Impaired Swallowing - NCP for Esophageal Spasm

Swallowing is a complex physiological actions in which food or liquid goes to the stomach. Swallowing also a series of highly coordinated muscle movements, starting from volunteer movements of the tongue, and completed reflexes in the pharynx and esophagus. During swallowing, upper esophageal sphincter opens momentarily to give way to the swallowed food bolus. Swallowing unleashed a wave of contractions that move down to the stomach. This is made possible by the cooperation between the two layers of the esophageal muscle that runs circular and longitudinal and the attraction of gravity. However, there is some evidence that a series of complex movements that cause ingestion may be disrupted if there were a number of pathological processes. This process can interfere with the transport of food and prevent gastric reflux.

One of the disorders of the esophagus is oesophageal spasm is a condition that is characterized by esophageal contractions uncoordinated, non-propulsive (peristaltic tertiary) and occurs when swallowing.

Diffuse esophageal spasm is a disease whose cause is unknown and seems to be more common in older patients. The same motility disorders can arise as a result of reflux esophagitis or obstruction of the lower esophagus, for example carcinoma (usually manometrik examination results at an early stage carcinoma is normal). Primary diffuse esophageal spasm usually occurs in patients aged over 50 years.

The occurrence of diffuse esophageal spasm is common in women than men. The existence of other factors that increase the risk of oesophageal spasm, among others:

• Eating or drinking very hot or very cold.
• Gastro esophageal reflux disease (GERD)
• Anxiety
• Age

Symptoms most often arises is intermittent dysphagia and odynophagia, which is exacerbated by swallowing food cold, a large bolus, and nervous tension. If there are intermittent chest pain, diffuse esophageal spasm may be misrepresented as angina pectoris, especially when symptoms are not related to eating.

Signs and symptoms of oesophageal spasm may include:

• Feel intense pain in the chest.
• Difficulty swallowing (dysphagia).
• Feeling like something is stuck in the throat.
• Cough.
• Regurgitation.
• Sound breathless.

Impaired Swallowing related to Esophageal Spasm

Goal : Demonstrated ability to swallow

Expected outcomes:
Clients can demonstrate proper methods of swallowing food without causing despair.

Interventions :

• Review the client's ability to swallow.
• Increase efforts to be able to conduct effective ingestion, such as helping the client to enforce the head.
• Put the client in a sitting position / upright during and after the meal.
• Give eating slowly in a quiet neighborhood.
• Start by giving oral semi-liquid foods, soft foods when clients are able to swallow the water.
• Help the client to choose foods that are small or do not need to chew and easy to swallow.
• Suggest to participate in an exercise program.

Rationale :

• To determine the level of the client's ability to swallow food.
• To increase efforts the client in the process of swallowing effective.
• To facilitate the client in consuming food.
• So that the client is easy to eat and not getting distracted in swallowing.
• Soft foods facilitate food goes unscathed in the esophagus.
• For ease of swallowing and the client still get nutrients.
• To speed healing at the swallowing disorder.