The client is recovering from stroke. He has residual dysphagia. While feeding the patient the nurse should avoid?

Appeared in: SCTIMST Staff Nurse - 2016

Explanation

Thin liquids are difficult to control for a person with weakened oral and pharyngeal muscles due to a stroke.
They move very quickly, often entering the airway (aspiration) before the protective swallowing reflex can be effectively triggered.
Aspiration of thin liquids can lead to serious complications, including choking and aspiration pneumonia.

Option B: This is a recommended and safe practice. Placing food on the unaffected (stronger) side of the mouth allows the patient to use intact musculature to better manipulate and swallow the food.
Option C: This is a safe option. Liquids with an oatmeal-like consistency are considered thickened. Thickened liquids are recommended because they move slower, giving the patient more time to manage the swallow and reducing aspiration risk.
Option D: This is a critical safety intervention that should be implemented, not avoided. Keeping the patient in a propped-up, upright position (ideally 90 degrees) uses gravity to help prevent aspiration.

Clinical Relevance

Nursing practice connection: Use the key finding related to Aspiration precautions and safe feeding techniques for a patient with dysphagia to guide bedside assessment, documentation, and the next nursing action.
Preventing aspiration pneumonia is a top nursing priority for patients with dysphagia, as it is a common and potentially fatal complication after a stroke.
Nurses must work closely with Speech-Language Pathologists (SLPs) to implement the correct diet consistency and feeding strategies.
Patient and family education on safe swallowing techniques is crucial for preventing aspiration, especially as the patient transitions to home.

How to Approach the Question

First, identify the core clinical problem in the question: the patient has dysphagia after a stroke.
Next, determine the primary risk associated with this condition, which is aspiration.
The question asks what the nurse should 'avoid.' This means you are looking for the option that is an unsafe practice or would increase the risk of aspiration.
Evaluate each option against the goal of preventing aspiration.
Option A (Thin liquids) increases aspiration risk. Options B, C, and D are all standard safety measures to decrease aspiration risk.
Therefore, the action to avoid is giving thin liquids.

Concept Tested & Keywords

Concept Tested: Aspiration precautions and safe feeding techniques for a patient with dysphagia.
Stem keywords: stroke, dysphagia, feeding, avoid
Lead-in keywords: avoid
Clinical cues: The patient's diagnosis of residual dysphagia post-stroke is the key information, as it directly implies a high risk for aspiration.
Negative lead-in flag: The question asks what action the nurse should AVOID, which requires identifying an unsafe practice among recommended ones.

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E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 213-215

E6 Nursing Brunner Adult Health 3SA Vol 2 Part 2 p. 71-73

Practise the full SCTIMST Staff Nurse - 2016

Attempt every question from this paper in a timed mock, then review the full solution for each one.