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Difficulty: HardBasic Care and Comfort

A practical nurse is assisting a client with a meal who is recovering from a recent cerebrovascular accident (CVA). The client has right-sided hemiplegia and has been diagnosed with oropharyngeal dysphagia. The dietary prescription is a pureed diet with honey-thick liquids. Which action should the practical nurse implement to ensure client safety and comfort during the feeding?

  1. Instruct the client to flex the neck and tuck the chin downward toward the chest when swallowing.Answer
  2. B
    Elevate the head of the client's bed to a semi-Fowler's position of 45 degrees before initiating the meal.
  3. C
    Place small spoonfuls of the pureed food directly into the right side of the client's mouth.
  4. D
    Provide a flexible drinking straw to help the client safely consume the honey-thick liquids.

Answer

The practical nurse should instruct the client to use a chin-tuck maneuver (flexing the neck downward) while swallowing to protect the airway and prevent aspiration.
The chin-tuck maneuver is an evidence-based compensatory strategy for clients with oropharyngeal dysphagia. Flexing the neck and tucking the chin downward before swallowing narrows the laryngeal opening, widens the vallecular space, and pushes the epiglottis backward to protect the airway, significantly reducing the risk of aspiration. This is a primary basic care and comfort priority for stroke recovery.

Step-by-Step Solution

1
Analyze the client's physiological deficits and risks based on the clinical presentation.
The client has right-sided paralysis and dysphagia, meaning they have impaired swallowing mechanics and a high risk of airway compromise (aspiration).
Identifying the specific impairments dictates which compensatory feeding strategies are required to maintain ABCs (Airway, Breathing, Circulation).
2
Select the appropriate evidence-based intervention for airway protection during oral intake.
The chin-tuck maneuver is identified as the safest technique, as it anatomically protects the trachea.
Flexing the neck widens the vallecular space and forces the epiglottis backward, mechanically blocking the airway during the swallow.

Key Concept

Dysphagia aspiration precautions and safe feeding techniques
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Topics

Basic Care and Comfort

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