Nursing Diagnosis – Code 00103 Impaired swallowing (1986, 1998)

Domain 2. Nutrition Class 1. Ingestion

Impaired swallowing

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

Defining Characteristics

First Stage: Oral ■ Abnormal oral phase of swallow study ■ Choking prior to swallowing ■ Coughing prior to swallowing ■ Drooling ■ Food falls from mouth ■ Food pushed out of mouth ■ Gagging prior to swallowing ■ Inability to clear oral cavity ■ Incomplete lip closure ■ Inefficient nippling
■ Inefficient suck ■ Insufficient chewing ■ Nasal reflux ■ Piecemeal deglutition ■ Pooling of bolus in lateral sulci ■ Premature entry of bolus ■ Prolonged bolus formation ■ Prolonged meal time with insufficient consumption ■ Tongue action ineffective in forming bolus
Second Stage: Pharyngeal ■ Abnormal pharyngeal phase of swallow study ■ Alteration in head position ■ Choking ■ Coughing ■ Delayed swallowing ■ Fevers of unknown etiology ■ Food refusal
■ Gagging sensation ■ Gurgly voice quality ■ Inadequate laryngeal elevation ■ Nasal reflux ■ Recurrent pulmonary infection ■ Repetitive swallowing

Third Stage: Esophageal

■ Abnormal esophageal phase of swallow study ■ Acidic-smelling breath ■ Bruxism ■ Difficulty swallowing ■ Epigastric pain ■ Food refusal ■ Heartburn ■ Hematemesis ■ Hyperextension of head ■ Nighttime awakening
■ Nighttime coughing ■ Odynophagia ■ Regurgitation ■ Repetitive swallowing ■ Reports “something stuck” ■ Unexplained irritability surrounding mealtimes ■ Volume limiting ■ Vomiting ■ Vomitus on pillow

Related Factors

Congenital Deficits

■ Behavioral feeding problem ■ Conditions with significant hypotonia ■ Congenital heart disease ■ Failure to thrive ■ History of enteral feeding
■ Mechanical obstruction ■ Neuromuscular impairment ■ Protein-energy malnutrition ■ Respiratory condition ■ Self-injurious behavior ■ Upper airway abnormality

Neurological Problems

■ Achalasia ■ Acquired anatomic defects ■ Brain injury (e.g., cerebrovascular impairment, neurological illness, trauma, tumor) ■ Cerebral palsy ■ Cranial nerve involvement ■ Developmental delay ■ Esophageal reflux disease ■ Laryngeal abnormality
■ Laryngeal defect ■ Nasal defect ■ Nasopharyngeal cavity defect ■ Neurological problems ■ Oropharynx abnormality ■ Prematurity ■ Tracheal defect ■ Trauma ■ Upper airway anomaly