Dysphagia
Dysphagia is difficulty swallowing food, liquids, or saliva, which increases the risk of aspiration (food or liquid entering the airway), choking, malnutrition, and dehydration. Dysphagia is common in elderly patients and those with stroke, dementia, or neurological conditions.
Exam Tip
Dysphagia = difficulty swallowing. Position upright at 90 degrees for meals. ONLY serve the ordered diet consistency. Check for food pocketing. Chin-tuck position reduces aspiration risk. Thickened liquids are safer than thin liquids for dysphagia patients. Report all swallowing difficulties to the nurse.
What Is Dysphagia?
Dysphagia refers to any difficulty moving food or liquid from the mouth to the stomach. It can affect the oral phase (chewing and forming a bolus), the pharyngeal phase (triggering the swallow reflex), or the esophageal phase (moving food through the esophagus). For CNAs, recognizing signs of dysphagia and following aspiration precautions is critical for patient safety.
Common Causes of Dysphagia
| Cause | Mechanism |
|---|---|
| Stroke | Damages swallowing muscles/nerves |
| Dementia/Alzheimer's | Forgets how to chew/swallow |
| Parkinson's disease | Impairs muscle coordination |
| Head/neck cancer | Structural obstruction or surgical changes |
| Aging | Weakened swallowing muscles |
| Intubation | Throat irritation/damage from tubes |
Signs of Dysphagia (What the CNA Should Observe)
- Coughing or choking during or after eating/drinking
- Wet or gurgling voice quality after swallowing
- Food remaining in the mouth (pocketing) after swallowing
- Drooling or difficulty managing saliva
- Taking a very long time to eat
- Refusing food or showing fear of eating
- Weight loss or signs of dehydration
- Recurrent respiratory infections (possible aspiration pneumonia)
CNA Interventions for Patients with Dysphagia
- Follow the diet order exactly: serve only the prescribed consistency (pureed, mechanical soft, thickened liquids)
- Position upright (90 degrees) during meals and for 30-60 minutes after
- Use the chin-tuck technique if ordered (chin toward chest while swallowing)
- Feed slowly: small bites, wait for complete swallow before offering more
- Check for food pocketing in cheeks after each bite
- Provide thickened liquids as ordered (never give thin liquids to a patient ordered for thickened)
- Never rush meals or force food
- Report signs of difficulty swallowing to the nurse immediately
Diet Texture Levels (IDDSI Framework)
| Level | Texture | Description |
|---|---|---|
| 0 | Thin liquids | Water, juice, coffee (highest aspiration risk) |
| 1 | Slightly thick | Thicker than water but pours easily |
| 2 | Mildly thick | Flows off a spoon |
| 3 | Moderately thick (honey) | Can be eaten with spoon, does not pour |
| 4 | Pureed | Smooth, no lumps, does not require chewing |
| 5 | Minced and moist | Small soft pieces, minimal chewing |
| 6 | Soft and bite-sized | Soft, tender, can be mashed with fork |
| 7 | Regular/easy to chew | Normal food textures |
Exam Alert
Dysphagia management is heavily tested on the CNA exam. Key points: always position the patient upright (90 degrees) during meals, provide ONLY the diet consistency ordered (never give thin liquids to someone on thickened liquids), check for food pocketing, and report any signs of difficulty swallowing immediately. The chin-tuck position reduces aspiration risk.
Study This Term In
Related Terms
Aspiration
Aspiration is the entry of food, liquid, saliva, or other foreign material into the airway and lungs instead of the esophagus. Aspiration can cause choking, aspiration pneumonia, and in severe cases, death, making prevention a critical nursing assistant responsibility.
Aspiration Precautions
Aspiration precautions are nursing interventions designed to prevent food, liquid, or gastric contents from entering the airway and lungs. Key measures include elevating the head of bed to 30-45 degrees, thickening liquids, and monitoring swallowing ability.
Thickened Liquids
Thickened liquids are beverages and liquid foods that have been modified to a thicker consistency using commercial thickening agents to make them safer to swallow for patients with dysphagia (difficulty swallowing). Thickening liquids slows the flow, giving the patient more time to control the swallow and reducing the risk of aspiration.
Intake and Output (I&O)
Intake and Output (I&O) is a nursing measurement that tracks all fluids entering (intake) and leaving (output) a patient's body over a specified period, typically 24 hours. Accurate I&O monitoring is essential for assessing fluid balance, kidney function, and hydration status.
Fowler's Position
Fowler's position is a standard patient positioning in which the head of the bed is elevated to a 45-90 degree angle while the patient sits semi-upright or upright. Variations include low Fowler's (15-30 degrees), semi-Fowler's (30-45 degrees), standard Fowler's (45-60 degrees), and high Fowler's (60-90 degrees).
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