Scientific care for patients with swallowing disorders

Author: Bu Hongwei China Rehabilitation Research Center

Reviewer: Zhang Xiaonian, Chief Physician, China Rehabilitation Research Center

Stroke, commonly known as "stroke", is a relatively common disease with high morbidity, high disability rate and high mortality rate. Dysphagia is one of the common functional disorders in stroke patients, which not only affects the daily life of patients, but also may delay their recovery. Therefore, popularizing the knowledge of dysphagia caused by stroke and mastering effective nursing skills are crucial to improving the quality of life of patients and helping them recover faster.

1. What is dysphagia?

Dysphagia refers to a clinical manifestation in which food cannot be safely and effectively delivered from the mouth to the stomach due to damage to the structure and/or function of organs such as the mandible, lips, tongue, soft palate, throat, and esophagus.

The cause of dysphagia after stroke is related to damage to brain nerves, which affects the movement and coordination of swallowing-related muscles. In addition, factors such as the patient's state of consciousness, cognitive function, and oral hygiene may also affect swallowing function.

2. What impact does dysphagia have on patients?

1. Patients with dysphagia experience difficulty, pain, or choking when eating or drinking.

2. Food residue: Food remains in the mouth or pharynx and cannot enter the esophagus smoothly.

3. Accidental inhalation of food or liquid into the trachea, causing coughing, difficulty breathing, or even suffocation.

Malnutrition Due to difficulty in swallowing, the patient's food and water intake is reduced, which can easily lead to malnutrition and dehydration.

3. What are the dangers of swallowing disorders caused by stroke?

1. Affecting the quality of life Swallowing disorders can cause patients to feel discomfort and pain when eating and drinking, affecting their appetite and mood. Long-term swallowing difficulties may also cause patients to have fear and resistance to eating, further affecting their quality of life.

2. Increased risk of complications

(1) Aspiration and pneumonia: Food or liquid entering the trachea is the main cause of aspiration and pneumonia. Aspiration pneumonia is one of the common complications of stroke patients and can be life-threatening in severe cases.

(2) Malnutrition and dehydration: Dysphagia can affect the patient's nutritional intake and water intake, leading to malnutrition and dehydration. Malnutrition can affect the patient's recovery process and increase the risk of infection; dehydration can affect the patient's body metabolism and organ function.

3. Prolong hospitalization and increase medical expenses Swallowing disorders and their complications will prolong the patient's hospitalization time and increase medical expenses. It is also a heavy burden on the family and society.

4. Nursing methods for dysphagia caused by stroke

1. Assess swallowing function

(1) Clinical evaluation: Preliminary assessment of the patient's swallowing function is made by observing the patient's swallowing movements, oral hygiene, cough reflex, etc. The standard examination method commonly used in clinical practice is the Kubota water drinking test.

(2) Instrumental evaluation: Use swallowing angiography, laryngoscopy and other instruments to conduct a detailed evaluation of the patient's swallowing function. Develop a personalized nursing plan based on the evaluation results.

2. Care Tips

(1) Food selection: Choose appropriate food according to the patient's swallowing function. Generally speaking, you should choose soft, easy-to-chew, and easy-to-digest food, such as paste food, soft food, etc. Avoid choosing food that is dangerous and difficult to swallow.

(2) Eating posture: Patients should maintain a correct posture when eating, such as sitting upright (sitting position) or semi-recumbent position, with the head slightly tilted forward, to reduce the risk of food residue and aspiration.

Figure 1 Copyright image, no permission to reprint

(3) Eating speed: Patients should eat slowly and avoid eating too fast or too hastily. The amount of food in each mouthful should be moderate, not too much or too little.

(4) Eating environment: Create a quiet and comfortable eating environment to avoid distracting the patient. During the eating process, give the patient enough time and patience and do not rush the patient.

(5) Keep the oral cavity clean: Regularly clean the patient's oral cavity, such as brushing teeth and gargling. Oral care liquid or saline can be used for gargling to remove bacteria and food residues in the oral cavity.

(6) Oral movement training: Oral movement training can enhance the strength and coordination of oral muscles and improve swallowing function. For example, patients can be asked to perform exercises such as opening and closing the mouth, extending the tongue, and retracting the tongue.

Licking the upper lip (first picture on the left) sticking out the tongue (second picture on the left) licking the corners of the lips (first and second pictures on the right)

Figure 2 Copyright image, no permission to reprint

3. Swallowing training

(1) Master basic training: including breathing training, coughing training, and laryngeal lifting training. Breathing training can enhance the patient's respiratory function and reduce the risk of aspiration; coughing training can help patients clear foreign objects in the trachea; and laryngeal lifting training can improve the patient's swallowing ability. In addition, nodding swallowing and lateral swallowing training can also be performed.

Nodding swallowing (left picture) Lateral swallowing (middle and right pictures)

Figure 3 Copyright image, no permission to reprint

(2) Strengthen feeding training: After the patient's swallowing function improves, feeding training can be carried out. Feeding training should start with a small amount of mushy food, and gradually increase the amount and difficulty of food. During the training process, the patient's reaction should be closely observed. If choking, breathing difficulties, etc. occur, the training should be stopped immediately.

4. Psychological care

(1) Provide psychological support: Patients may feel anxious, depressed or inferior due to dysphagia. Nurses and family members should provide psychological support to patients and encourage them to face the disease positively. They can make patients feel cared for and supported by communicating with them and listening to their feelings.

(2) Enhance patients’ confidence in recovery: Introduce rehabilitation methods and successful cases of dysphagia to patients, let them know that dysphagia can be improved through treatment and training, and enhance their confidence in recovery.

5. Notes

1. Closely observe the patient's reaction during swallowing training and eating. If choking, breathing difficulties, etc. occur, stop training or eating immediately and take appropriate first aid measures.

2. Provide training and guidance on the Heimlich maneuver. For patients with dysphagia, the Heimlich maneuver should be given to their family members and caregivers after hospital evaluation to prevent accidents.

Figure 4 Copyright image, no permission to reprint

3. Ensure nutritional intake For patients with severe swallowing disorders, nutritional support methods such as nasogastric feeding or gastrointestinal fistula should be carried out under the guidance of a doctor to ensure the patient's nutritional intake and safety.

4. Personalized care The degree and characteristics of swallowing disorders of each patient are different. Nursing staff should develop personalized care plans based on the specific conditions of the patients. During the nursing process, the nursing plan should be adjusted in time according to the patient's recovery progress to ensure the effectiveness and pertinence of the care.

5. Multidisciplinary cooperation The care of stroke dysphagia requires multidisciplinary cooperation, including doctors, nurses, rehabilitation therapists, nutritionists, etc. Nursing staff should work closely with other professionals to provide comprehensive nursing services for patients.

6. Family support The support and participation of family members are also very important. Nursing staff should guide family members to master the correct nursing methods and work together to help patients recover.

In summary, dysphagia after stroke is a common complication that seriously affects the patient's quality of life and rehabilitation process. Through comprehensive care methods such as scientific evaluation, reasonable dietary care, effective oral care, systematic swallowing training and psychological care, and personalized dietary guidance, the patient's swallowing function can be effectively improved, the occurrence of complications can be reduced, and the patient's quality of life can be improved.