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Course: Medical Surgical Nursing

Topic: Aspiration Pneumonia and Foreign Body Aspiration

The Nurses International Community

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Module Goals

Learners will be able to

Define aspiration pneumonia.
Describe the clinical manifestations of aspiration pneumonia.
Discuss the assessment and diagnostic findings of aspiration pneumonia.
Discuss the complications of aspiration pneumonia.
Describe the medical management of aspiration pneumonia.
Discuss the nursing management of aspiration pneumonia.

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Aspiration Pneumonia

Pulmonary aspiration occurs when food, stomach acid, or saliva is inhaled into the lungs.
Aspiration may occur when food travels back up from the stomach into the esophagus.
All of these things may carry bacteria that affect the lungs.
Healthy lungs can clear up on their own. If they don’t, pneumonia can develop as a complication.
The term aspiration pneumonitis refers to acute lung injury that occurs after aspiration of sterile gastric contents.

Sanivarapu & Gibson, 2022

Contact info: info@nursesinternational.org

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Etiology

Pathophysiology

Normal defense mechanisms fail:

closure of the glottis
cough reflex

Common flora organisms from the oropharynx and esophagus are inhaled into the lungs.
Leading to aspiration pneumonia.

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Clinical Manifestations

Sudden onset dyspnea
Fever
Hypoxemia
Bilateral infiltrates seen on Xray
Crackles on lung auscultation

Sanivarapu & Gibson, 2022

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Critical Thinking Question

Which of the following statements best explains the etiology of aspiration pneumonia?

Failure of the natural defense mechanisms
It is rarely caused by streptococci, haemophilus, and gram-negative bacilli
It is caused by Mycobacterium tuberculosis
Occurs to a hypersensitive response to an inhaled environmental allergen

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Risk Factors

Stroke
Drug overdose
Alcohol use disorder
Seizures
General anesthesia
Head trauma
Intracranial masses
Dementia
Parkinson disease
Anesthesia

Sanivarapu & Gibson, 2022

Esophageal strictures
Gastroesophageal reflux disease
Pseudobulbar palsy
Tracheostomy
Nasogastric tube
Bronchoscopy
Protracted vomiting

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Assessment and Diagnostic Findings

Imaging studies

Chest X-ray
Computed tomography of the chest
Bronchoscopy*

Arterial blood gas (ABG)

Sanivarapu & Gibson, 2022

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Complications

Acute Respiratory Distress Syndrome (ARDS)
Empyema
Lung abscess
Parapneumonic effusion
Sepsis
Respiratory failure

Sanivarapu & Gibson, 2022

Contact info: info@nursesinternational.org

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Medical Management

Antibiotic therapy

Initiated immediately to prevent the progression of the disease.
Ampicillin-sulbactam or a combination of metronidazole and amoxicillin is the preferred choice.
In patients with penicillin allergy, clindamycin is the preferred option.

Once the culture results are obtained, the antibiotic regimen should be organism-specific.
Flexible bronchoscopy to remove secretions.

Sanivarapu & Gibson, 2022

Contact info: info@nursesinternational.org

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Critical Thinking Question

A client is seen at the emergency department for aspiration pneumonia. Which of the following complications can the client develop if the condition is not treated effectively?

Acute Respiratory Distress Syndrome (ARDS)
Asthma
Lung abscess
Sarcoidosis

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Nursing Management

Protect airway
Suction if thick secretions
Provide oxygen
Position client upright
Monitor vitals signs
Listen to lung sounds
Ensure swallow screen is done before feeding
If a nasogastric tube placed for feeding, make sure chest X-ray is done to confirm the position
Check ABGs to ensure adequate oxygenation

Sanivarapu & Gibson, 2022

Contact info: info@nursesinternational.org

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Nursing Management (Continued)

Observe for signs of sepsis and respiratory distress.
Educate the client and family to minimize risks.
Determine the optimal method of providing nutrition.

Small, thickened meals are recommended.

If there is suspicion of aspiration, a swallow study should be performed before initiating feedings.

Sanivarapu & Gibson, 2022

Contact info: info@nursesinternational.org

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Nursing Management (Continued)

Educate the staff on prevention of further aspiration:

Elevate the head of the bed
Close monitoring of oxygen status
Regular suctioning of the oral cavity in clients with swallowing difficulties.
Clients with suspected aspiration should be evaluated by a speech pathologist.

Community education about gastrointestinal reflux disease.

