Aspiration does not always result in pneumonitis or pneumonia.
Some people with aspiration on MBS are asymptomatic.
It is important to balance the benefits and burdens of PEG placement.
If someone with advanced dementia enjoys eating and has not had documented episodes of aspiration pneumonia it is unreasonable to stop them from eating.
If the patient has had pneumonia but the family feels the patient would not want a PEG, they can be managed with strict aspiration precautions, puree diet and thickened fluids.
Remember that thickened fluids are a major cause of dehydration in this population as it is not possible to get them to swallow adequate amounts.
Remember that swallowing problems are usually worse when the patient is sick and may improve once the acute illness is treated, so do not rush to recommend a PEG based on MBS findings alone.
Don't order an MBS in a patient with advanced dementia without having discussed PEG placement with the family.
If PEG placement is not an option, don't order an MBS at all! |
- Be sure before ordering an MBS.
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