HELP!!!!Inability to swallow.....

  1. 0 OK...My neuro experience is very limited. I had a pt the last 2 days. Young man in his 20's. Extensive HX of neuro impairment related to brain tumor etc. ( trying not to give too much info here for privacy reasons) Anyway, on Sat. he was eating and swallowing liquids slowly but fine. Sunday comes and he can't swallow at all. Nothing. Water just dribbles out of mouth, can't swallow food, can't swallow crushed meds in sherbert. I worked with him on and off most of my 12 hour shift. I was pretty worried about him. I realized this was a significant change in his condition. SO, I called neuro doc. Doc orders NG, NPO, and modified barium swallow. Parents come in after all this, and the pt is then starting to swallow sherbert. Slowly and is struggling very much doing so. I informed parents of what had happened during the shift and my concerns etc. Pt starts to eat solid food and swallowing but still struggling to do so.
    OK.....My question is...Did I over react to this situation? NG was never placee related to refusal by parents. I'm worried that I may have over reacted, but, common sense tells me that this pt was progressing backwards instead of forwards. If I didnt notify the doc of the condition, what would have happened if the patient aspirated etc? Any thoughts. I'm second guessing myself here. My specialty is cardiac, not neuro.
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  3. Visit  mamason} profile page

    About mamason

    mamason has '5' year(s) of experience and specializes in 'cardiac'. From 'southern illinois'; Joined Sep '06; Posts: 574; Likes: 217.

    12 Comments so far...

  4. Visit  Jolie} profile page
    0
    It is NEVER wrong to notify a physician of a change in a patient's condition. Even though this young man improved slightly, it sounds like he still had great difficulty with swallowing, which could signal a change in his condition, and place him at risk for aspiration. You did the right thing by reporting this change, and altering his care as needed.

    You can be my nurse any time
  5. Visit  nrsang97} profile page
    0
    You did the right thing. He had a change in condition and you notifed the doc and received appropriate orders. Its ok that mom and dad refused the NGT, and that you kept him NPO. You kept him from aspirating.
  6. Visit  Sabby_NC} profile page
    0
    No you did not over react. When in doubt 'shout' out about it and you did so by contacting the Neuro Dr. Always err on the side of caution no matter how you feel it is better to inform then ignore. Good for you.
  7. Visit  mamason} profile page
    0
    Thanks for the input. I had worried about this all last night and all day today. Instinct told me something was going on with him. I just didn't know exactly what. And neuro in unfamilar territory for me. Actually, it really scared me. Upon admission, pt had an allergic reaction to two drugs while being dialyized. This was before being admitted to my unit. Actually a couple ays prior to coming to our unit. Protusion of tongue and hyper tonic neck muscles etc. So, I was wondering if this could have also been a contributing factor. Maybe the soft tissue in the neck was inflammed, swollen, or sore throat? No respiratory distress was noted at anytime under my care. But, what if? I guess I'll just drive myself crazy thinking about this.
  8. Visit  mamason} profile page
    0
    Thanks for everyone's reassurance. Today, I have come to the conclusion that I did my job. I had the pt's best interest at heart. And I can feel good about that. Like someone mentioned earlier, it's better to error on the side of caution.
  9. Visit  LadyNASDAQ} profile page
    0
    Sounds like you did everything perfectly and you are a safe Nurse. Don't sweat it. You thought he would aspirate. That's enough right there.
  10. Visit  Aquarian} profile page
    0
    You did the right thing, mamason.

    I'm just wondering why an aspiration precaution was not ordered in the first place, when as you have said, the px had hx of protruding tongue and hypertonic neck prior to getting transferred?
    Last edit by Aquarian on May 9, '07
  11. Visit  CHATSDALE} profile page
    0
    if a patient is having difficulty swallowing stop attempts until md is notified and appropriate action taken

    high danger of aspiration resulting in a whole other set of problems that the patient does need

    pat yourself on the back on this one
  12. Visit  mamason} profile page
    0
    That took place prior to him being admitted to our unit. I should have worded it a little better I think. But, it was still significant enough to warrant an aspiration precaution. Because, after the fact, I was told by night shift that this pt had a hx of pocketing food. That would have been reason enough to institute aspiration precautions I think. The pocketing of food info was given to me a little too late and had not been passed on in report. I think that this was overlooked by quite a few different nurses. Maybe it should have been addressed right away. But, I made sure that he was put on aspiration precautions after what I had observed from caring for this pt. It just shook me up a little. I wasn't sure if I was over reacting to the situation or if I had missed something while caring for him. I've learned a lot from this experience though.
  13. Visit  GrnHonu99} profile page
    1
    Quote from mamason
    OK...My neuro experience is very limited. I had a pt the last 2 days. Young man in his 20's. Extensive HX of neuro impairment related to brain tumor etc. ( trying not to give too much info here for privacy reasons) Anyway, on Sat. he was eating and swallowing liquids slowly but fine. Sunday comes and he can't swallow at all. Nothing. Water just dribbles out of mouth, can't swallow food, can't swallow crushed meds in sherbert. I worked with him on and off most of my 12 hour shift. I was pretty worried about him. I realized this was a significant change in his condition. SO, I called neuro doc. Doc orders NG, NPO, and modified barium swallow. Parents come in after all this, and the pt is then starting to swallow sherbert. Slowly and is struggling very much doing so. I informed parents of what had happened during the shift and my concerns etc. Pt starts to eat solid food and swallowing but still struggling to do so.
    OK.....My question is...Did I over react to this situation? NG was never placee related to refusal by parents. I'm worried that I may have over reacted, but, common sense tells me that this pt was progressing backwards instead of forwards. If I didnt notify the doc of the condition, what would have happened if the patient aspirated etc? Any thoughts. I'm second guessing myself here. My specialty is cardiac, not neuro.
    HECK NO!! You did the right thing. I work in the neuro ICU and if a pt. even looks funny we will order a swallow eval immediately. Aspiration is not good, at all. If a 20 yr pt. is having trouble swallowing it is usually directly related to their condition and if he was getting worse, then that is def. a neuro change and you notify the MD asap...a neuro change usually means something is going on in the brain that shouldnt be! Good call!
    Patient_Care_Asst likes this.
  14. Visit  Patient_Care_Asst} profile page
    0
    I agree with a swallowing evaluation/assesment. Most places use Occupational therapy for that purpose. However, I am a bit troubled by your description because it raises questions about any recent med changes flag with me.

    Certain meds may injure the mucus lining of the esophagus, increasing difficulties with swallowing and may cause pronounced dysphagia. These meds include antibiotics, antipsychotics, vitamin C and nonsteroidal anti-inflammatory drugs (NSAIDS).

    Hmmm... and considering you did say something about the pt having a recent medication reaction...?

    "Upon admission, pt had an allergic reaction to two drugs while being dialyized. This was before being admitted to my unit."

    Consideration: A medication reaction may result in an inflammed esophagus causing increased swallowing difficulties?

    Just thinking...

    My Best.
    Last edit by Patient_Care_Asst on Sep 23, '07
  15. Visit  Christie RN2006} profile page
    0
    You did the right thing by calling the doctor! Neuro patients do crazy things and the swallowing problems could definitely be signs of changes in the brain. For example, a lot of our stroke patients have difficulty swallowing. We always order a swallowing evaluation for patients we notice having difficulty and they will come in, evaluate the problem and suggest appropriate actions such as further tests, diets, etc.


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