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Difficulty: MediumBasic Care and Comfort

A client recovering from a cerebrovascular accident has documented dysphagia and right-sided facial weakness. The client is currently alert and ready to eat lunch. Which technique is correct for the practical nurse to implement when assisting this client with their meal?

  1. Instruct the client to tilt their chin downward toward their chest when swallowing.Answer
  2. B
    Position the head of the bed at a 45-degree angle during the meal.
  3. C
    Place each spoonful of food into the right side of the client's mouth.
  4. D
    Provide a straw for the client to drink liquids between bites of solid food.

Answer

Instruct the client to tilt their chin downward toward their chest when swallowing.
The chin-tuck maneuver is a standard aspiration precaution. It narrows the airway opening and directs the food bolus toward the esophagus, significantly decreasing the risk of aspiration.

Step-by-Step Solution

1
Identify the client's deficits and associated risks.
The client has dysphagia and right-sided weakness, placing them at high risk for aspiration and airway compromise.
Recognizing physical limitations dictates the necessary safety interventions during oral intake.
2
Determine the optimal positioning and feeding techniques for aspiration precautions.
The client needs to be seated upright at 90 degrees, food must be placed on the strong side (left), and airway-protecting maneuvers like a chin-tuck should be utilized.
Gravity and anatomical positioning help direct food into the esophagus rather than the trachea.
3
Evaluate the provided options against established dysphagia guidelines.
The chin-tuck method correctly protects the airway, while the other options introduce significant aspiration risks.
Choosing the intervention that actively promotes airway safety is the clinical priority.

Key Concept

Aspiration Precautions for Dysphagia
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Topics

Basic Care and Comfort

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