How would you approach this situation. A family member comes to you after many weeks of
pt occasionally coughing while eating. Pockets food in mouth and sometimes coughs with thin liquids.
Family member requests a swallow study to be done. Why I ask, we already know what the problem is. She is having trouble swallowing. She is on hospice, why would we need to put her through stressful tests and sometimes lengthy tests just to find out what we already know. I asked her what would she do about it anyway after getting definate diagnosis of difficulty swallowing, would she place a feeding tube for nutrition. She says definately not, so what are we gaining here, but to put hospice patient through the mill. That in my opinion is not comfort care. I doubt medicare would pay for it either.
I always like to be present when a pt eats or is fed to see if they are having any difficulty swallowing. I havent been certified in a bedside swallow study, but I know a problem when I see it.
The symptoms are almost always seen in end stage disease process with dementia . I recommended
that we thicken the fluids and puree the diet on a 3 day trial basis with a nurse or cna always
present during meals to intervene if she should start to aspirate. Also to avoid straws. To my knowledge, aspiration has not occured at this time. Unless it was silent. Lungs always clear and respirations even and unlabored. Pt resides in nursing home and DON and ADON agree with this approach. What would you have done?
Family member ok with trial, but if it doesnt work, still wants swallow study done.