Dysphagia
Surviving a severe stoke often leads to a new problem. Almost half of patient affected by severe stroke develop difficulty in swallowing that is known as dysphagia. People in this condition have trouble in holding food and fluid in their mouth or swallowing. When food passes from the mouth into oropharynx and laryngopharynx, it enters the esophagus and muscular contraction propels it to the stomach, but when process goes wrong the food and fluids re-enter the esophagus which is known as reflux (Nozarka, 2010).
There are factors that disrupt normal swallowing. These include stroke, age-related changes, medication and neurological disease (Nozarko, 2010). Signs of dysphagia are cough during eating, change in voice tone or quality after swallowing, abnormal movements of the mouth, tongue or lips and slow, weak, precise, or uncoordinated speech. Other signs of the disease are abnormal gag, delayed swallowing, incomplete oral clearance or pocketing, regurgitation, pharyngeal pooling, delayed or absent trigger of swallow, and inability to speak consistently (Potter & Perry, 2009).
Dysphagia can leads to aspiration pneumonia. During aspiration, the food or fluid passes through the vocal folds and enters the airway. It can be caused by impaired laryngeal closure or overflow of food or liquids retained in pharynx. This increases the risk of choking and aspiration pneumonia. Through coughing the body tries to free from aspiration that helps to clear food and fluid from lungs. However, silent aspiration is very dangerous because food and fluid penetrate the airway and move deep into the lungs that cause major respiratory problems. Dysphagia also results to malnutrition and dehydration. This increases the risk for pressure ulcer (Nozarko, 2010).
Assessment of the gathered data leads to a nursing diagnosis. A client who is a stroke survivor complains in difficulty when swallowing that is associated to deficit in oral, pharyngeal, or esophageal structure or function. In this case the nursing diagnosis is impaired swallowing related to neurological problem (Ackley & Ladwig, 2011).
As a caregiver of a client in this condition, setting goals and outcome is needed. The goal and outcome for a client suffering from dysphagia are; the client can effectively swallow without choking within seven days, and the client will be free from aspiration evidence by clear lung sound within five days (Ackley & Ladwig, 2011).
To meet the goals and outcomes for this patient first determine the severity of dysphagia. “If a person has mild dysphagia, simply provide a suitable and advice about eating slowly and sitting upright while eating may enable the person to remain well nourished [sic] and problem free” (Nozarka, 2010, para.
Unpleasant breathlessness that comes on suddenly or without expectation can be due to a serious underlying medical condition. Pneumonia can impact the very young and very old, asthma tends to affect young children, smokers are at greater risk of lung and heart disease and the elderly may develop heart failure. However, medical attention always needed by all these conditions as it can affect any age group and severe breathlessnes. There are short and long term causes of dyspnea. Sudden and unexpected breathlessness is most likely tend to be caused by one of the following health conditions. There is accumulating evidence that in many patients, dyspnea is multifactorial in causes, and that in most patients, there is no single, all-encompassing explanation for dyspnea.
As mentioned beforehand flaccid dysarthria occurs when there is damage to the lower motor neurons, specifically the region affected is the pons and the medulla located in the lower brainstem. An injury at this site is going to cause any number of the following characteristics to manifest: breathiness, hypernasality, short phrases, monopitch, imprecise consonants, diplophonia, poor intelligibility, impairment in elevating the tongue, drooling and or poor lip seal. Basically any of the subsystems of our speech system can be affected such as resonance, articulation, phonation, respiration and/or prosody. The damage that is caused to the lower motor neurons can be attributed ...
The most common speech symptom is hypophonia which is reduced vocal loudness. Hypokinetic dysarthria often is associated with variables of pitch and loudness where a patient may be monopitch or exhibit monoloudness (Johnson & Adams, 2006). Speech movements ...
In this case we are presented with Dr. Marshall Westood who was sitting down for dinner that consisted of pufferfish and rice. Within an hour of eating his meal Dr. Marshall Westwood felt numbness to his lips and tongue, which quickly spread to his face and neck. The symptoms increasingly got worse as he began to feel pain in his stomach and throat that lead to severe vomiting. He was soon after rushed to the hospital. On the way there he experienced difficulty breathing and health care workers had to maintain a patent airway. At this point Dr. Marshal Westwood was experiencing paralysis to the upper body that included the face and the neck. His vital signs showed that he was having an irregular heartbeat. When admitted to the hospital he was given activated charcoal which helped absorbed any remnants of chemicals still present in his stomach. Within a few hours, Dr. Marshall Westwood ‘s symptoms were subsiding and his condition improved.
In the adult intensive care unit, the patients who are mechanically ventilated with a need for enteral nutrition will be the population in question. The intervention is the use of small bowel enteral feedings, and the control is the feeding route via a gastric tube. The intervention and the control are the two aspects one wishes to compare. The outcome in question is decreased aspiration of enteral feedings. The research question can be stated as the following: In the adult intensive care unit, with ages ranging from 18-89 years, intubated and mechanically ventilated critically ill patients who require enteral nutrition will have a decreased risk for aspiration with the implementation of small bowel enteral nutrition compared to gastric enteral
A big part of Dysautonomia is knowing what it is, its symptoms, and causes. First, Dysautonomia is an umbrella term which describes multiple problems throughout the body. Such as dysfunction of the autonomic nervous system which controls functions of the body like the cardiovascular system, gastrointestinal system, metabolic system, endocrine system. Those who get Dysautonomia have trouble regulating these systems. Second, Dysautonomia can be life threatening and ranges from mild to disabling. Those who have Dysautonomia report increased symptoms after illness, trauma, or immunizations and children tend to struggle more than adults with basic functions of life. Dysautonomia tends to affect more females than males; it has a female to male ratio of 5-1. This disease is not very well known or heard about in society because it is such a rare disease (“What is Dysautonomia? What Causes Dysautonomia?”). Third, Dysautonomia can be diagnosed in different forms and with other diseases. Most people get diagnosed with another disease along with Dysautonomia. Some of these diseases or conditions that Dysautonomia is diagnosed with are Diabetes, Rheumatoid Arthritis, and Parkinson’s disease. People can also be diagnosed in different forms such as; Neurally Mediated Syncope (chronic condition where blood pools and there is a decrease in blood pressure and heart rate), Pos...
