Aspiration Pneumonia in Nursing Homes
Unraveling the mystery of Aspiration Pneumonia in Nursing Homes! Curious about respiratory issues? Gain simple insights to protect your loved ones from this common health concern. In this week’s episode, nursing home abuse attorney Rob Schenk welcomes guest Dr. McAdams-Jones to talk about understanding and preventing Aspiration Pneumonia in nursing homes, ensuring your family’s respiratory health is in good hands.
Schenk:
Aspiration pneumonia in nursing homes and what you should know. Stick around.
Hello out there. Welcome back to the nursing home abuse podcast. My name is Rob. I’ll be your host today. It’s all about aspiration pneumonia, risk factors, interventions, what to do afterwards, what are some lifestyle and dietary choices that affect the risk of aspiration pneumonia. But we don’t do that alone.
We have a fantastic guest Dr. Diane McAdams Jones. She is absolutely wonderful. Many years of experience, a lot of diplomas hanging on her wall. We have a very lively discussion about aspiration, pneumonia, and skinny assessments. We’ll get into that here, just in a few seconds.
So we’re going to be talking today about aspiration pneumonia. Yeah. with Dr. Dianne McAdams-Jones. Now Dr. McAdams Jones has been practicing being a licensed nurse for over 50 years and hospitals.
Learn more about Dr. Diane McAdams Jones.
And she now teaches. Let me just give you a brief synopsis of her CV. She’s got a lot of framed diplomas hanging on her wall. She got her bachelor’s of nursing degree from Tuskegee university in 1973. She got her master’s in education. management from Tuskegee University in 1979. She received a master’s in nursing education from Westminster College in 2008.
She received a doctorate in education, nursing and health professions from College of St. Mary in 2012, and a post doctorate in nursing education, program planning and evaluation. In 2018 from teachers college, Columbia university. So long story short, very qualified to talk about nursing and aspiration pneumonia.
We are so happy to welcome Dr. Diane McAdams Jones to the show. Dr. McAdams Jones, welcome to the show.
McAdams-Jones:
Thank you.
Schenk:
And I’m only laughing. I’m saying that because you and I have just recorded about 15 minutes of material, but I had forgotten to hit record. So we are going to do this once more. And my apologies to you.
What Are the Risk Factors Associated with Aspiration Pneumonia?
Of course, the audience is none the wiser. If I hadn’t said anything, they would have never known. So the first thing I want to get to is definitions. I want to understand. When we’re talking about aspiration pneumonia, what is it, and how is it different, if at all, from when we just talk about regular pneumonia?
McAdams-Jones:
So aspiration pneumonia is just that aspiration. You have taken something into your lungs that you didn’t intend to take into your lungs, and your lungs doesn’t want it. You took it in, and you wanted it to go to your stomach, but for some reason, and there could be several reasons, you could have weakened structures in that process that takes food down to your belly and you could have had a tube.
in your lungs. You could have had a tracheostomy, an opening into your lungs to breathe because you had some trauma. All these things affect those structures. Or you could be a more mature person. We don’t like to say elderly or old. The term now is more mature. You could be a more mature person whose structures have weakened because of time.
And if your muscular structures are weakened, When you do not take food down to your stomach as easily as the process was intended, you may cough, spit, or you may choke. And you may do it even when you’re young. And that there could be other reasons for that. But let’s talk about that. So this is the reason why we call it aspiration pneumonia.
Read about educational paths in nursing.
You took it in from the outside. It wasn’t a bunch of germs or viruses that went, Oh, whoopie doo. Let’s get down here on these lawns and we can just wreak havoc. There were not any. It was you who took something down. Into your lungs that you didn’t intend to and the other piece of that is the cognitive space that you might be in if you’re demented if you don’t really have a good connection between what you want and what your brain signals down to your muscles to do if they’re not working together cooperatively because of deterioration of nerves and the more mature you are as a human, then you’re going to have that problem too.
So those are the things that can cause it. Those are your risk factors. And that is what it is. You took something in from the external space here, and it was not intended to be there versus germs and viruses said, whoopie doo, here are the lungs, let’s go have a good time.
Learn more about aspiration pneumonia.
What Are the Common Causes of Aspiration Pneumonia in Nursing Home Residents?
