Dysphagia Surviving a severe stroke often leads to a new problem. Nearly half of severe stroke patients develop difficulty swallowing, known as dysphagia. People with this condition have difficulty keeping food and liquids in their mouths or swallowing. When food passes from the mouth to the oropharynx and laryngopharynx, it enters the esophagus and muscle contraction pushes it into the stomach, but when the process goes wrong the food and liquids re-enter the esophagus, a phenomenon known as reflux (Nozarka, 2010) . they are factors that interrupt normal swallowing. These include stroke, age-related changes, medications, and neurological diseases (Nozarko, 2010). Signs of dysphagia are coughing during meals, change in tone or quality of voice after swallowing, abnormal movements of the mouth, tongue, or lips, and slow, weak, precise, or uncoordinated speech. Other signs of the disease are abnormal retching, delayed swallowing, incomplete oral emptying or pouching, regurgitation, pharyngeal stagnation, delayed or absent triggering of swallowing, and inability to speak coherently (Potter & Perry, 2009). Dysphagia can lead to aspiration pneumonia. During aspiration, food or fluid passes through the vocal cords and enters the airway. It can be caused by impaired laryngeal closure or by an overflow of food or liquids retained in the pharynx. This increases the risk of suffocation and aspiration pneumonia. By coughing, the body tries to free itself from the aspiration that helps eliminate food and liquids from the lungs. However, silent aspiration is very dangerous because food and liquids enter the airways and move deep into the lungs causing serious breathing problems. Dysphagia also causes malnutrition and dehydration. This increases the risk of pressure ulcers (Nozarko, 2010). The evaluation of the data collected leads to a nursing diagnosis. A client who has survived a stroke complains of difficulty swallowing associated with deficits in oral, pharyngeal, or esophageal structure or function. In this case the nursing diagnosis is a swallowing impairment related to a neurological problem (Ackley & Ladwig, 2011). As a caregiver of a client with this condition, you need to establish goals and outcomes. The goal and outcome for a client suffering from dysphagia is; the client can swallow effectively without choking within seven days and will be free from signs of aspiration with clear lung sounds within five days (Ackley & Ladwig, 2011). To achieve goals and outcomes for this patient, first determine the severity of dysphagia. “If a person suffers from mild dysphagia, simply providing appropriate advice on eating slowly and sitting upright while eating may allow the person to remain well nourished [sic] and problem-free” (Nozarka, 2010, para.