Dysphagia Care Plan
Optimize patient outcomes with our free Dysphagia Care Plan template. Streamline care delivery for individuals with swallowing difficulties.
Fact Checked by RJ Gumban.
What is dysphagia?
Dysphagia is a medical term used to describe difficulty in swallowing. It can occur during the swallowing process, including when chewing food, starting the swallowing reflex, passing food from the mouth to the throat (pharynx), or moving food down the esophagus to the stomach.
It can range from mild to severe and can be temporary or persistent. It may result from various causes, including neurological disorders, muscular disorders, structural abnormalities, or as a side effect of specific medical treatments.
Dysphagia can lead to complications such as malnutrition, dehydration, aspiration pneumonia (inhalation of food or liquid into the lungs), and decreased quality of life. Treatment for dysphagia depends on its underlying cause and severity and may include dietary modifications, swallowing therapy, medication, or surgical interventions.
Printable Dysphagia Care Plan PDF
Download this Dysphagia Care Plan to streamline care delivery for individuals with swallowing difficulties.
The symptoms and causes of dysphagia
The symptoms of dysphagia can vary depending on the underlying cause and the severity of the condition. Common symptoms include:
- Difficulty swallowing: This is the primary symptom of dysphagia. It may feel like food is getting stuck in the throat or chest, or there may be pain or discomfort when swallowing.
- Pain: Some individuals with dysphagia may experience pain while swallowing (odynophagia). This pain can occur anywhere from the mouth to the chest.
- Coughing or choking: Difficulty swallowing can lead to coughing or choking, especially if food or liquid enters the airway instead of going down the esophagus.
- Drooling: Dysphagia may cause difficulty controlling saliva, leading to drooling.
- Regurgitation: Food or liquid may come back into the mouth or throat after swallowing, mainly if the muscles that generally keep the esophagus closed are weak.
- Unexplained weight loss: Dysphagia can lead to inadequate intake of food and liquids, resulting in weight loss.
- Aspiration pneumonia: In severe cases, when food, liquid, or saliva is inhaled into the lungs (aspiration), it can cause pneumonia, leading to symptoms such as fever, cough, and difficulty breathing.
The causes of dysphagia can be broadly categorized into two main types: oropharyngeal dysphagia and esophageal dysphagia.
Oropharyngeal Dysphagia
This type of dysphagia involves problems swallowing in the mouth and throat (pharynx). Causes of oropharyngeal dysphagia include:
- Neurological disorders such as stroke, Parkinson's disease, multiple sclerosis, or amyotrophic lateral sclerosis (ALS).
- Structural abnormalities or disorders affecting the muscles and nerves in the throat or mouth, such as tumors, inflammation, or muscle weakness.
- Conditions that affect coordination and movement, such as muscular dystrophy or myasthenia gravis.
- Aging-related changes in swallowing function.
Esophageal dysphagia
This type of dysphagia involves problems swallowing muscles in the esophagus, the muscular tube connecting the throat to the stomach. Causes of esophageal dysphagia include:
- Gastroesophageal reflux disease (GERD) can cause narrowing or inflammation of the esophagus.
- Esophageal strictures or narrowing due to scar tissue formation from conditions such as acid reflux, radiation therapy, or ingestion of corrosive substances.
- Esophageal tumors, both benign and malignant.
- Disorders affecting the movement and coordination of the esophageal muscles, such as achalasia or diffuse esophageal spasm.
- Systemic diseases such as scleroderma or eosinophilic esophagitis.
Treatment for dysphagia depends on its underlying cause and severity. It may include dietary modifications (such as altering food texture or consistency), swallowing therapy, medication, dilation procedures to widen the esophagus, or surgical interventions. Early diagnosis and appropriate management are essential to improve swallowing function and prevent complications.
Dysphagia diagnosis
Diagnosing dysphagia involves a combination of medical history evaluation, physical examination, and various diagnostic tests. Here's an overview of the diagnostic process for dysphagia:
1. Medical history evaluation
The healthcare provider will ask detailed questions about the individual's symptoms, including when they started, their severity, and any factors that worsen or improve them. They will also inquire about underlying medical conditions, past surgeries, medications, and dietary habits.
