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    Nursing Priority No. 3: Risk For Aspiration

    Uploaded by

    Rae Marie Aquino
    This nursing document contains assessments, diagnoses, plans, and evaluations for a patient with a nasogastric tube. The nursing priorities include risk for aspiration related to the nasogastric tube and decreased tissue perfusion in the brain. The plan is to establish rapport, monitor vital signs, elevate the patient during feeding to decrease aspiration risk, and provide oral care. After 5 days of interventions, the goal is for the patient to have adequate nutrition without signs of aspiration such as noisy breathing or coughing.

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    © All Rights Reserved
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    Nursing Priority No. 3: Risk For Aspiration

    Uploaded by

    Rae Marie Aquino
    26 views3 pages
    This nursing document contains assessments, diagnoses, plans, and evaluations for a patient with a nasogastric tube. The nursing priorities include risk for aspiration related to the nasogastric tube and decreased tissue perfusion in the brain. The plan is to establish rapport, monitor vital signs, elevate the patient during feeding to decrease aspiration risk, and provide oral care. After 5 days of interventions, the goal is for the patient to have adequate nutrition without signs of aspiration such as noisy breathing or coughing.

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    NCP

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    7amncp3

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    This nursing document contains assessments, diagnoses, plans, and evaluations for a patient with a nasogastric tube. The nursing priorities include risk for aspiration related to the nasogastric tube and decreased tissue perfusion in the brain. The plan is to establish rapport, monitor vital signs, elevate the patient during feeding to decrease aspiration risk, and provide oral care. After 5 days of interventions, the goal is for the patient to have adequate nutrition without signs of aspiration such as noisy breathing or coughing.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    26 views3 pages

    Nursing Priority No. 3: Risk For Aspiration

    Uploaded by

    Rae Marie Aquino
    This nursing document contains assessments, diagnoses, plans, and evaluations for a patient with a nasogastric tube. The nursing priorities include risk for aspiration related to the nasogastric tube and decreased tissue perfusion in the brain. The plan is to establish rapport, monitor vital signs, elevate the patient during feeding to decrease aspiration risk, and provide oral care. After 5 days of interventions, the goal is for the patient to have adequate nutrition without signs of aspiration such as noisy breathing or coughing.

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    © All Rights Reserved
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    ASSESSMENT NURSING

    DIAGNOSIS
    INFERENCE PLANNING INTERVENTION RATIONALE EVALUATION
    S/O
    Objective:
    > with
    nasogastric
    tube for
    feeding and
    medication
    administration
    Risk for
    Aspiration
    related to
    presence of
    nasogastric
    tube
    Decreased
    Tissue
    perfusion in
    brain
    Cerebral
    Hpo!ia
    Cerebral
    ischemia
    "lood flow in
    #ertebrobasilar
    arter
    $fter % das of
    nursing
    intervention the
    client will
    achieve
    ade&uate
    nutrition' and
    e!perience no
    aspiration as
    manifested b:
    > ()* noiseless
    respiration and
    has clear
    breath sounds
    >no episodes
    of coughing'
    >+stablish
    rapport
    >,onitor #ital
    signs
    > elevate client
    to highest or
    best possible
    position during
    tube feeding
    > ascertain that
    feeding tube is
    in correct
    >To gain trust
    and have good
    communication
    >To obtain
    baseline data
    > to decrease
    ris- for
    aspiration
    .O$/ ,+T
    $fter % das of
    effective
    nursing
    intervention the
    client will
    achieve
    ade&uate
    nutrition' and
    e!perience no
    signs
    aspiration as
    manifested b
    > ()* noiseless
    respiration and
    has clear
    Nursing Priority No. 3: Risk for Aspiration related to presence of nasogastric tube
    wea-ness of
    the muscles of
    the tongue'
    pharn!'
    glottis' and
    esophagus
    impaired
    swallowing
    (0* nasogastric
    tube
    1is- for
    $spiration
    cho-ing'
    canosis while
    feeding2
    position2
    >as- client
    about feeling of
    fullness and
    measure
    residuals just
    prior to feeding
    or several hours
    after feeding
    when
    appropriate2
    >give oral
    feeding slowl2
    > 3rovided
    mouth care
    before and after
    meals
    > record
    patient4s inta-e
    >refer to
    phsician/
    speech therapist
    for medical
    interventions or
    e!ercises2
    > promotes
    comfort
    >to strengthen
    muscles and
    learn
    techni&ues to
    enhance
    swallowing2
    breath sounds
    >no episodes
    of coughing'
    cho-ing'
    canosis while
    feeding
    2

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