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    NCP-Combate-Risk For Aspiration

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    Kayelyn-Rose Combate
    St. Paul University Philippines provides a 3-sentence summary of a nursing care plan for a patient at risk of aspiration. The patient has an NGT and ET tube due to decreased consciousness and requires oxygen. The plan identifies aspiration risk factors like the tubes and impaired swallowing. Goals are to prevent aspiration by monitoring tubes, consciousness levels, and oxygen saturation for 2-3 hours using interventions like positioning and suctioning. Progress is evaluated by maintaining stable vital signs and oxygen saturation within normal limits.

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    NCP-Combate-Risk For Aspiration

    Uploaded by

    Kayelyn-Rose Combate
    149 views2 pages
    St. Paul University Philippines provides a 3-sentence summary of a nursing care plan for a patient at risk of aspiration. The patient has an NGT and ET tube due to decreased consciousness and requires oxygen. The plan identifies aspiration risk factors like the tubes and impaired swallowing. Goals are to prevent aspiration by monitoring tubes, consciousness levels, and oxygen saturation for 2-3 hours using interventions like positioning and suctioning. Progress is evaluated by maintaining stable vital signs and oxygen saturation within normal limits.

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    NCP-Combate-Risk for aspiration

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    St. Paul University Philippines provides a 3-sentence summary of a nursing care plan for a patient at risk of aspiration. The patient has an NGT and ET tube due to decreased consciousness and requires oxygen. The plan identifies aspiration risk factors like the tubes and impaired swallowing. Goals are to prevent aspiration by monitoring tubes, consciousness levels, and oxygen saturation for 2-3 hours using interventions like positioning and suctioning. Progress is evaluated by maintaining stable vital signs and oxygen saturation within normal limits.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    149 views2 pages

    NCP-Combate-Risk For Aspiration

    Uploaded by

    Kayelyn-Rose Combate
    St. Paul University Philippines provides a 3-sentence summary of a nursing care plan for a patient at risk of aspiration. The patient has an NGT and ET tube due to decreased consciousness and requires oxygen. The plan identifies aspiration risk factors like the tubes and impaired swallowing. Goals are to prevent aspiration by monitoring tubes, consciousness levels, and oxygen saturation for 2-3 hours using interventions like positioning and suctioning. Progress is evaluated by maintaining stable vital signs and oxygen saturation within normal limits.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    St.

    Paul University Philippines


    Tuguegarao City, Cagayan 3500

    School of Nursing and Allied Health Sciences


    College of Nursing
    Bachelor of Science in Nursing – 3
    CUES NURSING BACKGROUND GOALS AND INTERVENTIONS EVALUATION
    DIAGNOSIS KNOWLEDGE OBJECTIVES
    Subjective: Risk for NANDA defined it NOC:  Risk NIC: Aspiration. Precautions GOAL MET
    aspiration rt as at risk for entry Control
    Objectives: presence of of gastrointestinal Short Term:
    NGT and ET secretions, Short Term: After 2-3 hours of
    - GCS: 9/15 secondary to oropharyngeal After 2-3 hours of nursing
    -W/ NGT for decrease level secretions or solid nursing interventions the
    fluids of fluids into interventions the client will be able
    -W/ consciousness tracheobronchial client will be able to
    Endotracheal . passages. to:
    Tube for A1. Determine patient as at-risk
    suctioning A. Identify patient according to - Identified 2-3
    -W/ IFC Aspiration occurs causative/ condition/disease process. (Patients contributing
    -W/crackles when food, contributing with impaired swallowing factors for
    -W/ o2 at secretions, fluids, factors for (dysphagia) from a stroke, aspiration aeb
    2Lpm or other substances aspiration. Parkinson’s disease, or spinal cord by oxygen
    enter the airways or injury or suffering neurological saturation
    Vital Signs: lungs. When you damage with the inability to clear within normal
    BP: 120/80 swallow, the secretions require assessment and limits.
    HR: 60 epiglottis should monitoring when providing
    RR: 15 close over the anything by mouth.)
    SpO2: 98% trachea which
    Temp: 35.9 prevents food or A2. Determine Glasgow scale. Note
    fluids from level of consciousness and oxygen
    entering the trachea saturation every hour. (Patients who
    (often called the are sedated either intentionally or
    windpipe). If this unintentionally are at risk for
    mechanism fails, aspiration. Patients with cognitive
    unintended delays may not be able to clear
    substances can end secretions themselves.)
    up in the lungs
    which can cause A3. Assess client’s ability to
    complications such swallow and strength of gag reflex.
    as aspiration (Helps to determine presence and
    pneumonia. effectiveness of protective
    Sometimes gastric mechanism.)
    contents can also
    reflux which causes A4. Monitor for tubes that increase
    stomach contents to aspiration risk. (A nasogastric tube
    regurgitate into the that is dislodged from the stomach
    esophagus. can cause aspiration if gastric
    Symptoms such as contents get into the lungs)
    vomiting and
    belching can cause A5. Monitor abdomen and listen to

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