Risk for Aspiration in a Rehabilitation Unit

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Table of Contents

Introduction
Assessment and analysis of an aspiration problem
Planning/Literature Review
Intervention
Evaluation
Conclusion
References

Introduction

Aspiration is a medical condition that results from an accidental inhalation of food particles or fluids into the respiratory track. Inhalation of the stomach contents into the respiratory track causes infections in the lower respiratory track. A normal cough or lung cilia removes the foreign particles in a healthy person, and thus prevents infections (Butler, Stuart, Wilhelm, Rees, Williamson, & Kritchevsky, 2011). However, aspiration would occur in patients who are under acute care in rehabilitation units. A set of professionals attend to the patients and subject them to complex processes that aim at enhancing their quality of life. Patients suffering from chronic diseases are at a high risk of aspiration, thus they may have bacterial infections and chemical irritations in their lungs. Severe aspiration of gastric substances into the respiratory track is a serious condition that can cause fatal illnesses to the chronically ill patients. It is evident that patients at the rehabilitation units are at a high risk of respiration. This paper will give a reflective analysis of an aspiration incidence in a rehabilitation unit. It will give a literature review of the aspiration medical condition; provide an intervention, evaluative and resolution program for the medical condition.

Assessment and analysis of an aspiration problem

During a clinical rotation in the inpatient rehabilitation unit, I happened to witness a chronically ill patient suffering from a severe chock. This was because of the obstruction of the respiratory track, and the patient coughed and puffed out solid particles. I believe the condition resulted from chocking and obstruction of the airway. Despite the weakened body of the patient, the patient had an adaptive behavior because he tried to collaborate with the caregiver to sit at the right position to avoid more chocking. The caregiver, who was either a non-experienced medical practitioner or a nurse student panicked and was unsure of the next step to take. The caregiver held the patient at a 90⁰ angle, which is not right. These weird happenings certified my judgment that something was not right in the inpatient rehabilitation unit. A non-experienced medical practitioner was attending to a patient whose risk of aspiration was not fully determined. Within not time, I witnessed the death of the patient.

Planning/Literature Review

The problem of aspiration has prevailed for a long time, where, the patients suffering from chronic conditions are at a high risk of having aspiration conditions. These patients need utmost care given their severe conditions, and that is why medical centers have chosen to have rehabilitation units within the hospital setup. These rehabilitation units help in maximizing the healing process. Patients diagnosed with acute medical conditions cannot eat, thus they use the feeding tubes to hydrate and feed the body. The feeding tubes are inserted through the nose or the stomach abdomen to reduce the risk of aspiration.

Of the various forms of aspirations, aspiration pneumonia is the commonest. The complication starts from the lower lobe of the lungs, and whenever the patient lies facing upwards for prolonged periods, the aspiration material may extend to the upper lobes. The condition may get worse in the hospital environment where the patients are exposed to multiple bacteria, pathogens and anaerobes (Shakespeare, 2012). Interestingly, women are at a lower risk of contracting aspiration pneumonia, as it is common in children, men, and the elderly.

The risk factors associated with aspiration pneumonia include trachea-esophageal fistula, which may cause foreign particles entering into the lungs (Asian Pacific society of Respirology, 2009). Medical procedures such as anesthesia and sedation make patients unconscious, thus exposing them to aspiration pneumonia. Swallowing disorders caused by a bulbar palsy, a pharyngeal disease, or an esophagus stricture places the patient at a high risk of aspiration pneumonia. If patients have poor mobility due to ageing and several numbers of medications, or if they suffer from chronic pulmonary diseases, they are at a high risk of aspiration pneumonia. Other medical conditions that present risk factors for aspiration pneumonia include bronchitis, epiglottises, asthma, cardiovascular diseases, or any form of foreign material in the respiratory track.

Aspiration pneumonia has no particular symptoms and the patient may have an acute headache, nausea, anorexia, fever. The patient could have difficulties in breathing, reoccurring coughs, purulent sputum, tachycardia and excessive dullness (Vacca, 2012). In the case of a severe infection, patients suffer from hypoxia and septic shock. However, to make the right diagnosis it is necessary to carry out deep investigations. There is the need to test the blood count, electrolyte imbalance, renal functionality, blood gases, and blood culture. However, screening of the culture of sputum is the most significant test. If a patient suffers from aspiration pneumonia, the culture of sputum shows pharynx organisms. A chest x-ray, especially for patients who use alcohol is very essential. An x-ray in the right upper lobe of the lung shows the consolidated amounts of alcohol (Association of Physicians Association, 2012). A computer tomography of the lungs is necessary but it is not sufficient to diagnose aspiration pneumonia.