Schenk:
Okay, so for so what I hear you say is that there’s the kind of the 3 primary risk factors are cognitive, like a cognitive impairment which basically is meaning that your brain is not sending the appropriate signals or the signals that used to command the mechanisms of the esophagus and the swallowing apparatus.
The other would be. Literally, like you’ve got some type of mechanical trauma, like whether it’s a tube or something that’s affecting your ability to work, you’re swallowing and then it’s, as you mentioned, you’re more mature. What you have already is not functioning as well as it used to so tell me, then that’s the, those are the risk factors.
Can nursing home staff. How can they jump ahead of it? How can they, how can A-A-C-N-A or a nurse understand the signs or the symptoms of aspiration pneumonia, either before it’s happening or as it’s happening.
McAdams-Jones:
Okay. So you summarized what I said very well. Thank you. I want to add You’re very welcome.
I wanna add a little to that. Those are. the risk factors that I point out. Number one, if we’re talking nursing homes, I don’t want to tell you those are the only ones. I was looking at an article from the National Institute of Medicine and National Institute of Health. That’s a good place to go online if you want peer reviewed articles from the experts in these spaces.
to talk about all kinds of information. I looked at an article by Santa Varapu and Gibson 2023. Those are some of the ones I’d be concerned about his risk factors for nursing homes. Let’s not forget drug overdose, alcohol use disorder, seizures, general anesthesia, head trauma, intracranial masses, Parkinson’s disease.
Details on aspiration pneumonia
The list goes on. But if you’re in a nursing home, typically you might see these, number one, let’s don’t get away from the fact that they’re young people in nursing homes. We call them rehab centers, but they’re because these young people have nowhere to go. Their parents and families can’t take care of them and they may be quadriplegics.
So you get all kinds of people in a nursing home. Now you’re the nursing assistant. But first of all, and foremost, I’m going to say, know what your policy is for your facility. Always know the facility protocols. That is what you’re going to be held accountable for if you ever are sitting on the other side of your patient’s family’s lawyers.
So if you’re ever on the other side of that table and you’ve got to answer questions, always know what your protocols are because if you don’t trust me, the other side will know what they are. So know what they are and always go to those first. Now, what can you do? You’re a nursing assistant, you know the protocols.
Protocol braces are probably going to tell you. To pay attention to that patient, learn the skin in minute assessment. I’ve branded that over time. You, this is what you do. And as you look at the patient and in a skinny minute, you sum them up, right? You look at, are they pale? Are their lips a little bit blue?
Are they not breathing well? Are they complaining about breathing? Are they looking labored when they breathe? And I think I’m playing the chest pain. Do they look right to you? You are the nursing assistant. You probably see this patient. Two or three times a week because you probably work two or three schedules.
So you see them that often. If you’re a family member, you know you’re a family member. When I say skinny minute, that’s like looking at your child and saying I know when they’re lying. That’s a skinny minute assessment. If you’re a skinny minute patient, you look at your loved one and you can see, they don’t really look quite right.
And you just start checking them and asking questions. So that is what I would say to do. Now you’re going to call somebody while you’re waiting for the help to come. It’s the head of the bed. All right. Then if it’s not let up, nobody should be sleeping with the head of the bed down period these days and time.
Learn more about Preventive measures in nursing homes.
Everybody’s got indigestion, GERD. You’ve heard that term. Everybody’s got it. Even little babies come here with it. So just head off the bed. And then if you know how to use a pulse oximeter, if you had a nursing assistant, of course, you know how to use the pulse oximeter. , put it on the patient’s finger.
You want it to be above 90, but sometimes these patients are way lower. If you are at home and you’re taking care of a loved one, you can buy these pulse oximeters at a pharmacy, any pharmacy, Walmart, Target, they have them go ask the pharmacist and that staff inside of this ed advice, where can I get a pulse ox?
Because this is a good thing to have at home. So these are the things you can do. And even at home, I would suggest putting your head in the bed. If you don’t, pillows are great guys, but when you go to sleep, you roll off of them. So we’ve always suggested putting blocks under the head of your bed. Right now, for those of you that can afford these sleep number beds, you got it made in a shade, just raise the head of the bed because it’s going to stay up, right?
But otherwise put some blocks under the head of your bed. I don’t know, whatever you have, if it’s a, if it’s wheels, take the wheels off. and put the blocks there because then you’re going to stay in an elevated position. But to answer your question, I’ll probably answer it more than you wanted, but that is my answer.
