Thesis Statement
A patient prescribed a Dysphagia Mechanically Advanced Diet can have certain oral medications crushed and mixed with food at a consistency appropriate for the patient.
Pathophysiology
On October 6, 2015, in clinical, I cared for an 82 year-old female named Ms. M. She had presented to the hospital Emergency Room with altered mental status and shortness of breath. Ms. M had a past medical history including Parkinsonism resulting in dysphagia. The abnormal lab results that supported the eventual primary diagnosis of a urinary tract infection and possible sepsis include an elevated Absolute Neutrophils Count (ANC) 72%-normal ANC 55%-70% and decreased Absolute Lymphocyte Count (ALC) 16%-normal ALC 22%-44%. (Pagana & Pagana, 2013) …show more content…
coli normally found in colon gain access to the urethra. Once inside the urethra, the normal flora of the area is overwhelmed. (Treas & Wilkinson, 2014) It is not uncommon for an older adult to present with altered mental status secondary to a UTI, as cognitive changes are often the first sign of an infection in the elderly. (Lewis, Dirksen, Heitkemper, & Bucher, 2014). Sepsis can result if the bacteria get in the blood, and would cause a systemic response. (Lewis, Dirksen, Heitkemper, & Bucher, 2014) Parkinsonism is a cluster of symptoms similar to Parkinson’s disease including bradykinesia (slowness of movement), rigidity, tremors, and gait disturbance, but it does not share the degenerative nature of the disease. (Lewis, Dirksen, Heitkemper, & Bucher, 2014) Dysphagia can often occur as a result of Parkinsonism. For the purpose of this analysis of evidence-based practice, I will be focusing on Ms. M’s dysphagia, which is defined simply as “difficulty swallowing.” (Lewis, Dirksen, Heitkemper, & Bucher, 2014) Dysphagia is a major barrier to the safe administration of oral medications to a patient. A typical oral medication in pill form would be swallowed accompanied by a drink of water or juice. The concern here is that, not only could Ms. M choke on a whole pill taken orally, should Ms. M eat or drink food or liquid of a consistency that is too thin, she could cough, potentially choke, and is at great risk …show more content…
They hoped to determine what the rate of medication errors was for dysphagia patients in acute settings. Their findings highlighted the pitfalls of crushing medication and administering with food, in that if nurses are not knowledgeable of which medications are acceptable to crush, a medication error can result. While this study does not contradict other available evidence, I believe it is for this reason that Lowell General Hospital has a specific “red flag” warning in their nursing policy that directs nurses to the “Do Not Crush” list of