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Question

Difficulty: EasyBasic Care and Comfort

During mealtime on a medical-surgical unit, an elderly client with a known history of dysphagia requires assistance. What is the most appropriate action by the registered nurse to ensure safe ingestion and comfort?

  1. Maintain the client in a high-Fowler's position for the duration of the meal and for at least 30 minutes afterward.Answer
  2. B
    Assist the client into a flat, supine position immediately after eating to promote energy conservation and rest.
  3. C
    Assign the unlicensed assistive personnel (UAP) to evaluate the intactness of the client's gag reflex before offering solid foods.
  4. D
    Document the client's sudden episodes of coughing during fluid intake as a normal physiological consequence of advanced age.

Answer

The nurse must ensure the client remains in an upright, high-Fowler's position during the meal and for at least 30 minutes after eating to prevent aspiration.
For a client with dysphagia, sitting fully upright in a high-Fowler's position uses gravity to direct food and fluids safely into the stomach rather than the airway. Maintaining this elevated position for at least 30 minutes after the meal prevents the regurgitation of gastric contents, serving as a fundamental and highly effective aspiration precaution.

Step-by-Step Solution

1
Identify the client's primary risk factor during basic care.
The client has a history of dysphagia, which places them at a high risk for aspirating food or fluids into the lungs.
Recognizing specific physical vulnerabilities determines which safety precautions must be implemented during routine tasks like feeding.
2
Determine the optimal physical position for oral intake.
The client should be positioned in a high-Fowler's position (sitting up at 90 degrees).
An upright position enlists gravity to help guide the bolus of food down the esophagus and away from the trachea.
3
Establish the necessary post-meal positioning timeline.
The upright position must be maintained for 30 to 45 minutes after the meal has concluded.
Maintaining the position after eating allows time for gastric emptying and prevents the reflux of stomach contents back into the upper airway.

Key Concept

Aspiration Precautions and Safe Client Positioning
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Topics

Basic Care and Comfort

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