— 基本照護與舒適 · HARD · SATA —
對於吞嚥困難的病人，下列哪些評估結果顯示有吸入性肺炎的風險？（選所有適合的）
Which assessment finding indicates a potential risk for aspiration in a client who is dysphasic? (Select all that apply.)
- AWet or gurgly voice after swallowing✓ 正解吞嚥後聲音濕潤或帶有咕嚕聲
- BPocketing food in the affected side of the mouth✓ 正解患側口腔食物殘留
- CFrequent coughing during mealtime✓ 正解進餐期間頻繁咳嗽
- DDrooling excess saliva✓ 正解流涎過多
- EAbility to swallow dry crackers without water無需飲水即可吞下乾燥餅乾
— Explanation · 中文詳解 —
吞嚥障礙導致吸入風險的臨床表現包括：聲帶受唾液影響產生的咕嚕聲、口腔內側食物殘留（Pocketing）、進食時反覆咳嗽代表有氣管誤吸，以及因吞嚥肌無力導致的流口水。能夠吞嚥乾脆餅乾反而代表吞嚥功能良好，並非風險指標。
Clinical manifestations indicating aspiration risk in dysphagia include: a gurgly voice produced when vocal cords are affected by saliva, food pocketing on the affected side of the mouth, repeated coughing during meals indicating tracheal aspiration, and drooling due to weak swallowing musculature. The ability to swallow dry crackers actually demonstrates intact swallowing function and is not a risk indicator.
✦ 台美臨床差異
美國由 Speech-Language Pathologist (SLP) 進行吞嚥評估，台灣則多由醫師或護理師進行初步篩檢後轉介復健科。