The Cough at the Dining Table
Mr. Alvarez, 82, had a stroke three weeks ago and has left-sided weakness. It is 1215 and you are assisting him with lunch at the dining table. He is on a regular diet with nectar-thick liquids. He takes a bite of diced chicken, then begins coughing forcefully. His face is flushed, his eyes are watering, and he grips the table edge. Between coughs he says in a hoarse voice, "It went down wrong." A nursing student nearby asks, "Should I run and get the suction machine?" Fourteen other residents are eating in the room, and the charge nurse is at the far end of the hall giving a treatment.
1. What is the first thing you do - and what do you deliberately NOT do? Explain your reasoning.
Read the worked answer
Recognize the pattern before acting. Mr. Alvarez is coughing forcefully, speaking, and moving air. That is a partial obstruction with an effective cough - not a complete airway obstruction.
Do now:
- Stay with him; do not leave to fetch equipment.
- Coach him: "Keep coughing. Cough it out."
- Position him upright and leaning slightly forward; support his weak left side so he does not slide.
- Send the student for the nurse (a person, not the machine) so someone with a higher scope arrives.
- Keep watching for deterioration.
Do NOT:
- Do not give back blows or abdominal thrusts. Those are for an ineffective cough. On a partial obstruction they can drive the object deeper or cause injury.
- Do not do a blind finger sweep.
- Do not give him liquids or bread to "push it down."
Decision point: if he goes silent, cannot speak or cough, turns blue, or clutches his throat, the cough has become ineffective - that is when you activate the emergency response and begin the choking protocol your facility trains you in.
2. The coughing stops after about 30 seconds, but he pushes the tray away and refuses more food. His voice now sounds wet and gurgly. What do you do next and what do you report?
Read the worked answer
Stop feeding immediately. Do not coax "just one more bite." A wet, gurgly voice after a choking event suggests material may have entered the airway.
Actions within aide scope:
- Keep him upright in the chair (not flat in bed) and continue to observe.
- Take his temperature, pulse, respirations, and note any color change, noisy breathing, or new cough.
- Record exactly how much he ate before the event and that he refused the rest.
- Offer ice chips or sips only if allowed by his current diet order - do not independently change his liquid consistency to "help" him.
Report promptly, not at end of shift:
- The choking episode, time, and what he was eating.
- The new wet voice and the food refusal.
- That he needs a swallow re-check before his next meal. Speech-language pathology, not the aide, decides whether his diet texture changes.
Document objective facts: what happened, what you did, who you told, and when. Avoid writing conclusions such as "probably aspirated."