In conclusion, early diagnosis followed by an appropriate airway intervention is essential to prevent cardiac arrest or irreversible brain damage that occurs within minutes of complete airway obstruction. Although the conventional techniques remains standard option, every physician has to be familiar with the process of evaluating a difficult airway and, in the event of the unanticipated difficult airway and be able to use a wide variety of techniques to avoid complications and fatality. Airway management of the patient requires a coordinated effort from other consultants or colleagues, if available, can be the key to success in some circumstances.
Like with anything else, it is imperative to ensure a patent airway, adequate ventilation, good oxygenation, and adequate circulation. However, stroke patients have an increased risk of losing the ability to protect their own airway and subsequently aspirate. You can help protect the patient from aspirating by simply placing them in the semi-fowlers position. Now if severe vomiting becomes a factor and the airway is compromised, intubation may need to be used to protect the patient from any further aspiration. If either the tidal volume or rate becomes inadequate, quickly assist their ventilations at a rate of 10-12 breaths per minute. If assistance is needed with ventilations, its good practice to have your BVM hooked up to oxygen too because unless your patient is intubated at this point, some of the room air you pump into them is going to go into the stomach, making for less adequate oxygenation. Along with the ABC component, you’re going to establish IV access and apply the cardiac monitor to see what the heart is doing (Mistovich, 2008). Treating the symptoms is all you’re going to be able to do. As it was mentioned before, the only way to treat the underlying problem is to get the patient to the hospital as quickly as you
Cerebrovascular disease or the term stroke is used to describe the effects of an interruption of the blood supply to a localised area of the brain. It is characterized by rapid focal or global impairment of cerebral function lasting more than 24 hours or leading to death (Hatano, 1976). As such it is a clinically defined syndrome and should not be regarded as a single disease. Stroke affects 174-216 people per 10,000 population in the UK per year and accounts for 11% of all deaths in England and Wales (Mant et al, 2004). The risk of recurrent stroke within 5 years is between 30-43%. One problem is that the incidence of stroke rises steeply with age and the number of elderly people in the UK is on the increase. To date people who experience a stroke occupy around 20 per cent of all acute hospital beds and 25 per cent of long term beds (Stroke Association, 2004). The British Government now identifies stroke as a major economic burden on the National Health Service (DoH, 2002).
...llen S. “Dysphagia and Aspiration Pneumonia in Older Adults.” Journal of the American Academy of Nurse Practitioners 22 (2010) 17-22 *
Stroke is a commonly known disease that is often fatal. This cellular disease occurs when blood flow to the brain is interrupted by either a blood clot halting the progress of blood cells in an artery, called an Ischemic stroke, or a blood vessel in the brain bursting or leaking causing internal bleeding in the brain, called a hemorrhagic stroke. When this happens, brain cells are deprived of oxygen and nutrients because the blood cells carrying these essential things are stopped, causing them to die. When the cells in the brain die, sensation or movement in a limb might be cut off and may limit an organism’s abilities. A person with stroke is affected depending on where in the brain the stroke occurs. In other words, symptoms of a stroke
The clinical manifestation one may see in patients with chronic bronchitis are chronic cough, weight loss, excessive sputum, and dyspnea. Chronic cough is from the body trying to expel the excessive mucus build up to return breathing back to normal. Dyspnea is from the thickening of the bronchial walls causing constriction, thereby altering the breathing pattern. This causes the body to use other surrounding muscles to help with breathing which can be exhausting. These patients ca...
If the patient has an inadequate or no oral intake of food for 1 - 3 days, then nutritional support by the enteral route is required.
Sleep Apnea (cessation of air flow at the mouth for greater than 10 seconds) can
Nursing Diagnosis I for Patient R.M. is ineffective airway clearance related to retained secretions. This is evidenced by a weak unproductive cough and by both objective and subjective data. Objective data includes diagnosis of pneumonia, functional decline, and dyspnea. Subjective data include the patient’s complaints of feeling short of breath, even with assistance with basic ADLs. This is a crucial nursing diagnosis as pneumonia is a serious condition that is the eighth leading cause of death in the United States and the number one cause of death from infectious diseases (Lemon, & Burke, 2011). It is vital to keep the airway clear of the mucus that may be produced from the inflammatory response of pneumonia. This care plan is increasingly important because of R.M.'s state of functional decline; he is unable to perform ADL and to elicit a strong cough by himself due to his slouched posture. Respiratory infections and in this case, pneumonia, will further impair the airway (Lemon, & Burke, 2011). Because of the combination of pneumonia and R.M's other diagnoses of lifelong asthma, it is imperative that the nursing care plan of ineffective airway clearance be carried out. The first goal of this care plan was to have the patient breathe deeply and cough to remove secretions. It is important that the nurse help the patient deep breathe in an upright position; this is the best position for chest expansion, which promotes expansion and ventilation of all lung fields (Sparks and Taylor, 2011). It is also important the nurse teach the patient an easily performed cough technique and help mobilize the patient with ADL's. This helps the patient learn to cough and clear their airways without fatigue (Sparks a...