The primary management measure for aspiration pneumonia is tracheal suction, provided the condition is diagnosed early enough. In the case of a visible solid foreign particle, mechanical obstruction can work perfectly. Bronchoscope would help in removing the object before it causes bacterial infections. If the patient is suspected to have contracted a bacterial infection, it is necessary to detect a previous antibiotic treatment from a microbiology culture test. Past records of the patients’ resistance to pathogens help in determining the right antimicrobial therapy. Community acquired transpiration are common within the hospital setup because of the patients’ exposure to pathogens and microbes from the other infected patients (Bosch, Formiga, Cuerpo, Torres, Rosón, & López-Soto, 2012). To help in managing this, the hospital ventilators need enhancement. Further, patients with high risk of aspiration pneumonia need intubation with pressure ventilators. In the case of extreme cases of lung abscess, patients need Metronidazole treatments. Use of steroids and supportive therapy could work in managing aspiration pneumonia. Bronchodilators and physiotherapy may work greatly, however, if the conditions worsens, one will need to consult a speech and language therapist. Generally, the level of well-being and the promptness to diagnose the aspiration determines the treatment to employ in treating aspiration.

Intervention

It is a sad incidence that I witnessed the death of a patient. I later learned that the medical practitioners did not diagnose the patient’s risk of aspiration in time. The patient had a swallowing problem and he died because of suffocation resulting from the chocking and blocking of the respiratory system. There is need for various interventions to help in improving the risk of deaths due to aspiration.

There should be a thorough screening for all patients in the rehabilitation units, whether newly diagnosed or acute patients. The patients should undergo a nutrition and hydration examination immediately after admission. This should take place within 24 hours of admission and it should involve duly trained medical practitioners and not medical students, unless they are under the supervision of an experienced medical practitioner. Prior to any oral intake, the patients need a check-up to ensure they do not have swallowing problems. The patients’ food intake, fluid intake, and the body weight are recorded on a daily routine. The rationale for this recommendation lay in the fact that some of the medical staffs are likely to administer medications and fluids without full knowledge of the patients’ risk of aspiration. The medical staffs would handle patients recklessly without knowing the exact medical condition, position, and progress of the patient.

There should be a way to discriminate the patients with a high risk of aspiration and those with a low risk of aspiration. Cooperative patients who voluntarily cough, swallow saliva, and can talk are at a low risk of aspiration. However, those patients who are non-cooperative, they have a history of swallowing problems and aspirations are at a high risk of aspiration. All patients’ records should show any symptoms of dysphasia, the risk of aspiration, and the specific recommendations. The rationale for this recommendation is the fact that some medical staff could be tempted to subject patients under the same treatments, yet each of the patients need special care. Food, oral medication, and fluids are withheld from the high-risk patients, and the patient is subjected under NPO (Nil per oral).

There should be close supervision for unconscious patients. The rationale for this is the fact that patients who are not alert are at a high risk of aspiration. Timely swallowing screenings are necessary for such patients to avoid chocking. Unconscious patients diagnosed with dysphasia need close monitoring and comprehensive clinical evaluations to reveal their swallowing physiology and anatomy. It is noteworthy that the lying position of the unconscious patient is very important. Keeping the patient’s head at an angle of 30⁰ reduces the risk of aspiration pneumonia. Extreme care is necessary in the process of nose-gastric feeding of unconscious patients because of their high risk of aspiration.

Evaluation

The interventions listed above are somewhat complex and the evident of their effectiveness must be sufficient to convince the hospital’s top management team that they are worthwhile. To determine the success of these interventions, a data collection exercise will be necessary. It is necessary to analyze data from the death records in the inpatient rehabilitation unit before and after the interventions, with emphasis on the cause of death. If the research outcomes indicate that the number of deaths after the interventions surpass the number of deaths before the intervention, it clearly shows that the interventions were unfeasible. However, the interventions would prove to be worthwhile if there is a decrease in the number of deaths after the interventions.

Conclusion

The hospitals and all medical setups are very significant places. These are the places where weakened patients hope to find relieve and utmost care. The rehabilitation unit patients lay their lives in the hands of the medical caretakers. It is upon the medical practitioners and all caregivers to ensure they offer the best of care to patients. In case of a loop that calls for interventions, the medical practitioners should accept to embrace the interventions, provided they are worthwhile.

References

Asian Pacific society of Respirology. (2009). Respirology. Respirology, 14(2), S59 – S64.

Association of Physicians Association. (2012). Clinical picture. Q J Med, 105(1), 903–904.

Bosch, X., Formiga, F., Cuerpo, S.,Torres, B., Rosón, B., & López-Soto, A. (2012). Aspiration pneumonia in old patients with dementia. Prognostic factors of mortality. European Journal of Internal Medicine, 23(1) 720–726.

Butler, S. G., Stuart, A., Wilhelm, E., Rees, C., Williamson, J., & Kritchevsky, S. (2011). The effects of aspiration status, liquid type, and bolus volume on pharyngeal peak pressure in healthy older adults. Dysphasia, 26(3), 225-31.

Shakespeare, A. S. (2012). Aspiration lung disorders in bovines: A case report and review. Journal of the South African Veterinary Association, 83(1), 1-7.

Vacca, V. M. (2012). Aspiration pneumonia. Aspiration pneumonia in adults, 42(9), 72.

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