An 87-year-old female previously independent comes to the ER with 2 days of difficulty swallowing,productive cough,and dyspnea.History includes hypertension and atrial fibrillation.She has a low-grade fever and increased blood pressure.Physical examination and chest radiography are consistent with consolidation in left lower lobe.On bedside testing,she immediately sputters and coughs after drinking a small amount of water from a cup.There are no other neurological signs.Labs: Mild dehydration and WBC increased.MRI reveals a new small brain-stem infarction and mild generalized cerebral atrophy.Treatment for aspiration pneumonia is instituted.Five days later a speech therapy consult was ordered to evaluate swallowing.No improvement has been noted and formal evaluation shows aspiration with most consistencies of food and liquid.Which of the following is the best recommendation?

Question

Quizplus · Accepted Answer

Given the patient's continued aspiration with most consistencies of food and liquid, the best recommendation would be gastrostomy feeding, which ensures that the patient receives adequate nutrition without the risk of further aspiration. This would be a more long-term solution compared to nasogastric feeding, which can be uncomfortable and has a higher risk of dislodgement, and hospice, which is not appropriate at this time given that the patient is still receiving treatment for her pneumonia. Careful oral feeding would not be recommended due to the risk of further aspiration.

An 87-Year-Old Female Previously Independent Comes to the ER with 2