Nursing Students: How to Give Medication to a Client that Has Swallowing Difficulties or is at Risk for Aspiration

Talk to health care providers about your client's swallowing difficulties before administering meds: asking health providers such as a night nurse who cared for the patient, your primary day nurse, your instructor, or the speech therapist if they are involved can help you to gain insight into the abilities of your patient.

Questions to think about / ask:

Can he/she swallow meds whole or do they need to be crushed?

Crushing tablets and even putting them into something good like ice cream probably won't taste that great. If they can be swallowed whole, the patient will prefer that. If they are able to tell you ask the patient what their abilities are.

Are there any liquid preparations available that can be substituted for this pill?

Many medications have liquid substitutions that are pharmacologically equivalent. Call and talk to the pharmacist. This will require a change in orders usually but will be a lot easier for the patient.

Are any of these medications time release?

Any medications that have an XL, SR, or CD in their name should not be crushed, since these meds are timed released and can result in giving the client 24 hours of medication at once. Some extended release medications that come in capsules have the medication embedded in small granules that dissolve over time. The capsule can be opened and the contents sprinkled on applesauce for example but the granules should not be crushed. Discuss with the pharmacist to determine if this is appropriate. If the patient cannot swallow the time release version the physician will need to order the shorter acting version that can be crushed.

General administration tips:

Super important--POSITION your patient. Sitting upright head slightly forward. This allows gravity to help you and not work against you. It is extremely important.

Follow aspiration precautions and proper feeding/swallowing techniques

Give meds from smallest to biggest. If client can't tolerate small pills, he/she won't be able to take large ones

If allowed: Use applesauce, ice cream, mashed potatoes, or pudding to provide a larger bolus to swallow. Many elderly have reduced saliva and applesauce acts as a lubricant. Consider food / drug interactions (example: don't give tetracyclines with milk products) Nifty trick: if applesauce not available, take apple juice or other fruit juice and add thickening agent such as Thick it, to make it the consistency of applesauce.

If you believe your patient is aspirating (look for change in respirations, coughing, change in lung sounds) STOP and get the primary nurse or your instructor