[Dysphagia] IV hydration

[dmhignight at comcast.net (dmhignight@comcast.net)]

My problem was actually with the logic of the whole situation.  I have no problem with the family refusing thickened liquids, but I would think the patient's doctor and the nurse could come up with a better solution to hydrating a patient with dysphagia than pushing thin liquids.  

The patient's doctor is actually the person who determines if the patient is dehydrated.

Thanks!
Donna
-------------- Original message -------------- 

> 
> " I actually had one patient who's family signed a 
> waiver to give him thin liquids ama, then overheard 
> the nurse telling them to push fluids! Has anyone 
> else encountered this?" 
> 
> Don't forget that patients/families have a right to 
> direct their own care and therefore reject our 
> suggestions. If you have given the information and 
> your reasoning for why thicker liquids may be safer, 
> they can still decide that for quality of life they 
> still want thin fluids. I think it is our role to 
> present both sides and let the patient decide , 
> especially in the geriatric/near end of life 
> population. I am surprised that they needed to sign a 
> waiver in order to go against your advice. In my 
> practice I just document that they have been given all 
> the info (pros/cons, possible consequences) and state 
> that they have made an informed decision to take 
> whatever despite risk. Signing a waiver sounds a 
> little harsh. 
> 
> "hydrating dysphagia patients with an IV when they are 
> not getting 
> enough fluids through thickened liquids." 
> 
> Have you spoken with the dietician regarding this? In 
> my setting, it is the RD's role , not mine, to 
> evaluate whether or not a patient is dehydrated. 
> Perhaps you can work together to determine if the 
> patient on thick liquids is acually dehydrated and 
> then on solutions. IV is a temporary solution and if 
> the patient is likely to stay on thick liquids it may 
> be a shortsighted fix to a long term problem. 
> 
> Good luck. 
> Annemarie 
> 
> 
> 
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