السبت، 21 يوليو 2018

Some Essential Concepts Regarding Aspiration Pneumonia Prevention

By Martha Wilson


Aspiration usually occurs as a result of lack of control of muscles in the upper gastrointestinal system. Inability to control food propulsion and swallowing may result in some of the digested food material getting into the respiratory tract. When this happens, the affected individual may suffer from what is termed aspiration pneumonia. It is, therefore, prudent to observe aspiration pneumonia prevention measures particularly for high risk groups. Some of these high risk groups include the aged, those with neuromuscular diseases, surgical patients and those who spend a long time in the intensive care unit.

For patients whose muscles are weak or completely paralyzed, feeding should be carried out through a tube that runs from the nostril to the stomach. This tube is medically referred to as a nasogastric tube, NGT. When inserting the tube, it is better to mildly sedate the patient as the process can be very uncomfortable if performed on someone that is awake.

The doctor can request for a check radiograph (X-ray) to ensure that tube has been correctly placed. One should also ensure the tube remains patent by administering only liquids and partial solids. The tubes need to be cleaned from time to minimize the risk of infection. Another precaution to be undertaken is that the caregiver should make sure that the food being administered is not too hot to cause damage to the tube and corrosion to the stomach lining.

In the event that an tube cannot be inserted even after several attempts, an alternative should be sought. Nutrients can reach the body through an infusion that runs via an intravenous system. Placement of a tube or setting up parenteral nutrition should only be used once it has been ascertained that the individual cannot tolerate any oral feeds.

One of the medical conditions that may require placement of a nasogastric tube is stroke which typically occurs among the elderly. Those with heart disease, high blood pressure and diabetes are at a high risk of getting a stroke. In persons affected by stroke, certain muscles suddenly become paralyzed. Doctors need to do a swallow test for patients presenting with stroke in order to adjust their feeding in the event that their swallowing is compromised.

The importance of nursing the patient in a propped up position cannot be overemphasized. Elevating the head of the bed not only keeps the patient comfortable but it also ensures that any food remnants are directed downwards along the gastrointestinal tract. The patient can also be made to lie on one side to minimize regurgitation.

Patients being nursed in intensive care units over a long period of time are also likely to aspirate. Apart from propping them up and feeding them through a nasogastric tube, intubation also helps to separate the trachea from the food pipe. Those with chronic conditions also need to be monitored closely for any complications that may arise. This includes doing imaging studies of the lungs to detect any abnormalities.

In conclusion, prevention of aspiration pneumonia is possible as long as there is commitment from the caregivers. Individuals who are susceptible to aspiration include the very old, those in a coma and those with neuromuscular diseases. Prevention involves basic measures such as monitored feeding and elevating the head of the bed.




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