When do you do a swallow test on a patient who is sleeping most of the time?

[mlauren]

I had a patient who was NPO, because they needed to do a dysphasia test. This patient had bipolar disorder and Alzheimer's and was sleeping most of the time. When she did wake up it was only for a minute. So anyways, I was told that when she was fully awake and sitting all the way up they would do the test. My question is, why would they just wait around for this to happen when the patient clearly wasn't going to do either of those on her own? Wouldn't you have to make the patient sit up and then just do the test? This patient was so thirsty and kept asking for something to drink and also needed her meds. I don't see why they couldn't have done the test sooner or why they weren't trying to get it done faster. The patient was sitting up and awake at one point, but I couldn't find the nurse anywhere and by the time I got back to the patient's room she was already asleep again.

[nurseprnRN, BSN, RN]

The person to whom you should address this question is the SPL (speech-language pathologist) who will do the test. They are usually fully-scheduled and can't drop everything to come when called. If there's a problem with getting patient cooperation, perhaps the staff, the SLP, and the physician can coordinate an effective approach.

[mlauren]

Ok, the nurse did not tell me this. She actually said she would do it when the patient sat up. So how do you go about getting the test done. Does the nurse just wait on the SPL?

[Penelope_Pitstop, BSN, RN]

The person to whom you should address this question is the SPL (speech-language pathologist) who will do the test. They are usually fully-scheduled and can't drop everything to come when called. If there's a problem with getting patient cooperation, perhaps the staff, the SLP, and the physician can coordinate an effective approach.

At my hospital, nurses are qualified to do swallow screens. If the patient fails the swallow screen, at that time speech is consulted. But it may be different because we're a certified stroke center and it's part of stroke standards.

From what the OP states, I can't tell which situation is the case.

[dah doh, BSN, RN]

Same for us, nurse does swallow screening on stroke patient or upon physician orders. If the patient fails it, a formal dysphagia evaluation is done by the speech pathologist. They are super busy and only a few of them cover the entire hospital so if the patient won't wake up or is uncooperative, they move on.

[mlauren]

Ok, I'm pretty sure the nurse was qualified to do the swallow test. So my question is, was she just too busy to do it all day? I mean, since this patient wasn't going to wake up on her own wouldn't the nurse just have to get her up and do it then? I think she was waiting on me to get the patient up and I did, but like I said, I could never find the nurse when I needed her. So obviously she wasn't too worried about getting it done. Of course, I don't know what other things she was dealing with at the time. The reason I'm so concerned with this is because this patient needed her meds and was so parched I couldn't even get a thermometer under her tongue. She was constantly asking for something to drink and it was just terrible to have to say no. Should this nurse have done the test sooner? Or am I wrong?

[KBICU]

Ok I'm pretty sure the nurse was qualified to do the swallow test. So my question is, was she just too busy to do it all day? I mean, since this patient wasn't going to wake up on her own wouldn't the nurse just have to get her up and do it then? I think she was waiting on me to get the patient up and I did, but like I said, I could never find the nurse when I needed her. So obviously she wasn't too worried about getting it done. Of course, I don't know what other things she was dealing with at the time. The reason I'm so concerned with this is because this patient needed her meds and was so parched I couldn't even get a thermometer under her tongue. She was constantly asking for something to drink and it was just terrible to have to say no. Should this nurse have done the test sooner? Or am I wrong?[/quote']

If the patient is that out of it or unable to get an oral temp there's no way a nurse would do a swallow test. Patient needs to be awake and alert sitting straight up or preferably out of bed. It's possible the nurse never got to it but it sounds like the patient didn't get her PO meds which makes me think the nurse held them for a reason ie the patient couldn't swallow. If a patient seems this way to me, I skip the bedside sip test and go straight to SLP dysphasia screening. I'm not gonna attempt sips on a patient who appears to be the way your describing.

[mlauren]

ok, thank you. Maybe she had planned on doing that.

[SaoirseRN]

We have an RN stroke swallow screen protocol where I work, and one of the criteria for "failing" is the inability to stay awake for 15 minutes. Now, possibly if the patient had some stimulus, she could have met that criterion, but if the person isn't able to stay awake they likely can't reliably eat.

That said -- I agree that somebody should have tried to assess her by planning a time and waking the patient rather than waiting for the patient to wake up.

[KelRN215, BSN, RN]

Ok, I'm pretty sure the nurse was qualified to do the swallow test. So my question is, was she just too busy to do it all day? I mean, since this patient wasn't going to wake up on her own wouldn't the nurse just have to get her up and do it then? I think she was waiting on me to get the patient up and I did, but like I said, I could never find the nurse when I needed her. So obviously she wasn't too worried about getting it done. Of course, I don't know what other things she was dealing with at the time. The reason I'm so concerned with this is because this patient needed her meds and was so parched I couldn't even get a thermometer under her tongue. She was constantly asking for something to drink and it was just terrible to have to say no. Should this nurse have done the test sooner? Or am I wrong?

Presumably this patient was being hydrated and medicated by another route, no?

[MunoRN, RN]

At least at my facility, having that much difficulty staying awake is an automatic fail on a swallow test. You have to have some ability to maintain wakefulness without constant stimulation to assume that someone is able to safely swallow and properly clear and protect their airway against any residual (they have to be able to stay awake for at least a couple of minutes after eating).

Usually you can still moisturize the mouth when a patient is NPO due to a swallow concern, check with your nurse. I realize it's no fun not to be able to drink, but it beats aspiration pneumonia and resulting death.