How Can Nursing Home Staff Recognize Early Symptoms of Aspiration Pneumonia?
Schenk:
Let me just say this again the skinny minute copyright, dr mcadams jones. That’s wonderful. I love it. And again, you mentioned the NIH website. I love the NIH website. Peek behind the curtain. I use the NIH website so I love reading the articles, but that’s where I’ll get a lot of the guests for this show from, as I see their articles and I’ll reach out to them.
I would recommend that everybody check that out if you’re interested in science, if you’re interested in statistics and nursing home statistics, it’s a great place. Anyway, okay. We’ve got to understand now that We’re looking for a pulse, we’re looking at is breathing obstructed in some way?
Is the head of the bed up? Do they just get through eating? And there seems to be some type of issue with that. These are the signs that we’re looking for. So once we understand that it’s happening and we’ve hit the call button. The nurse is in or maybe the nurse is already in. What are the next steps?
Reference to a specific article on risk factors in nursing homes. Related research on PubMed
What are the next interventions to either understand if it’s happening and be treated if it is happening?
McAdams-Jones:
All right. So to understand you’ve already said, Hey, this is a problem here. Something to look right. So you’ve called for help and you got the head of the bed up and you’re checking everything out as best you can.
And a nursing assistant is there. I’m Perhaps because you may be at home. There may not be a nursing assistant. I want to talk about skin types and skin colors because you can’t always see everything the same way. Yes, when you cut us all, we bleed red. Yes, we’re 97 percent more alike than we are different, but shades of skin color.
will make a difference. If you have a family member that has a dark complexion, they’re dark complexion, they’re not going to look pale. But I’ll tell you, you will probably see paleness if you have been around them forever. You’ll look and see something’s not right, but a regular person is taking care of pale skin.
People of color that have dark skin, they don’t always get it. And sometimes our lips may just be naturally purple anyway. I’ve seen dark skinned people. I’ve got people in my family like that. Their lips are a little purple. They don’t have to wear lipstick. They’re cute. But anyway, when you’re worried about people breathing, That gets to be a little bit of an issue.
So how can I tell? So I can open their mouth and look inside the buccal mucosa that’s inside of the cheek or just pull it, pull the chin down, look down in front of those teeth, look down there. Is it pink? Everybody’s pretty much pink inside of their mouth. If it’s really dark or purple inside, you got a problem.
So that’s how you can tell a person as Dr. Scant far away from their nail bed. All right The nail bed is hard on women because we’ve got all of this nail stuff on our nails So you can’t tell you can go to the ear pinch the ear Does the blood go away and come back go to their nail beds if they don’t have the nail polish on?
Men typically may not Press the nail bed down, hold it down for a few seconds, let it go. Did it get pale and did the blood come back in? That is another, it’s a three second test. You can do that on people that are non melanated is the term I use. Some people don’t like to be called white. So non melanated versus melanated.
Melanated people that have color on their skin. So press that nail bed down and watch it turn pale and see how quick the blood comes back in. We want three seconds or less, right? If it’s longer than that, you got a problem. So now you got the buccal mucosa inside. Pull the chin down, look inside by the teeth, look up in the cheeks, or do the nail beds.
You can also go to the toes. Some people won’t have nail polish on their toes. If they’re females, they may not. Check the toes, but you’re pressing it down, holding it down for a couple of seconds. Turn it loose, it should be pale, and the blood should come back in. That won’t happen to people of color. It will happen to people that don’t have color.
So those things right there, just pay attention.
What Are Some Immediate Interventions When Aspiration Pneumonia Is Recognized or Likely?
Schenk:
Thank you for that. I’d never heard of non melanated. That’s a new term for me. Okay. So we’ve, we’ve got the nurse and perhaps as a physician, we go, we get the X ray and we go from there. Um, what are some, and let me, let’s back up all the way to the beginning.
Okay. What would you say, if any, are some either like dietary things or other I don’t know, lifestyle choices that could potentially lead to aspiration pneumonia, like other than what we’ve already talked about, which is maybe a history of stroke or something like that. Is there any, Like anything like that could potentially also put you at risk for it or contribute to it.
McAdams-Jones:
All right. So I’m going to back up a little bit because you did ask me what to do. And I did say know your protocols, know what your facility says. If you’re the nurse and assistant, know what it is you can do. You can let the head of the bed up. You can put the pulse, pulse like symptoms. You want to go get some help.
