![]() For more specific swallowing assessments, fiberoptic endoscopy of swallowing (FEES) or videofluoroscopy (VFS) may be used (Gallegos et al., 2017). Most swallow screens use varying volumes of water to assess the ability to swallow (Smithard, 2016). Assessment may begin at the bedside, using a variety of tools. While dysphagia screening by nurses does not replace assessment by other health professionals, it enhances the provision of care to at-risk patients by allowing for early recognition and intervention (Hines et al., 2016 Palli et al., 2017). Conditions that suppress the cough reflex (such as sedation) further increase the risk for aspiration.īEST PRACTICES: ASSESSMENT AND PREVENTION ASSESSMENT: A multidisciplinary approach to identify dysphagic patients is important (Aoki et al., 2016). The older adult with one of these conditions is at even greater risk for aspiration because the dysphagia is superimposed on the slowed swallowing rate associated with normal aging. TARGET POPULATION: Dysphagia is common in persons with neurologic diseases such as stroke, Parkinson’s disease, and dementia. Dysphagia is a significant predictor of worse clinical outcomes in hospitalized patients with dementia (Paranji et al., 2017). Other harmful sequelae of dysphagia include malnutrition and dehydration (Wilmskoetter et al., 2017). ![]() In fact, the risk of pneumonia is three times higher in patients with dysphagia (Hebert et al., 2016). WHY: Aspiration (the misdirection of oropharyngeal secretions or gastric contents into the larynx and lower respiratory tract) is common in older adults with dysphagia and can lead to aspiration pneumonia. An upright upper trunk results in higher stroke volume and preload and a lower heart rate compared with an upright whole trunk in Fowler’s position. Kubota et al found that slight differences in trunk posture while in Fowler’s position affect hemodynamics. A study of young healthy individuals has shown that blood pressure in Fowler’s position is intermediate between the seated and supine positions and a cross-sectional study of hypertensive patients found the same tendency. reported that cardiac output is decreased in patients under intensive care who are in the Fowler’s position, compared with those who are supine. Some studies have described a relationship between the angle of Fowler’s position and the accuracy of hemodynamic measurements among patients in intensive care units and Driscoll et al. Thus, to understand the most effective posture required to counteract the downward fluid shift while in Fowler’s position should be clinically meaningful. On the other hand, such patients develop orthostatic hypotension because they cannot physically compensate quickly for the downward fluid shift caused by assuming an upright position. Patients who are confined to bed or frail are frequently placed in Fowler’s position instead of remaining supine to assist ambulation, monitor hemodynamics and facilitate breathing as well as routine activities such as eating or conversation. The upright head and trunk in Fowler’s position are more essential for the quality of life of patients who are confined to bed or frail and it is clinically applied most frequently at inclinations between 30° and 60°. High Fowler’s position (Full Fowler’s position): head of the bed raised between 60 and 90 degrees.Standard Fowler’s position: head of the bed raised 45-60 degrees.Semi Fowler’s position: head of the bed raised 30-45 degrees.Low Fowler’s position: head of the bed raised 15-30 degrees.Peristalsis and swallowing are aided by the effect of gravitational pull. High Fowler’s position with the head of the bed between 60 and 90 degrees is useful during placement of orogastric and nasogastric feeding tubes as it decreases the risk of aspiration. Fowler’s position is also frequently used when feeding a patient with feeding precautions, during breathing treatments, to perform activities of daily living, for dependent drainage after abdominal surgery, pneumonectomy or other such surgeries. Fowler’s position increases comfort during eating and other activities, is used in postpartum women to improve uterine drainage, and in infants when signs of respiratory distress are present. Fowler’s position is usually implemented in cases of respiratory distress. Respiratory changes result in increased oxygenation by maximizing chest expansion. Fowler’s position includes angles between 30 and 90 degrees. Fowler’s position is used in nursing to promote oxygenation to allow for maximum chest expansion, minimizing abdominal muscular tension and minimizing the effects of gravity on the chest wall, therefore, a useful maneuver for patients in mild to moderate respiratory distress. Fowler’s position is a standard patient position in which the patient is seated in a semi-sitting position (45 to 60 degrees) with knees either straight or slightly bent.
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