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Aspiration pneumonia prevention skilled nurse facility 2012
The document discusses aspiration as the inhalation of foreign materials into the trachea and lungs, highlighting the risks and preventive measures for aspiration pneumonia in at-risk patients. It outlines factors increasing aspiration risk, signs and symptoms to observe, and a multidisciplinary approach for assessment and intervention, including guidelines for mealtime practices and the use of feeding tubes. Lastly, it emphasizes the need for proper training for caregivers and includes a care bundle to systematically address aspiration risks.
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Aspiration pneumonia prevention skilled nurse facility 2012
- 1. skilled nursing facilitySNF 2012 Rumailah Hospital Dr. Ibrahim Mahamoud (Al –Omary) Geriatrics Department Rumailah Hospital
- 2. Aspiration Aspiration isdefined as the inhalation of food, fluid, saliva, medication or other foreign material into the trachea and lungs. Any material can be aspirated on the way to the stomach or as stomach contents are refluxed back into the throat.
- 3. Aspiration Pneumonia Prevention MultidisciplinaryTeam Approach Physicians Nurses Speech Language Pathologists Patient Care Assistants Dieticians and Nutrition Services Respiratory Therapists (RT) Quality Coordinator
- 4. Patients at RISKfor Aspiration 1) Being fed by others. (Caregiver , family member,....) 2) Inadequately trained caregivers assisting with eating/drinking . 3) Weak or absent coughing/gagging reflexes . 4) Poor chewing or swallowing skills Gastro-esophageal reflux disease (GERD, GER) . 5) Food stuffing, rapid eating/drinking and pooling of food in the mouth
- 5. 6) Inappropriate fluidconsistency and/or food textures 7) Medication side effects that cause drowsiness and/or relax muscles causing delayed swallowing and suppression of gag and cough reflexes 8) Impaired mobility that may leave individuals unable to sit upright while eating 9) Epileptic seizures that may occur during oral intake or failure to position a person on their side after a seizure, allowing oral secretions to enter the airway.
- 6. past medical historyfor aspiration risks Hx of past episodes of aspiration Hx of cerebral palsy, muscular dystrophy, epilepsy, GERD, Dysphagia or hiatal hernia Hx of aspiration pneumonia Needing to be fed by others Hx of choking, coughing, gagging while eating
- 7. MEALTIME BEHAVIORS THATMAY INDICATE ASPIRATION Eating slowly Fear or reluctance to eat Coughing or choking during meals Refusing foods and/or fluids Food and fluid falling out the person’s mouth Eating in odd or unusual positions, such as throwing head back when swallowing or swallowing large amounts of food rapidly Refusing to eat except from a “favourite caregiver.”
- 8. SIGNS AND SYMTPOMSTHAT MAY INDICATE ASPRIATION RISK Gagging/choking during meals Persistent coughing during or after meals Irregular breathing, turning blue, moist respirations, wheezing or rapid respirations Food or fluid falling out of the person’s mouth or drooling Intermittent fevers Chronic dehydration Unexplained weight loss Vomiting, regurgitation, rumination and/or odour of vomit or formula after meals
- 9. ASPIRATION INTERVENTIONS Call999 if the person stops breathing and start CPR Stop feeding/eating immediately Keep person in an upright position and encourage coughing Use suction machine If in doubt on what to do, call for help (? Doctor)
- 10. GUIDELINES ON HOWTO PREVENT OR MINIMIZE THE RISK OF ASPIRATION 1) Obtain a consultation by a swallowing specialist if symptoms occur 2) Change diet consistency, texture or temperature (need a physician’s order) 3) Slow the pace of eating and decrease the size of the bites 4) Position to enhance swallowing during meal times 5) Keep in an upright position after meals for 45 minutes or as ordered
- 11. 6) Elevate thehead of the bed 30 to 45 degrees 7) Avoid food/fluids 2-3 hours before bedtime 8) Consider the use of medications to promote stomach emptying, reduce reflux and acidity 9) Write an aspiration protocol and written instructions on how the person is to eat or be fed and provide caregiver training.
- 12. ASPIRATION RISKS ANDFEEDING TUBES Have a feeding tube does not eliminate the risk of aspiration. Stomach contents can still enter the airway via regurgitation or oral secretions can be aspirated if the person has dysphagia.
- 13. Some standard aspirationprecautions feedings in an upright sitting position and keep upright for at least 45 minutes after If the person must be fed in bed, keep the head of bed at a 45 degree angle while feeding and for 45 minutes to an hour after Don’t overfill the stomach Formula given at room temperature is better tolerated Don’t feed too rapidly; feedings should be administered over at least 30 minutes or as ordered
- 14. Aspiration & AspirationPneumonia Bundle 6 Bundle Elements: 1. Assess ALL patients for aspiration risk. 2. Bedside Swallow Screening. 3. Suction set-up at bed-side. 4. HOB at 30 degrees. 5. Frequent Oral Care. 6. Safe care delivery of 1:1 supervise/assist meals.
- 16. 1. Assess ALLpatients for aspiration risk
- 17. Posting at Headof Bed
- 18. 5. Frequent OralCare
- 19. 2. Bedside SwallowScreening
- 20. Education Tools: ‘Bundle’poster Oral Care Table Bedside Swallow Screening Tool Risk Assessment Flow Chart Nursing Bedside Swallow Screening
- 21. summary for prevention HOB 30°-45° Frequent and Thorough Oral Hygiene Routinely verify appropriate placement of feeding tubes Implement Bedside Swallow Screening
- 22. Investigations Blood count:CBC Electrolytes and renal function. Blood culture Blood gases ABG , if hypoxia Culture of sputum: (Many aspiration pneumonias are mixed aerobic-anaerobic infections). Chest x-ray Right middle and lower lung lobes are the most common sites. Aspiration when upright may cause bilateral lower lung infiltrates. Lung CT Bronchoscopy . If foreign body are suspected.
- 23. Management Oxygen Trachealsuction if seen early. Initial empirical antibiotic therapy while awaiting culture results.( cefuroxime plus metronidazole) or Tazocin (piperacillin and tazobactam). Mechanical obstruction: removal of object normally by Bronchoscopy Intubation with positive pressure ventilation may be required..
- 24.