[Dysphagia] IV hydration

[sargeantannemarie at yahoo.com (Annemarie Sargeant)]

" 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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