Dysphagia

Definition

Dysphagia is difficulty swallowing, either transferring food from mouth to pharynx (oropharyngeal) or moving food through the esophagus (esophageal). It increases the risk of aspiration and malnutrition.

Causes

• Oropharyngeal: Stroke, Parkinson's, ALS, myasthenia gravis, head/neck cancer.
• Esophageal: GERD, stricture, achalasia, cancer, esophagitis.

Assessment

Coughing/choking with swallowing, wet/gurgly voice, drooling, pocketing food, prolonged mealtimes, weight loss, recurrent pneumonia. Speech-language pathologist performs formal swallow evaluation; videofluoroscopic swallow study is the gold standard.

Nursing Interventions

Elevate HOB 90° for meals; maintain upright 30 to 60 minutes after. Use thickened liquids as ordered. Position chin down (tucked) during swallowing. Offer small bites and single-consistency foods (avoid straws). Perform oral care before and after meals. Monitor for aspiration pneumonia.

NCLEX Relevance

Aspiration prevention is paramount. HOB elevation during and after meals.