Question

Roy McNamara is a 92-year-old retired pastor hospitalized after a stroke. He is in stable condition and expected to return home to his wife within a few days. The couple has a live-in caregiver and a daughter who lives nearby. Prior to his hospitalization, Roy had a good appetite for a variety of foods and maintained his weight at 170 pounds. He is 5 feet 8 inches tall. After observing him for the past 24 hours, his nurse reports that he coughs when he tries to drink coffee and juice and leaves some of the solid foods on his tray uneaten. His doctor orders a barium swallow evaluation, which reveals normal chewing but aspiration of thin liquids into his lungs. Further evaluation reveals a normal swallow with yogurt and pudding but not with eggnog. (See Note below) 1. Refer to Table 23-1. What is the most likely cause of Roy's dysphagia? Based on his symptoms, what category of dysphagia does Roy likely have? Describe other signs and symptoms of this type of dysphagia. 2. Based on the standardized National Dysphagia Diet recommendations from Table 23-2, what nutrition prescription would you recommend for Roy? Include your recommendation for liquid consistencies as well. 3. What general information could you provide to Roy's family and caregiver regarding the properties and preparation of acceptable meals for Roy 4. What suggestions would be helpful to make sure Roy gets adequate fluids in his diet? 5. What is the main concern that should be conveyed to the family and caregiver regarding the need to adhere to the dysphagia diet recommendations?

Answer 1

Stroke is the most likely cause of Roy's dysphagia. He is a poststroke elderly patient with probably reduced skeletal muscle strength and other post-stroke issues. Based on his symptoms like coughing with the intake of thin liquids like coffee and juice, Roy likely has poststroke oropharyngeal dysphagia. Other signs and symptoms of this type of dysphagia include recurrent pneumonia, change in voice, change in dietary habits, weight loss, sialorrhea, difficulty initiating swallowing, food sticking to throat etc.