Sanivarapu & Gibson, 2022

Contact info: info@nursesinternational.org

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Critical Thinking Question

Which nursing intervention would be of highest priority for a client who has been diagnosed with aspiration pneumonia?

Educate the client and family to minimize risks
Monitor vitals signs
Position client upright

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Foreign Body Aspiration

An increased incidence of aspiration of tracheobronchial foreign bodies (TFBs) is expected with the aging population.

People with no predisposing factors are at risk of aspiration during dental treatment.

The risk is increased by

Local anesthesia
Supine position
Decreased cough reflex due to sedation

(Jang et al., 2022)

Jang et al., 2022

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Foreign Body Aspiration: Predisposing Factors

Alcohol intoxication
Sedative or hypnotic drug use
Neurologic disorders

Stroke
Hemiparesis
Neuromuscular diseases

Amyotrophic lateral sclerosis
Myasthenia gravis
Sarcopenia

Seizure
Parkinson diseasez

Jang et al., 2022

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Foreign Body Aspiration: Facts

Occult TFBs in adults can remain undetected for years, leading to incorrect diagnoses.
In adults, the most common TFBs are

Teeth
Fish/Chicken bones

Flexible bronchoscopy is relatively safe and has a high success rate for foreign-body retrieval.

Jang et al., 2022

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Critical Thinking Question

Which of the following are considered predisposing factors for foreign body aspiration? (Select all that apply).

Alcohol intoxication
Parkinson disease
Seizure
Stroke

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Foreign Body Aspiration: Complications

Recurrent pneumonia
Bronchiectasis
Lung abscess
Atelectasis
Bronchial stenosis
Emphysema

Cramer et al., 2022

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Foreign Body Aspiration: Medical Management

Chest X-rays
The definitive diagnosis and management typically involves bronchoscopy to remove the offending object.

Rigid or flexible bronchoscopy

Cramer et al., 2022

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Foreign Body Aspiration: Nursing Management

Assess vital signs
Assess for respiratory distress
Listen to the chest for wheezing
Provide oxygen if saturations are low
Start two large-bore intravenous lines
Keep patient NPO in case endoscopy is required
Provide comfort care
Suction to ease drooling
Frequent oral hygiene

Conners et al., 2022

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Critical Thinking Question

The nurse cares for a client who is scheduled to have a bronchoscopy for foreign-body removal.

Which of the following interventions should the nurse include in the care plan? (Select all that apply).

Assess for respiratory distress
Assess vital signs
Keep patient NPO
Provide comfort care

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Red Flags

Chronic unexplained cough

Delays in diagnosis and treatment result in a prolonged hospital stay and additional complications.

Sanivarapu & Gibson, 2022

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Cultural Considerations

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Health beliefs: In some cultures talking about a possible poor health outcome will cause that outcome to occur.
Health customs: In some cultures family members play a large role in health care decision-making.
Ethnic customs: Differing gender roles may determine who makes decisions about accepting & following treatment recommendations.

AHRQ, 2020

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Cultural Considerations (Continued)

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Religious beliefs: Faith and spiritual beliefs may affect health seeking behavior and willingness to accept treatment.
Dietary customs: Dietary advice may be difficult to follow if it does not fit the foods or cooking methods of the family.
Interpersonal customs: Eye contact or physical touch may be ok in some cultures but inappropriate or offensive in others.

AHRQ, 2020

Contact info: info@nursesinternational.org

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References

Agency for Healthcare Research and Quality (AHRQ). (2020). Health literacy universal precautions toolkit (2nd ed.). U.S. Department of Health and Human Services, National Institutes of Health. https://www.ahrq.gov/health-literacy/improve/precautions/tool10.html

Conners, G., Mohseni, M., & Wallace, D. (2022). Pediatric foreign body ingestion (nursing). StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK568742/?report=reader

Cramer, N., Jabbour, N., Tavarz, M. M., & Taylor, R. S. (2022). Foreign body aspiration. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK531480/

Contact info: info@nursesinternational.org

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References

Jang, G., Song, J. W., Kim, H. J., Kim, E. J., Jang, J. G., & Cha, S.-I. (2022). Foreign-body aspiration into the lower airways in adults; multicenter study. PLoS ONE, 17(7), e0269493. https://doi.org/10.1371/journal.pone.0269493

MedlinePlus. (updated 2023, August 13). Aspiration pneumonia. National Library of Medicine. https://medlineplus.gov/ency/article/000121.htm

Sanivarapu, R., & Gibson, J. (2022). Aspiration pneumonia. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK531480/

Contact info: info@nursesinternational.org

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