A practical nurse (PN) is assigned to feed a client who is recovering from a recent stroke that caused left-sided hemiparesis and severe dysphagia. The client also has a tracheostomy tube in place. The speech-language pathologist has cleared the client to begin a pureed diet. Which approach by the PN ensures the highest level of safety during this basic care activity?
- Elevate the head of the bed to 90 degrees, place the food on the right side of the client's mouth, and instruct the client to tuck the chin downward when swallowing.Answer
- BPosition the client at a 45-degree angle, encourage the client to tilt the head backward to utilize gravity, and offer small sips of thin water between bites to clear the airway.
- CTransfer the client to a bedside chair, place the pureed food on the left side of the oral cavity to stimulate sensory recovery, and provide a straw for liquids.
- DMaintain the client in a high-Fowler's position, independently deflate the tracheostomy cuff to reduce esophageal pressure, and use a syringe to deliver food to the back of the throat.
Answer
The correct action is to elevate the head of the bed to 90 degrees, place the food on the right side of the mouth, and instruct the client to tuck their chin downward when swallowing.
A high-Fowler's position (90 degrees) safely utilizes gravity for swallowing. Placing food on the right (unaffected) side allows the client to effectively control the bolus and prevents dangerous pocketing on the paralyzed side. Finally, instructing the client to tuck their chin to their chest mechanically protects the airway by narrowing the laryngeal opening and directing food properly into the esophagus.
Step-by-Step Solution
Key Concept
Dysphagia Management and Airway Protection