Fundamentals of Nursing Q 388
What should Nurse Mavie do first if a patient is choking on food?
A. Apply sharp for thrusts over the patient's xiphoid process.
B. Determine if the patient can make any verbal sounds.
C. Hit the middle of the patients back firmly.
D. Sweep the patient's mouth with a finger.
Correct Answer: B. Determine if the patient can make any verbal sounds.
When a person is choking on food, the first intervention is to determine if the person can speak because the next intervention will depend on if it is partial or total airway obstruction. With a partial airway obstruction, the person will be able to make sounds because some air can pass from the lungs through the vocal cords. In this situation the person’s own efforts open parentheses gagging and coughing) should be allowed to clear the airway. With a total airway obstruction, the person will not be able to make a sound because the airway is blocked and the nurse should immediately initiate the abdominal thrust maneuver (Heimlich maneuver).
Option A: Thrusts to the xiphoid process may cause a fracture that may result in a pneumothorax. The foreign body lodged in the larynx or trachea is most dangerous as this causes complete airway obstruction. Alternatively, foreign bodies such as small beads or small pieces of food may pass below the vocal cords and become lodged at the carina or within a mainstem bronchus. In adults, due to differences in right versus left pulmonary anatomy, foreign bodies are more commonly retrieved from the right main bronchus. However, children will have equal likelihood in either bronchus, due to equal growth until the age of 16.
Option C: All adults can and should receive the Heimlich maneuver while they are conscious. If the Heimlich cannot be performed due to body habitus or pregnancy, the American Heart Association recommends a supine patient with force again applied just above the umbilicus in a cephalad posterior vector. If the adult loses consciousness, it is imperative to check for a pulse and begin cardiopulmonary resuscitation if a pulse is not detected. Advanced airway techniques are now indicated, and you may be able to visualize the foreign body under direct laryngoscopy.
Option D: Never sweep a choking patient’s mouth with a finger. It might further dislodge the food. The commonly known abdominal thrust maneuver, known as the Heimlich maneuver, is performed by a bystander on a person who appears to be choking. The bystander stands behind the subject and wraps his/her arms around the upper abdominal region, about two inches above the belly button. Making a fist with one hand and wrapping the other hand tightly over the fist and delivering five sharp midline thrusts inward and upward.