The nurse in the rehabilitation unit is caring for a 74-year-old female client.
Click to highlight the findings below that require immediate follow-up.
Day 5
1210: History of a stroke with dysphagia and weakness of the right arm. Lunch observed. The unlicensed assistive personnel (UAP) helping with the meal is trained to feed clients with dysphagia. Client is sitting upright in a chair. The UAP gave mouth care before the meal. A visitor poured the client a glass of plain, unthickened water. Client coughed right after swallowing the water, and her voice now sounds wet and gurgling. Client takes small bites of the pureed food and eats slowly. She tucks the chin toward the chest with each swallow but falls asleep between bites and has to be woken to eat. Weakness of the right arm is unchanged since admission.
1210: History of a stroke with dysphagia and weakness of the right arm. Lunch observed. The unlicensed assistive personnel (UAP) helping with the meal is trained to feed clients with dysphagia. Client is sitting upright in a chair. The UAP gave mouth care before the meal. A visitor poured the client a glass of plain, unthickened water. Client coughed right after swallowing the water, and her voice now sounds wet and gurgling. Client takes small bites of the pureed food and eats slowly. She tucks the chin toward the chest with each swallow but falls asleep between bites and has to be woken to eat. Weakness of the right arm is unchanged since admission.