Coughing During a Meal After a Stroke
Mr. T is 76 and is 2 weeks post-stroke. He is on a dysphagia diet with nectar-thick liquids and needs help eating. At lunch he takes a bite of mashed potatoes, coughs twice, and says, 'I'm fine.' His voice sounds wet and gurgly. He has eaten four bites and drunk about 60 mL of nectar-thick juice. His respirations are 20 and his oxygen saturation is 93% on room air. The nurse is at the other end of the hall, and Mr. T reaches for his juice.
1. What should you do immediately after the coughing episode?
Read the worked answer
Stop the meal and assess breathing.
- Stop offering food and liquid. Do not give the juice he is reaching for.
- Sit him fully upright, lean him slightly forward if tolerated, and tell him to cough if he can.
- Stay with him and watch for choking: inability to speak, silent coughing, cyanosis, or distress. If he cannot breathe, call for help and follow facility emergency protocol.
- Call the nurse now. A CNA should not suction the airway unless specifically trained and authorized.
- Allow him to rest; do not force more food or liquid.
Reasoning: Coughing with a wet voice after eating is a warning sign of aspiration, especially after a stroke. The priority is to stop intake, keep the airway safe, and get nursing assessment.
2. What observations will you report and why are they significant?
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Report the feeding observations, not just 'he coughed.'
- Cough occurred after mashed potatoes; two coughs; voice became wet and gurgly.
- He has eaten four bites and had about 60 mL nectar-thick juice.
- Respirations 20; oxygen saturation 93% on room air.
- He said 'I'm fine,' but reached for more juice.
- History: stroke 2 weeks ago, dysphagia diet, nectar-thick liquids, needs feeding assistance.
Reasoning: Wet voice and cough during a meal suggest material may be entering the airway. The nurse needs the type of food, amount, timing, and oxygen saturation to decide whether to stop the meal, assess swallowing, or notify the provider.
3. How will you document and resume the meal?
Read the worked answer
Document objectively and do not resume on your own.
- Record time of cough, food and liquid taken, voice quality, respiratory rate, oxygen saturation, and that the nurse was called.
- Note that the tray was removed or held and that he was kept upright.
- Do not write 'aspirated' as a diagnosis; write what you observed.
- Resume feeding only when the nurse says it is safe. If resumed, use small bites, upright posture, and frequent checks for coughing or wet voice.
Reasoning: The nurse decides when to restart intake. The aide's documentation creates the record that supports that decision.