If you’re at home and your family member and things ain’t looking right, you want to call 9 1 1. All right. Because you don’t want to wait on somebody having trouble with breathing. Anytime you go to the hospital and you get discharged, one of the top things to say, if you have trouble breathing, you need to call and get some help.
So if you’re at home and it’s your loved one and things ain’t looking right, I’d rather you call and they come out and say, There’s nothing wrong with that for you not to call and then it’s too late. So you don’t play around. You don’t mess around with breathing, but let’s go back to the nursing home.
You’ve called the nurse or whomever. When they come in, they should have a stethoscope on. They should be checking the lungs. We can hear and tell a lot by listening to the lungs. We can hear fluid in their lungs. We know what it sounds like. So they should do that. They should put the pulse oximeter on if you have not and they should be getting a chest x-ray because you mentioned that and I failed to mention that.
Chest x ray should be done because you don’t send someone to a hospital if you’re in a facility without having a diagnostic test. Technique to prove whatever it is that’s going on with the area that we’re concerned with, and this is breathing, so there should be a chest x ray. So now, what was your other question since I went back and fixed that?
Are There Lifestyle or Dietary Changes That Can Contribute to Reducing the Risk of Aspiration Pneumonia?
Schenk:
Yes no no, the question was, are there any lifestyle or dietary factors involved in increasing the risk of aspiration pneumonia?
McAdams-Jones:
Got it. So just like we’re sitting here talking, I have to really, Caution myself to slow down. I’ve always spoken very fast and typically chewed up the very ends of my words because you know what they just run together so you know you have to really pay attention but what I want to say to you is that’s important.
I have to slow down because you need to chew your food and you shouldn’t be talking particularly if you talk fast like me while you’re trying to chew. So a lifestyle change, chew your food well. So make sure that you’re breathing in between you’re talking. And you’re chewing. That’s very important. I have seen, yes, people choke talking at dinner, out at restaurants, even in the hospital.
Down in the, we’re having lunch and someone, we’re talking and laughing. And it’s really easy to breathe in a piece of food and it goes the wrong way. So if you’re gonna talk, slow down while you’re eating and chew your food well. How do I know if I chewed it well? If you’re not choking, spitting, and coughing, you probably chewed it well.
All right, make sure you’re sitting up while you’re eating. And if you’ve got foods you know don’t work well with you, they make you cough and spit, don’t eat them. Is what I would say. So that’s my advice for lifestyle.
Are There Any Particular Groups of Nursing Home Residents That May Be More Prone to Aspiration Pneumonia?
Schenk:
And thank you for that. So to me, some of those things would, let me know if I’m wrong, would need to be carefully planned.
So if the individual is an extensive assist with eating, then that CNA needs to know, okay, like I’m, I’m not going to give you the next bit of food until I see that you’ve, you finished that first by these type of things along with, oh I’ve noticed over the past few weeks that Miss Johnson is reacting to this particular type of food.
Let’s change that. That’s a long winded question, but Is that the type of thing that you’ve seen that would need to be carefully planned to prevent aspiration pneumonia? But when you say lifestyle changes, I was thinking about us out here as a lifestyle. When you say care planning for the patient, what would you care about?
McAdams-Jones:
I would care plan just the things you just said. If I know, and I wouldn’t, I shouldn’t know because I should have done. Not only the skinny minute when I saw my patient, I should be doing a thorough assessment of the patient. Now, there are people available in nursing homes. They’re called speech language pathologists, and you probably have seen SLP.
That’s what it stands for. Typically, a nurse home is going to have one of those connected. They’re going to have a physician connected. They’re likely going to have a nurse practitioner, and they are great. Mhm. on site assessing patients regularly. But they would likely have the patient who’s having swallowing difficulty or who is a risk.
Remember the situations we talked about for risk. Dementia stroke. They’re going to have them likely assessed by speech, language, or hearing. pathologist. That person would do all of the appropriate testing and they’ll do their bedside swallow test. There are several ones that you can do. Back again to the NIH, also to John Hopkins website, to the Mayo Clinic’s website, the Cleveland Clinic website.
I’m throwing out some very valuable knowledge there for reputable spaces to go to, to get good information about this. But a speech language pathologist needs to assess this patient for swallowing when they come into the nursing home. So this is what I’m saying to you is, I should already know, Rob.
