Pt Name: Mr.Meyers
Age: 83
Sex: male
Referring Physician: Jimmy Hollinger, MD
Pt Summary: An 83 YOM was admitted to thehospital with a persistent cough. Pt has a hx of Alzheimer’sdementia, and his daughter is his caregiver. Upon arrival to theED, the daughter mentions that the pt has not been eating welllately, and she has noticed that his clothes seem to be fittingmore loosely than normal. After a chest X-ray and blood work werecompleted, it was confirmed that the pt has pneumonia. It issuspected that aspiration is the cause of the pneumonia. The MDconsulted the speech pathologist to perform a modified bariumswallow test. The speech pathologist recommends the pt switch to alevel 1 dysphagia diet and honey thick liquids. The RDN wasconsulted to provide diet education for the patient and hisdaughter. (Note, for your video vignette, you may select twovolunteers: one person to play the role of the patient and theother to play the role of his caregiver/daughter).
History:
Onset of disease: Decreased po intake for 2-3 weeks
PMH: T2DM, osteoporosis, Alzheimer’s disease
Surgical history: Skin cancer removed 10 years ago
Medications at home: Glucotrol, cholecalciferol,Colace
Allergies: NSAIDs
Tobacco use: Smoked for 20 yrs, quit ~30 yrs ago
Alcohol use: None
Family history: Mother died of a MI, Father died fromESRD
Demographics:
Marital Status: Widower
Number of children: Children are grown, daughter liveswith pt and is his caregiver
Education: Retired from the Army
Occupation: Taught ROTC in local high school
Household Members: daughter
Ethnicity: Caucasian
Religious Background: Catholic
Admitting History:
Chief complaint: Persistent cough and c/o “choking”with meals
Vital Signs:
Temp:101.7 Pulse:91 Resp Rate: 19
BP:100/72 Height:5’10” Weight: 183#
Heart: Regular rate and rhythm, no gallops or rubs,point of maximal impulse at the fifth intercostal space in themidclavicular line
HEENT: Head:Normocephalic
Eyes: WNL
Ears: Tympanic membranes normal
Nose: WNL
Throat: Slightly dry mucous membrane without exudatesor lesions.
Neurologic: Pt disoriented, not cognizant to self,time, or location. After speaking with daughter, pt seems belowbaseline for cognitive function. Will not follow commands. Pupilswith normal reactivity.
Extremities: WNL
Skin: normal without lesions
Chest/Lungs: abnormal; rhonchi and wheezing noted.
Abdomen: Normal bowel sound. No distention, guarding,rebound. No hepatomegaly, splenomegaly, masses.
PART I: Understanding the patient anddisease
- Define aspiration pneumonia, and describe a modified bariumswallow study.
- What is a level 1 dysphagia diet? What foods are allowed? Whatfoods are restricted?
- In light of the pt’s hx of Alzheimer’s dementia and his currentliving situation, explain how you will obtain diet hxinformation.
