CUES NURSING ANALYSIS NURSING NURSING RATIONALE EVALUATION

DIAGNOSIS OBJECTIVE INTERVENTION

S: risk for impaired Throat muscle Within the Independent: Level of Attainment:
“Hindi sya swallowing r/t movement shift: -place patient in upright -use appropriate gravity to -goal met
masyadong inflammation of -the will be position during and after facilitate swallowing and AEB: demonstration of
makakain ng the throat muscles Loss of muscle tone able to feeding. reduces risk of aspiration. strict aspiration
maayos” as and pharynx demonstrate precaution observed by
verbalized by the Muscle spasticity feeding -assist patient with head -counteracts hyperextension, the watcher when
watcher. methods control, support, and aiding in prevention of feeding the patient.
Dysphagia appropriate to position based on specific aspiration and enhancing
individual dysfunction. ability to swallow. Optimum
O: situation with positioning can facilitate intake
 Afebrile aspiration and reduce risk of aspiration. Patient Outcome:
 Don’t talk prevention. -patient did not loss
when asked -provide pleasant -Promotes relaxation and weight
by questions -Maintain environment free of allows patient focus on task of
 With an IVF desired body destructions. eating and swallowing.
of D5 IMB weight
500 ml @ Collaborative:
150 cc level -coordinate -inclusion of dietitian, speech
and multidisciplinary approach and occupational therapists can
regulated to to develop treatment plan increase effectiveness of long-
63 cc/H that meets individual term plan and significantly
 weak in needs. reduced risk of silent
appearance aspiration.

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