2. Physical examination
A physical exam may include assessing the mouth, throat, and neck for signs of abnormalities or swelling. The healthcare provider may also evaluate the strength and coordination of facial muscles and assess the individual's ability to swallow by observing them swallow saliva or small sips of water.
3. Clinical swallowing evaluation
A clinical swallowing evaluation, often conducted by a speech-language pathologist (SLP), involves a series of tests to assess the individual's ability to swallow different food and liquid consistencies. This evaluation may include swallowing observation, oral motor function assessment, and trials of various food and fluid textures to identify any difficulties or abnormalities.
- Imaging studies: Imaging studies are essential for diagnosing dysphagia. Fundamental techniques include the Barium Swallow Study, Endoscopy, and Esophageal Manometry. These tests allow for the visualization and assessment of swallowing function, aiding in identifying underlying issues.
- Barium swallow study (modified barium swallow): This imaging test involves swallowing foods or liquids mixed with barium, a contrast material visible on X-rays. X-ray images or fluoroscopy are used to observe the swallowing process in real-time and identify any abnormalities, such as aspiration or narrowing of the esophagus.
- Endoscopy: Upper gastrointestinal endoscopy (esophagogastroduodenoscopy or EGD) may be performed to visualize the inside of the esophagus, stomach, and upper digestive tract using a flexible, lighted instrument called an endoscope. Endoscopy can help identify structural abnormalities, inflammation, tumors, or strictures that may be causing dysphagia.
- Esophageal manometry: This test measures the pressure and coordination of muscle contractions in the esophagus using a thin, flexible tube (catheter) inserted through the nose or mouth into the esophagus. Esophageal manometry can help diagnose conditions affecting esophageal motility, such as achalasia or spasm.
4. Additional tests
Additional tests or evaluations may be ordered, such as imaging studies (CT scan, MRI), pH monitoring to assess for acid reflux, or biopsy to evaluate tissue samples for inflammation, infection, or malignancy.
Once a diagnosis is established, appropriate treatment and management strategies can be implemented based on the underlying cause and severity of dysphagia. This may include dietary modifications, swallowing therapy, medication, dilation procedures, or surgical interventions.
Dysphagia treatment
Treatment for dysphagia depends on its underlying cause, severity, and individual factors. Here's an overview of treatment options:
- Dietary modifications: Adjusting the texture and consistency of food and liquids can make swallowing more accessible and safer. This may involve consuming soft or pureed foods, thickened liquids, or avoiding foods that are difficult to swallow.
- Swallowing therapy: Speech-language pathologists (SLPs) can provide exercises and techniques to improve swallowing function. These may include specific swallowing exercises, postural adjustments, and strategies to coordinate swallowing movements.
- Medications: Depending on the underlying cause of dysphagia, medications may be prescribed to alleviate symptoms or manage contributing factors. For example, proton pump inhibitors (PPIs) or H2-receptor antagonists may be prescribed for gastroesophageal reflux disease (GERD), while botulinum toxin injections may be used for conditions like achalasia.
- Dilation: Esophageal dilation procedures may be performed to widen narrowed areas of the esophagus caused by strictures or other structural abnormalities. This can help improve swallowing function and alleviate symptoms.
- Surgical interventions: In some cases, surgical procedures may be necessary to address underlying structural issues contributing to dysphagia. This could include tumor removal, fundoplication for GERD, or myotomy for conditions like achalasia.
- Feeding tubes: In severe cases where oral intake is not possible or safe, feeding tubes may be temporarily or permanently used to provide nutrition and hydration. This could involve a nasogastric gastrostomy (PEG) or a jejunostomy tube.
- Lifestyle and dietary changes: Making lifestyle modifications, such as eating smaller, more frequent meals, avoiding lying down immediately after eating, and maintaining good oral hygiene, can help manage dysphagia symptoms.
