You are feeding Mr. Henderson lunch when he suddenly coughs violently after a bite of pureed peas. A few minutes later, his voice sounds raspy and wet. This is a classic sign that he may have aspirated, and recognizing it immediately prevents a serious lung infection.
What is Aspirate?
To aspirate (AS-pih-rate) means to inhale food, liquid, vomit, or saliva into the airway and lungs instead of swallowing it into the esophagus and stomach. It is essentially foreign material entering the lungs. This is different from simply choking, where the airway is blocked; aspiration involves material passing into the lungs. It is a critical safety concern, especially for residents with dysphagia (swallowing difficulties) or those who are bedridden.
Why Aspirate Matters in Your Daily Care
Aspiration is dangerous because it introduces bacteria and foreign particles into the lungs, which can lead to aspiration pneumonia—a severe lung infection and a leading cause of hospitalization and death in nursing home residents. When you catch signs of aspiration early, you stop the feeding, keep the resident safe, and alert the nurse to intervene. This protects the resident from fever, respiratory distress, and painful complications.
What You’ll See During Your Shift
You will mostly observe signs of aspiration during meal times or medication passes. Watch for coughing or choking while eating/drinking, a “gurgly” or wet-sounding voice after swallowing, watery eyes, or rapid breathing. Sometimes, a resident might not cough at all but just look uncomfortable or sound wet, known as “silent aspiration.”
“Nurse Jessica, I stopped Mr. Henderson’s lunch halfway through. He coughed hard after drinking water, and now his voice sounds really wet and gurgly like he’s gargling. I kept him upright in his chair. I think he might have aspirated.”
Common Pitfall & Pro Tip
⚠️ Pitfall: Assuming that because a resident isn’t coughing, they are swallowing safely. Many residents, especially those who have had a stroke, have “silent aspiration” where they don’t cough but food still goes into the lungs.
Pro Tip: Always perform the “water test” or listen to the resident’s voice after they swallow a spoonful. If their voice sounds wet, gurgly, or hoarse immediately after a swallow, stop the feed and report it. That “wet voice” is often more reliable than a cough.
Memory Aid for Aspirate
Think: “Wrong Pipe = World of Hurt.”
Or simply remember: “Wet Voice = Stop Choice.” If you hear a wet voice after a swallow, you have no choice—you must stop feeding.
State Test Connection
Appears frequently in CNA exams under Feeding Skills and Safety/Infection Control. You may be asked to identify the signs of aspiration or what to do if a resident coughs repeatedly during a meal (stop feeding, keep upright, report to nurse).
Related Care Concepts
This connects directly to dysphagia (difficulty swallowing), choking (airway obstruction), and aspiration precautions (like thickened liquids or upright positioning). It is also vital when performing oral care, as poor oral hygiene increases bacteria in the mouth, raising the risk of infection if aspiration occurs.
Quick Reference
✓ Key signs: Coughing during/after eating, wet/gurgly voice, watery eyes, shortness of breath ✓ When to report: Immediately after noticing coughing, wet voice, or distress ✓ Care reminders: • Keep resident upright (90 degrees) during and 30 minutes after meals • Feed slowly and ensure small bites • Check for pocketing of food in cheeks • Stop feeding immediately if signs appear • Perform good oral care to reduce bacteria risk
Bottom line: Your eyes and ears during mealtime are the first line of defense against pneumonia. Stopping a meal when you suspect aspiration is one of the most important ways you protect your residents’ lives.