For this, I should already know, I should already have a care plan. Now if I’m a nursing assistant, I need to go get the care plan and read it. And I say it like that because sometimes we don’t read, all right? So we need to have that care planned. We need to read it. And typically a dietician will have seen this patient as well because the speech and language pathologist is going to check the swallow business and they’re going to suggest or recommend dietician.
Dietician is going to recommend so many types of food preparations that we can do to help this person. to manage swallowing. They may have to have thicker food. They may have to have it pureed. They may have to have some product added to the food to make it thicker so they can swallow it. Just because I’m choking and spitting because water is thin, soda is thin, or milk or anything else, I don’t handle that well because I’m not responding that well.
My structures are weakened because of age. They’re not responding that well. But if I have bigger things going down, I can manage it. So that, and again, speech language pathologist, dietician, those are your friends. Check your care plan if you are the nursing assistant. The nurse is the one that planned it.
I should know if I’m the nurse already. The care plan, if I don’t know, I can get it. I can pull it up. Typically, these are electronically managed now in nursing homes. That’s what I have to say for that.
What Key Takeaways Would You Offer to Loved Ones of Nursing Home Residents About Aspiration Pneumonia?
Schenk:
In the last minute or so Dr. McAdams Jones what is some simple advice, some simple words of wisdom that you would give to a family member that has a loved one in a nursing home with respect to aspiration pneumonia.
Is there any, and I get the skinny minute and I love the skinny minute. I’m going to use a skinny minute and I’ll always copyright you when I do it. I’ll give you, I’ll drop your name, but is there anything simple, something simple that somebody can keep in mind with regard to aspiration pneumonia?
McAdams-Jones:
If you’re a family member and you’re coming to a nursing home, You want to again, make sure you look at your family member and you will know quicker than probably anybody else if everything’s okay. So that’s right there, check them out. If there’s anything that doesn’t look right, you go and ask for help.
And you know what, don’t worry about what people are going to think about you because you asked for help. If you don’t ask questions, guess what? You don’t get answers. So ask and never feel afraid to ask if people are probably not going to come right away when you call for them. Because yes, there are other people there that they need to take care of.
And they may be in a moment somewhere else with another patient. But if you’re a family member, And you think it’s critical, then you pull the call bell. I don’t think we have call bells anymore in nursing homes. I think we probably have little buttons we push on the side of the bed. Or we go to the end of the hall and we yell, go out the door and yell, if you think it’s an emergency.
But what I want to say to you is, Don’t ever underestimate what because you know this person. Same thing at home. Remember I said, I’d rather you call and they come out and say, there was nothing wrong, rather than for you not to call and it be a serious problem. If you got someone compromised, that you’re taking care of, and I mean by age, by trauma, by disease.
That’s their compromise. You don’t want to take chances with them because they don’t have the same immune system. They don’t have the same strength in their body structures is a person who’s not compromised. So that’s for you at home. So you call and if you are at the nursing home and you see your family member, they don’t look right.
You ask for help. And you stand in the doorway if you don’t want to leave them, you want to watch them, stand in the doorway and yell if you think they need someone to come and look at them. And again, don’t worry about what people are going to say about you. If you have that gut feeling, follow your gut feeling.
If you think it can wait, hold their hand, keep watching them, but try to get some help. And if you know it’s not quite an emergency, you can wait, but just stay there with them until someone comes and examines them. That’s what I’d have to say right away.
Schenk:
Fantastic advice. And not just the nursing home, but in life in general.
But thank you so much. Dr McAdams jones. We really appreciate you being on the show this week. This has been a fantastic conversation. I appreciate it.
McAdams-Jones:
I want to pitch my web page justussocializing.net if you’re in the healthcare field and you’re hearing this conversation, please go there. I have so much information that and courses already built out that I can teach and provide for your institution for your healthcare institution and for your personnel. Thank you.
Schenk:
No problem. And we’ll have that in, we’ll have that link in the show notes as well. Thank you so much. I was so embarrassed because Dr. McAdams Jones and I had been talking for, I don’t know, 10 or 15 minutes. And then I realized I hadn’t hit a record and this is like such a Bush league move. But she was a pro and we did it all again and it was just as good as the first time.
So I appreciate her very much for sticking around and having the patience with me, the bungling moron, especially as we taped this on a Friday afternoon. I hope that you enjoyed this episode. See you next time.