- Addressing underlying conditions: Treating underlying medical conditions contributing to dysphagia, such as neurological disorders, autoimmune diseases, or cancer, is essential for effective management.
Treatment plans for dysphagia are tailored to each patient's unique needs and may involve a team of healthcare providers such as SLPs, gastroenterologists, otolaryngologists, dietitians, and surgeons. Regular follow-up and monitoring are vital for assessing the effectiveness of treatment and making any necessary adjustments.
What is included in a Dysphagia Care Plan?
Developing a comprehensive dysphagia care plan is essential for optimizing patient outcomes to maintain adequate nutritional intake and minimize the risk of aspiration and associated complications. Dysphagia, characterized by swallowing difficulties, poses significant challenges in maintaining adequate dietary intake and preventing aspiration pneumonia, particularly among older adults and individuals with neurological disorders.
In this care plan, we outline evidence-based nursing interventions to promote safe swallowing techniques, manage swallowing disorders, and collaborate with other healthcare professionals to provide holistic care for patients with dysphagia.
By implementing these interventions and closely monitoring the patient's condition, nurses can effectively manage dysphagia, prevent aspiration, and enhance the overall quality of care.
Nursing assessment and diagnosis
A thorough nursing assessment should identify potential swallowing difficulties, risk factors for aspiration, and oral care needs to ensure proper nursing care. A nursing diagnosis should be performed to identify the specific issues contributing to impaired swallowing, such as oropharyngeal dysphagia or aspiration risk. This will help pinpoint the root cause of the problem and enable appropriate care to be provided.
Maintaining adequate nutritional intake
Work with speech pathologists to develop ways to help patients with swallowing problems. These techniques should ensure the patient can eat enough food safely, even with swallowing issues. Evidence-based solutions can prevent patients with swallowing impairment from inhaling their food and promote safe swallowing habits.
Preventing aspiration pneumonia
It is essential to take care of your mouth by regularly cleaning it and avoiding bacteria buildup. You can also reduce the risk of aspiration by eating slowly, chewing food thoroughly, and avoiding hot cereal or other problematic foods. Educate the patient and caregivers on these strategies to prevent aspiration.
Swallowing evaluation and management
To ensure safe swallowing during meals, it's essential to have a specialist in speech and language evaluate swallowing function and recommend appropriate interventions. This evaluation can help identify safe swallowing techniques, such as maintaining an upright position during meals and swallowing small, manageable portions of residual food, which can reduce the risk of aspiration.
Collaboration with healthcare professionals
Collaborate with other healthcare professionals, such as speech-language pathologists, respiratory therapists, and physicians, to improve patient outcomes in managing dysphagia. Coordinating their care ensures safe swallowing practices and minimizes the increased risk of respiratory complications for patients with enteral feeding or endotracheal/tracheostomy tubes.
Dysphagia Care Plan example (sample)
Unlock the power of effective dysphagia management with our free Dysphagia Care Plan template! This comprehensive template provides a structured framework for healthcare professionals to assess, plan, implement, and evaluate care for individuals with swallowing difficulties.
Whether you're a nurse, speech-language pathologist, or other healthcare provider, our template offers evidence-based interventions, clear goals, and monitoring tools to guide you in optimizing nutritional intake, promoting safe swallowing techniques, and preventing aspiration pneumonia.
Download now to access a valuable resource that will help you deliver high-quality care and support to patients with dysphagia, ultimately improving their quality of life and well-being.
Download our free Dysphagia Care Plan template here
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Commonly asked questions
The dysphagia care plan aims to improve impaired swallowing related to function, maintain adequate nutrition, prevent aspiration pneumonia, and enhance the patient's overall quality of life.
Interventions for dysphagia include modifying diet texture, implementing swallowing techniques, providing oral care, coordinating with other healthcare professionals, and monitoring the patient's progress.
The four stages of dysphagia are the oral preparatory phase, the oral phase, the oral cavity, the pharyngeal phase, and the esophageal phase. These stages represent the events involved in swallowing, from chewing and forming a bolus to passage through the throat and into the esophagus.
