[Dysphagia] ESRD, Diabetes and dysphagia

[v.cooper at sbcglobal.net (v.cooper)]

I have a 60 YO female pt. ESRD on dialysis w/severe Type 2 diabetes who had a CVA 4 months ago. GT feeder. She has been receiving ST for dysphagia for 3 mos, and although she has been d/cd to acute several times for CHF and ARDS, she is showing no s/s aspiration for pureed or thin liquids. She can tolerate mech soft but needs verbal cues due to decreased oral manip and mastication. Her primary SNF MD ordered for her to begin weaning from GT as her swallow is functional; however, her dialysis nephrologist called on Friday and ordered all po be held. Her rationale was that due to pts dx, she is at high risk for aspiration and unless ST is w/her 100% of the time, she should not eat. The pt and her sister are very upset and my pt loves to eat. 

Does anyone work w/nephrologists or this type of pt? Is the nephrologist on target or is there any research out there to support her extreme concern.

Our nursing staff/consultant dietician feels that if she were on a full po diet (she was on a regular renal ncs diet w/fluid restrictions before CVA) it would be easier to control her liquids and diabetes than all the problems they have w/formula.

Any help from our dieticians or experts would be greatly appreciated.

Virginia Cooper

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