F6 · Trouble chewing or swallowing
Actual Food and fluids
Definition
Chewing or swallowing is painful or unsafe, with coughing or choking at meals.- Stroke
- mouth or throat problems
- weak muscles
- dementia
- Coughing or choking at meals
- wet voice
- food held in cheeks
- drooling
- very slow meals
📋 Scenario
After a stroke, a patient coughs every time he drinks water.
Subjective (S): "It feels like the water goes the wrong way."
Objective (O): Coughs after each sip of water; wet gurgling voice; right facial droop; failed bedside swallow screen.
Assessment tools for this scenario: CP-FLUID Fluid Balance & Nutrition Score
Validated scales to consider: MUST, fluid chart, glucose
**CarePath diagnosis:** Trouble chewing or swallowing related to stroke, as evidenced by coughing or choking at meals and wet voice.
**Interventions and rationale**
| Intervention | Rationale |
|---|---|
| Screen swallowing. | A swallow screen shows whether swallowing is safe before food or drink can go into the lungs. |
| Sit upright for meals. | An upright position uses gravity and helps the airway close properly, lowering the risk of food entering it. |
| Follow texture advice from the speech therapist. | The speech therapist knows which food and drink textures he can swallow safely. |
| Supervise eating. | Supervision lets the nurse notice coughing or choking quickly and help. |
| Give mouth care. | Mouth care removes bacteria, so if saliva or food does enter the lungs, there are fewer germs to cause pneumonia. |
**Expected outcomes**
- No choking or aspiration during the stay.
- Within 48 hours: safe diet level confirmed by the speech therapist.
- Patient eats and drinks safely following advice.
**Linking the data to the diagnosis**
After a stroke the patient coughs after each sip of water, has a wet gurgling voice, a right facial droop and failed the bedside swallow screen. He says the water goes the wrong way. This is an actual problem because the swallowing difficulty is already shown. A statement about not eating enough would miss the safety issue, since the danger here is food or fluid entering the airway. The plan aims for no choking or aspiration during the stay, a safe diet level confirmed by the speech therapist within 48 hours, and the patient eating and drinking safely by following advice.
CarePath diagnosis
Trouble chewing or swallowing related to stroke, as evidenced by coughing or choking at meals and wet voice.
Interventions and rationale
Listed in priority order.
| Intervention | Rationale |
|---|---|
| 1. Screen swallowing. | A swallow screen shows whether swallowing is safe before food or drink can go into the lungs. |
| 2. Sit upright for meals. | An upright position uses gravity and helps the airway close properly, lowering the risk of food entering it. |
| 3. Follow texture advice from the speech therapist. | The speech therapist knows which food and drink textures he can swallow safely. |
| 4. Supervise eating. | Supervision lets the nurse notice coughing or choking quickly and help. |
| 5. Give mouth care. | Mouth care removes bacteria, so if saliva or food does enter the lungs, there are fewer germs to cause pneumonia. |
Expected outcomes
- No choking or aspiration during the stay.
- Within 48 hours: safe diet level confirmed by the speech therapist.
- Patient eats and drinks safely following advice.
Linking the data to the diagnosis
After a stroke the patient coughs after each sip of water, has a wet gurgling voice, a right facial droop and failed the bedside swallow screen. He says the water goes the wrong way. This is an actual problem because the swallowing difficulty is already shown. A statement about not eating enough would miss the safety issue, since the danger here is food or fluid entering the airway. The plan aims for no choking or aspiration during the stay, a safe diet level confirmed by the speech therapist within 48 hours, and the patient eating and drinking safely by following advice.