Nursing Care Plan: Dysphagia (Aspiration Risk) (2025)

The original article is in Japanese. Depending on where you live, some parts may feel out of place. Please take it as a reference.

If you’re in a hurry, feel free to skip ahead.

• ２．Nursing Goals The goals are focused on the patient:
• ３．Nursing Care Plan
  • １）Observation Plan (OP)
  • ２）Treatment Plan (TP)
  • ３）Education Plan (EP)

Nursing Care Plan: Dysphagia (Aspiration Risk)

Thank you for reading. This time, let’s consider dysphagia and aspiration risk. The number of deaths due to aspiration pneumonia has surpassed 60,000, as shown in the table below. This number is categorized separately from pneumonia-related deaths, highlighting how significant the impact of aspiration pneumonia is. It ranks as the 6th leading cause of death.

The increase in deaths from aspiration pneumonia is partly due to the aging population in Japan. As we age, changes such as decreased swallowing function, reduced saliva production, and a decline in self-care abilities like brushing teeth increase the risk of aspiration. However, some parts of this risk can be managed or mitigated with proper care, so let’s explore how we can help maintain function.

The table is quoted from the 2025 Population Dynamics Statistics Monthly Report Summary (https://www.mhlw.go.jp/toukei/saikin/hw/jinkou/geppo/nengai23/dl/gaikyouR5.pdf).

１．Nursing Diagnosis: Aspiration Risk State

• Organic Factors:
  • Tumors, ulcers, inflammation, or dysfunction of the digestive tract (mouth to anus) causing reduced motility or food reflux
  • Gastroesophageal reflux disease (GERD)
  • NG tube insertion, PEG (often used when repeated aspiration makes oral intake difficult, shifting to tube feeding)
  • Facial surgeries or injuries
  • Infants (who are prone to vomiting due to stomach shape)
• Functional Factors:
  • Decreased consciousness due to cerebrovascular diseases
  • Poor alertness due to sleep aids, sedatives, or psychotropic drugs
  • Post-stroke complications, such as paralysis, difficulty chewing, swallowing reflex impairment, or cough reflex impairment
  • Impairment of organs that control gastrointestinal activity
  • Neuromuscular diseases (weak cough, reduced swallowing function)
  • Difficulty expectorating
  • Silent aspiration (in the elderly)
• Psychological Factors: Eating disorders or dementia, depression, etc., leading to lack of enthusiasm for meals.

２．Nursing Goals The goals are focused on the patient:

• Remove airway secretions to prevent blockages and pneumonia.
• Prevent aspiration by incorporating meal methods and food textures suitable for the patient’s swallowing function.
• Keep the mouth clean.

３．Nursing Care Plan

１）Observation Plan (OP)

• History of aspiration pneumonia
• Conditions that can lead to vomiting (e.g., ileus, hypertension, brain hernia)
• Conditions prone to as１）ration (e.g., Parkinson’s, ALS)
• Respiratory rate and rhythm
• Breath sounds (air entry, asymmetry), lung crackles
• Shortness of breath, orthopnea, pursed-lip breathing, chest retractions
• Age (elderly)
• Degree of swallowing dysfunction, VT (swallowing fluoroscopy), VF (swallowing endoscopy)
• Level of consciousness, delirium
• Signs of pneumonia
• SPO2 levels (normal is 95% or above)
• Blood gases (PaO2 ≤ 90 Torr)
• Imaging (lung shadows)
• Blood tests (WBC, procalcitonin, CRP, neutrophils, etc., for inflammation)
• Cyanosis
• Sounds of phlegm retention in the throat
• Ability to expectorate, effective coughing
• Characteristics, quantity, and odor of sputum
• Fever (temperature increase of 1°C or more)
• Food texture (appropriate for swallowing function)
• Posture during meals
• Choking during meals
• Techniques used in meal assistance (by caregiver), portion size
• Cognitive decline
• Pica (e.g., eating tissue paper in dementia)
• Oral hygiene
• Abdominal symptoms (intestinal sounds, bloating, pain)
• Bowel movement status (e.g., constipation)
• Enteral Nutrition:　
• 　Tube fixation
• 　Insertion length
• 　Gastric bubble sounds
• 　Nutritional formula
• 　Gastrostomy
• 　Jejunostomy

２）Treatment Plan (TP)

• Perform swallowing exercises (neck, tongue, mouth, patakara exercises) and salivary gland massage before meals.
• If airway secretions are present, perform suctioning.
• Suctioning should be done with clean techniques.
• Monitor SPO2 during suctioning with a pulse oximeter to watch for drops in oxygen saturation.
• Perform sputum management (e.g., squeezing, postural drainage).
• Perform sputum management (e.g., cough assist, RTX).
• Administer nebulizer therapy if instructed.
• Assist the patient to expectorate on their own (apply pressure to the chest to help trigger coughing).
• Ensure proper posture during meals. For tube feeding, the head of the bed should be elevated to 30° or higher.
• Adjust food texture according to swallowing function (requires doctor’s orders).
  • Food size: bite-sized, coarse chop, finely chopped, mousse, paste
  • Rice: soft rice, full porridge, five-minute porridge, paste porridge
  • Liquids: according to the Japanese Care Food Association, thickness should range from thick (e.g., Worcestershire sauce), to medium (e.g., ketchup), to thickest (e.g., mayonnaise)
• Assist with meals one bite at a time, ensuring swallowing is confirmed before proceeding.
• Remove dentures after meals and perform oral care.
• Maintain an upright position for at least 30 minutes post-meal (even Fowler’s position).
• Control bowel movements.
• Enteral Nutrition:
• When administering enteral nutrition, keep the head of the bed elevated to at least 30 degrees.
• Ensure that the feeding tube (NG tube) is properly secured and correctly positioned, confirming placement with gastric bubble sounds.
• Check that the feeding tube is not coiling in the mouth or throat.
• Monitor for coughing or nausea at the start of feeding.
• Administer at the prescribed drip rate.

３）Education Plan (EP)

• Provide clear explanations to help the patient accept changes in food texture. (Many people dislike minced food or thickened liquids.)
• Instruct the patient to take one bite at a time, chew thoroughly, and swallow before taking the next bite.
• Encourage independent practice of swallowing exercises, as many can be done alone.
• Ask the patient to use the nurse call button immediately if they experience difficulty breathing or any changes.
• Explain the importance of infection prevention measures such as wearing masks and handwashing.
• Explain the method and precautions for enteral nutrition.

Thank you for reading to the end. If you have any comments, feedback, or questions, please feel free to share them in the comment section below.