1. Think of a recent therapy session or event.
Nursing staff had reported that a patient was coughing when drinking. The patient had sounded chesty the day before but I had not seen any signs of aspiration. The patient was asthmatic and had not previously tolerated an NG-tube.
2. Describe the session/experience
I observed the patient at lunch. They were able to manage a puree meal and a yogurt without signs of aspiration but coughed post swallow on water. Their eyes watered when they swallowed the water and they needed three swallows to clear a single sip. Previously they had needed two swallows and had not coughed/ no eye watering.
I trialled a thickened grade 1 fresubin drink – there were no signs of aspiration. I therefore put the patient on syrup fluids and recommended that fluids be stopped if they were having difficulties since they were regularly getting sub-cut fluids. As the patient did not tolerate NG-feeding and managed to eat puree consistencies safely I left them on a puree diet. The doctor decided to give the patient antibiotics for her chest infection. The chest infection may have caused her swallow to deteriorate.
3. What did this session make you feel?
I felt that I had little choice about whether to allow the patient to continue eating/ drinking. However my supervisor advised that if the patients swallowing was very unsafe or their chest infection progressed they may be less alert and may be able to tolerate NG-feeding.
4. What would you want to change, and why?
I would want to monitor stable dysphagia patients and proactively ask the nurses about their swallowing since they see the patients throughout the day.
5. What has this session has taught you?
- Asthmatic patients may get chest infections not related to aspiration.
- To continually monitor dysphagia patients and communicate with the nursing staff.
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