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Difficulty: MediumAging Process

A nurse is preparing to administer prescribed oral medications to an older adult client who experiences age-related changes in swallowing (presbyphagia). The client reports occasional coughing during meals. In what order should the nurse implement the following interventions to ensure safe medication administration?

  1. 1Position the client in a high-Fowler's position at a 90-degree angle.
  2. 2Conduct a bedside swallow evaluation using a small sip of water.
  3. 3Administer the prescribed oral medications one at a time.
  4. 4Inspect the inside of the client's mouth to check for pocketed pills.
  5. 5Maintain the client in an upright position for at least 30 minutes.

Answer

The correct sequence prioritizes immediate airway safety (positioning), followed by assessment of function (swallow screen), safe intervention (administering pills individually), verification of swallowing (checking for pocketing), and prevention of delayed complications (maintaining upright posture).
This sequence follows the nursing process and prioritizes airway safety. The nurse must first establish physical safety (positioning), assess capability (swallow screen), intervene safely (single pill administration), evaluate the intervention (checking for pocketing), and implement post-intervention safety measures (remaining upright).

Step-by-Step Solution

1
Position the client in a high-Fowler's position at a 90-degree angle.
The client is sitting upright, maximizing airway protection.
An upright position uses gravity to help clear the bolus and prevents anatomical structures from compromising the airway, which is the essential first step before any oral intake.
2
Conduct a bedside swallow evaluation using a small sip of water.
The nurse confirms the client can swallow without coughing or choking.
Due to age-related presbyphagia and a history of coughing, assessing the swallow reflex with water is necessary before attempting to give solid medications.
3
Administer the prescribed oral medications one at a time.
The client swallows each medication safely.
Giving pills one at a time prevents overwhelming a weakened swallowing mechanism, reducing the risk of choking.
4
Inspect the inside of the client's mouth to check for pocketed pills.
The nurse confirms no medications are hidden in the cheeks.
Older adults may have decreased oral sensitivity and muscle strength, leading to asymptomatic pocketing of pills which could later be aspirated.
5
Maintain the client in an upright position for at least 30 minutes.
The client safely digests the medications without reflux.
Age-related relaxation of the lower esophageal sphincter increases reflux risk; staying upright prevents delayed aspiration of regurgitated stomach contents.

Key Concept

Prioritization of care for older adults with presbyphagia (age-related swallowing changes).
Estimated Time:1m 0s
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Topics

Aging Process

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