest before feeding times, as this may decrease the patient’s difficulty with swallowing. Do not distract or allow the patient to talk while chewing or swallowing.

5. Consult with speech therapy.
If swallowing is impaired, the patient requires further screening. A speech-language pathologist (SLP) can test swallowing with different foods and liquids. They can also teach the patient techniques to reduce swallowing such as the “chin-tuck” maneuver.

6. Follow diet modifications.
Use thickening agents as ordered and ensure proper diet modifications such as pureed or mechanical soft foods if these are specified. Thicker foods and liquids are less likely to be aspirated so diet recommendations should be instituted for people at high risk of aspiration.

7. Position properly.
Patients with drooling or uncontrolled secretions should be placed side-lying to allow secretions to drain and not pool in their mouths. Patients on continuous tube feeds should always have the head of the bed elevated at least 30 degrees.

8. Educate about conditions that can cause aspiration.
Esophageal strictures (narrowing of the esophagus) can trap food. Gastroesophageal reflux disease (GERD) is a condition that causes gastric acid to back up into the esophagus which can cause damage and lead to strictures. Delayed gastric emptying doesn’t empty food as quickly as it should which can cause reflux, vomiting, and other problems.

9. Request medication formulation changes.
Patients who cannot swallow pills may need medications to be administered in liquid, IV, or powder form. Some pills cannot be crushed and may not come in other forms. In these situations, the nurse should consult a pharmacist. Some patients may also be able to tolerate swallowing pills by placing the pill in applesauce or pudding.

10. Monitor tube-feeding patients closely.
Check residuals as ordered, often every 4 hours. Facility policy will dictate when residuals are too high. Always alert the provider if residuals are increasing, bowel sounds are hypoactive or absent, if there is any vomiting or frequent diarrhea, and if abdominal distention is observed.

11. Provide mouth care.
Mouth care prior to meals increases the desire to eat, while oral care following meals removes any residual food that could cause aspiration.

Nursing Care Plans

Nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for risk for aspiration.

Care Plan #1

Diagnostic statement:

Risk for aspiration as evidenced by a reduced level of consciousness secondary to coma.

Expected outcomes: