Dysphagia Nursing Care Plan | Assessment & Interventions

Dysphagia, or difficulty swallowing, is a common clinical condition that can affect patients across the lifespan—especially the elderly, stroke patients, and those with neurological or muscular disorders. Creating a comprehensive dysphagia nursing care plan is essential for maintaining airway safety, adequate nutrition, and patient comfort. For NCLEX students, understanding how to assess, diagnose, and intervene in dysphagia cases is critical. This guide covers everything from clinical cues to NANDA-approved diagnoses, real-world interventions, and a complete nursing care plan on dysphagia aligned with NCLEX expectations.

What is Dysphagia?

Dysphagia is the medical term for difficulty or discomfort in swallowing. It may occur in the oral, pharyngeal, or esophageal phase of swallowing and can lead to serious complications such as aspiration, malnutrition, dehydration, and even pneumonia.

Patients with dysphagia may present with:

• Coughing or choking during meals

• Sensation of food sticking in the throat

• Pocketing of food in the cheeks

• Wet or gurgly voice after eating

• Unintended weight loss

• Frequent respiratory infections

Dysphagia often results from:

• Stroke

• Parkinson’s disease

• Multiple sclerosis

• ALS

• Head and neck cancers

• Trauma or surgery to the throat

Nursing Assessment for Dysphagia

Before developing a nursing care plan for dysphagia, the nurse must perform a thorough assessment to identify symptoms and associated risks.

Assessment Components:

• Observation during meals (watch for coughing, choking, delayed swallowing)

• Oral inspection for drooling, pocketing of food, tongue strength

• Listen to voice post-swallow (gurgly or wet tone may suggest aspiration)

• History taking: Recent stroke? Neuro conditions? Any known swallowing issues?

• Weight changes, intake diaries, lab markers of malnutrition

• Swallowing studies (e.g., videofluoroscopic swallow study if ordered)

NANDA Nursing Diagnosis for Dysphagia

When creating a nursing care plan on dysphagia, it is crucial to choose the appropriate NANDA-approved nursing diagnosis. Here are the most relevant ones:

1. Impaired Swallowing

Definition: Abnormal functioning of the swallowing mechanism associated with deficits in oral, pharyngeal, or esophageal structures.

Related to:

• Neuromuscular impairment (e.g., stroke, Parkinson’s)

• Mechanical obstruction (e.g., tumor, stricture)

• Reduced consciousness or sedation

As evidenced by:

• Coughing or choking during/after meals

• Difficulty managing secretions

• Reports of food “sticking”

• Drooling

• Delayed or absent swallow reflex

This is the primary nursing diagnosis for dysphagia and should always be considered in your nursing care plan dysphagia documentation.

2. Risk for Aspiration

Use this diagnosis if the patient has difficulty swallowing but hasn’t yet aspirated.

Risk factors include:

• Weak or ineffective cough

• Altered mental status

• Tube feeding

• Poor gag reflex

3. Imbalanced Nutrition

This can be used if the patient has experienced unintentional weight loss or inadequate intake related to dysphagia.

Nursing Care Plan for Dysphagia

Here’s a comprehensive example of a nursing care plan for dysphagia, ideal for NCLEX prep or clinical use:

Nursing Interventions for Dysphagia

Effective management involves collaboration, safety monitoring, and individualized dietary modifications. Below are key interventions to include in any dysphagia nursing care plan:

1. Positioning

Always place the patient in an upright (90°) seated position during feeding and maintain for at least 30 minutes post-meal.

2. Swallowing Techniques

Teach and supervise safe swallowing methods, such as:

• Chin-tuck technique

• Multiple swallows per bite

• Small bites and slow pace

3. Modify Food and Fluids

Collaborate with the dietitian or SLP to provide:

• Thickened liquids (nectar, honey consistency)

• Pureed or mechanical soft diet

4. Oral Care

Maintain good oral hygiene to reduce the risk of aspiration pneumonia caused by oral bacteria.

5. Monitoring During Feeding

Observe for:

• Coughing

• Pocketing of food

• Labored breathing

• Fatigue or refusal to eat

NCLEX Tips: Nursing Care Plan on Dysphagia

On the NCLEX, dysphagia questions often appear in the Safety and Infection Control or Basic Care and Comfort sections. Here’s what to keep in mind:

• Priority? Airway and aspiration prevention. Choose answers that reduce risk.

• Watch for keywords like “recent stroke,” “choking,” or “weak cough”—these usually indicate a swallowing disorder.

• Never lay flat post-meal or encourage thin liquids if dysphagia is suspected.

• Always follow standard protocols for aspiration precautions.

Real-World Example for NCLEX-Style Practice

Question: A nurse is caring for a patient who has impaired swallowing due to a recent stroke. Which intervention is appropriate?

A. Offer thin liquids to encourage hydration
B. Position the patient flat after meals
C. Collaborate with speech therapy for swallow evaluation
D. Encourage fast eating to prevent fatigue

Correct Answer: C. Collaborate with speech therapy for swallow evaluation

Final Thoughts

Creating an effective dysphagia nursing care plan is a crucial skill for any nurse, especially when dealing with elderly, post-stroke, or neuro-compromised patients. The nursing care plan on dysphagia must focus on airway protection, nutritional adequacy, and prevention of complications like aspiration pneumonia.

Always prioritize safety, consult interdisciplinary teams, and educate both patient and caregivers on proper techniques. For NCLEX, focus on recognizing high-risk symptoms and knowing the interventions that reduce aspiration risk.