Oesophageal Cancer Patient

Here are some of the factors i considered when assessing the swallowing of a patient on the Liverpool Care Pathway who had oesophageal cancer and a posterior cerebral artery infarct.

1. What type of foods they were eating before they were admitted to the unit (they haven't had any oral intake recently).
2. How they are managing their oral secretions. If not managing secretions they are unlikely to be able to manage oral intake.
3. Their respiratory rate - when a patient is near death they may have periods of shallow and then deep breathing/ or chain-stoke breating. This may in turn make it difficult for them to coordinate their swallow- breath cycle.
4. The clients preferences i.e. whether they wish to take oral intake and risk manage.

Assessment

• Asking the patient to voluntarily cough.
• Swallow trial on yogurt and water - thin fluids and softer food are likely to be easier for a patient with oesophageal cancer to swallow. Water rather than tea is less likely to cause an infection when aspirated.
• Palpation of the patient's larynx, hyoid and base of tongue while they swallowed - to feel for hyolaryngeal excursion.
• Asking the patient to say 'ahh' post swallow to listen for voice quality changes.
• Asking the patient to open their mouth for me to see if there was any residue post swallow e.g. due to pharyngeal and tongue muscle weakness since the patient was malnourished.