Aspiration is the inhalation of oropharyngeal secretions and/or

stomach contents into the lungs. It may produce an acute form

of pneumonia.
Pathkophysiology and Etiology
 Patients at risk and factors associated with risk:
o Loss of protective airway reflexes (swallowing,

cough) caused by altered state of consciousness,

alcohol or drug overdose, during resuscitation
procedures, seriously ill or debilitated patients,
abnormalities of gag and swallowing reflexes
o NG tube feedings

o Obstetric patients—from general anesthesia,

lithotomy position, delayed emptying of stomach from

enlarged uterus, labor contractions
o GI conditions—hiatal hernia, intestinal obstruction,

abdominal distention
 Effects of aspiration depend on volume and character of
aspirated material
o Particulate matter—mechanical blockage of airways

and secondary infection

o Anaerobic bacterial aspiration—from oropharyngeal

secretions
o Gastric juice—destructive to alveoli and capillaries;

results in outpouring of protein-rich fluids into the

interstitial and intra-alveolar spaces (Impairs
exchange of oxygen and CO2, producing hypoxemia,
respiratory insufficiency, and respiratory failure.)
Clinical Manifestations
 Tachycardia, fever.
 Dyspnea, cough, tachypnea.
 Cyanosis
 Crackles, rhonchi, wheezing
 Pink, frothy sputum (may simulate acute pulmonary
edema)
Diagnostic Evaluation
 Chest X-ray may be normal initially; with time, shows
consolidation and other abnormalities.
Management
Depends on the material aspirated.
 Clearing the obstructed airway.
o If foreign body is visible, it may be removed

manually.
o Place the patient in tilted head-down position on right

side (right side more commonly affected if patient has

aspirated solid particles).
o Suction trachea/ET tube—to remove particulate

matter.
 Laryngoscopy/bronchoscopy if patient has been
asphyxiated by solid material.
 Fluid volume replacement for correction of hypotension.
P.292
  Antimicrobial therapy if there is evidence of superimposed
bacterial infection.
 Correction of acidosis; respiratory acidosis and metabolic
acidosis indicate a severe reaction due to aspiration of
gastric contents.
 Oxygen therapy and assisted ventilation if adequate ABG
values cannot be maintained.
Complications
 Lung abscess; empyema.
 Necrotizing pneumonia
Nursing Assessment
 Assess for airway obstruction.
 Assess for risk factors for aspiration.
 Assess for development of fever, foul-smelling sputum,
and development of congestion.
Nursing Diagnoses
(See pages 287 and 290 for nursing interventions.)
 Impaired Gas Exchange related to decreased ventilation
secondary to inflammation and infection involving distal
airspaces
 Ineffective Airway Clearance related to excessive
tracheobronchial secretions
  Acute Pain related to inflammatory process and dyspnea
 Risk for Injury secondary to complications
Nursing Interventions
Improving Gas Exchange
 Observe for cyanosis, dyspnea, hypoxia, and confusion,
indicating worsening condition.
 Follow ABG levels/Sao2 to determine oxygen need and
response to oxygen therapy.
 Administer oxygen at concentration to maintain Pao2 at
acceptable level. Hypoxemia may be encountered because
of abnormal ventilation-perfusion ratios in affected lung
segments.
 Avoid high concentrations of oxygen in patients with
COPD, particularly with evidence of CO2 retention; use of
high oxygen concentrations may worsen alveolar
ventilation by depressing the patient's only remaining
ventilatory drive. If high concentrations of oxygen are
given, monitor alertness and Pao2 and Paco2 levels for
signs of CO2 retention.
 Place patient in an upright position to obtain greater lung
expansion and improve aeration. Frequent turning and
increased activity (up in chair, ambulate as tolerated)
should be employed.
Enhancing Airway Clearance
 Obtain freshly expectorated sputum for gram stain and
culture, preferably early morning specimen as directed.
Instruct the patient as follows:
o Rinse mouth with water to minimize contamination by

normal flora.
o Breathe deeply several times.

o Cough deeply and expectorate raised sputum into

sterile container.
 Encourage patient to cough; retained secretions interfere
with gas exchange. Suction as necessary.
 Encourage increased fluid intake, unless contraindicated,
to thin mucus and promote expectoration and replace fluid
losses caused by fever, diaphoresis, dehydration, and
dyspnea.
 Humidify air or oxygen therapy to loosen secretions and
improve ventilation.
 Employ chest wall percussion and postural drainage when
appropriate to loosen and mobilize secretions.
 Auscultate the chest for crackles and rhonchi.
 Administer cough suppressants when coughing is
nonproductive only if there is no evidence of retained
secretions.
 Mobilize patient to improve secretion clearance and
reduce risk of atelectasis and worsening pneumonia.
Relieving Pleuritic Pain
  Place in a comfortable position (semi-Fowler's) for
resting and breathing; encourage frequent change of
position to prevent pooling of secretions in lungs.
 Demonstrate how to splint the chest while coughing.
 Avoid suppressing a productive cough.
 Administer prescribed analgesic agent to relieve pain.
Avoid opioids in patients with a history of COPD.
 Apply heat and/or cold to chest as prescribed.
 Assist with intercostal nerve block for pain relief.
 Encourage modified bed rest during febrile period.
 Watch for abdominal distention or ileus, which may
be due to swallowing of air during intervals of severe
dyspnea. Insert a nasogastric (NG) or rectal tube as
directed.
GERONTOLOGIC ALERT
Sedatives, opioids, and cough suppressants should be
used cautiously in elderly patients, because of their
tendency to suppress cough and gag reflexes and
respiratory drive. Also, provide or encourage frequent
oral care for pneumonia prevention.
Monitoring for Complications
 Remember that fatal complications may develop
during the early period of antimicrobial treatment.
 Monitor temperature, pulse, respiration, blood
pressure, and oximetry at regular intervals to assess
the patient's response to therapy.
 Auscultate lungs and heart. Heart murmurs or friction
rub may indicate acute bacterial endocarditis,
pericarditis, or myocarditis.
 Employ special nursing surveillance for patients
with:
o Alcoholism, COPD, immunosuppression—these

people as well as elderly patients, may have little

or no fever.
o Chronic bronchitis—it is difficult to detect

subtle changes in condition, because the patient

may have seriously compromised pulmonary
function.
o Epilepsy—pneumonia may result from

aspiration after a seizure.

o Delirium—may be caused by hypoxia,

meningitis, delirium tremens of alcoholism.

 Assess these patients for unusual behavior,
alterations in mental status, stupor, and heart failure.
 Assess for resistant fever or return of fever,
potentially indicating bacterial resistance to
antibiotics.
NURSING ALERT
Delirium must be controlled to prevent exhaustion and
cardiac failure. Prepare for lumbar puncture, if indicated,
to rule out meningitis, which may be lethal. Mild
sedation may be given.

Additional Nursing Interventions

 Be on guard constantly and monitor patients at risk as
described above.
 Elevate head of bed for debilitated patients, for those
receiving tube feedings, and for those with motor diseases
of the esophagus.
 Place patients with impaired reflexes in a lateral position.
 Make sure NG tube is patent.
 Give tube feedings slowly, with patient sitting up in bed.
o Check position of tube in stomach before feeding.

o Check seal of cuff of tracheostomy or ET tube before

feeding.
 Keep the patient in a fasting state before anesthesia (at
least 8 hours).
 Feed patients with impaired swallowing slowly, and make
sure that no food is retained in mouth after feeding.
NURSING ALERT
Morbidity and mortality rate of aspiration pneumonia remain
high even with optimum treatment. Prevention is the key to the
problem.