Debate & concerns
• Teamwork is critical to implementing this type of water protocol.
• Ensuring pristine oral hygiene is critical for this type of protocol to work efficiently and effectively.
• Implementations across whole facilities and not just on a case-by-case basis can be problematic.
• Compliance of patients and families to remain on a modified diet of thickened liquids only can be difficult, especially after leaving facilities.
• Patients who are on a thickened liquids diet only may face dehydration which can cause more problems than aspiration of water alone.
• Allowing patients to consume water as they wish may increase in their quality of life.
• Individuals on a modified thickened liquid diet or feeding tube may aspirate
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Critique: This was a very small study done and did not provide a representative sample of the dysphagia population, only studying patients whom had suffered a CVA. The sample size of this study was limited due to the numerous subjects who declined participation after education of the protocol or because they did not meet the inclusion criteria. Even though there were no instances of aspiration pneumonia in the group who was allowed the free water protocol, this study is limited in it’s clinical significance. It is important to note however, that patients who were involved in the FWP study group had a much higher patient satisfaction compared to their modified diet of thickened liquids counterparts.
Pooyania, S. , Vandurme, L. , Daun, R. and Buchel, C. (2015) Effects of a Free Water Protocol on Inpatients in a
Since, I have been working on my fitness and health goals over the last year, I of course have needed to start drinking more water. Yet, I still have not been able to get myself to drink the daily-recommended amount of water. Therefore, there are a number of reasons that support my reasoning for wanting to increase my daily water intake. For instance, I want to incorporate drinking more water, because I know that it plays such an essential role in a persons overall health. Changing this behavior will ultimately benefit me in now and in the future. Also, not drinking enough water fatigues the body and muscles, especially for those that are actively exercising. Since, I have been incorporating more exercise into my daily routine, it is important that I also incorporate at least the recommended daily water intake if not more. Another significant factor is that water is essential to organ health and function. Therefore, in order for my organs to function properly I must be consuming the proper amount of water. That is why, I would like to make this behavior change in my life now, so that I could live a long and healthy life. As I reflect back on the experiences I encountered while trying to change my water consumption, I have to admit that overall I had a positive experience. I learned a lot about myself, and my own personal
NMC (2015) particularly points out hygiene care with fluid assistance is essential in the fundamentals of care. The study by Doyle, Lennox and Bell (2013) shows patient experience associates with the measures of quality of care. Without ongoing identify and meet patient changing needs, I would have not achieved the patient satisfaction as shown in appendix 1. NMC (2015) states all resources should be identified effectively to maintain or enhance the quality of care. For personal development both in practice and in theory, I feel I should carry on more research on diagnosing hydration for early effective interventions to prevent patient deteriorating directly or indirectly caused by dehydration (appendix 5). Wilson (2014) reports good hydration practice must become a part of regulated and inspected care
Describe how and when to seek additional guidance about and individual’s choice of food and drink.
"Drinking water is like washing out your insides. The water will cleanse the system, fill you up, decrease your caloric load and improve the function of all your tissues." -- Kevin R. Stone --
Aspiration, or the entry of foreign substances such as food or fluids into the lungs, may cause hypoxia or respiratory distress. Therefore, this is the highest priority in establishing the client's plan of care.
Likewise, the same survey was used to conduct meal rounds to assess food quality and patient acceptance during three different meal periods for three different diets in the 11AB Surgical Ward. The evaluation included three diets: a puree diet, 2.5-gram sodium diet and a VHA regular diet. It seemed that most of the patients understood why they required each one of the diets. However, most of them wanted their food with more flavor and more salt. The eating and feeding concern at CLC is the ability of the patients to get any foods they want from outside restaurants or family members. It is
However, dehydration is a common complication of dysphagia. Hydration is a process of maintaining a balance of water in the body. Half of our water intake is through drinking beverages including water (Sharpe et al., 2007). The standard daily fluid intake for individuals is 1500 mL per day. However, many individuals who are in acute care do not meet this daily standard (McGrail et al., 2012). The lack of fluid intake in individuals can impact their
(2015) found that the use of comprehensive hydration assessment tools implement and monitor a real change in culture and attitude towards hydration in hospitalised older adults. This change improves the recognition of hydration status and the compliance with treatment. It compared two cohorts, those who were assessed as dehydrated patient compared to the group of euhydarted (separated into two groups by using serum osmolality).
Dysphagia, the sensation of hesitation or delay in the passage of food during swallowing, is a common and debilitating symptom. It can be sub-classified by either location (oropharyngeal or oesophageal) or by the circumstances in which it occurs (functional vs obstructive) [see Differential Diagnosis]. It is of particular relevance in Head and Neck Cancer (HNC) and its treatment, imposing significant immediate and long-term physical, emotional and psychosocial burdens on both patients and carers. The complaint of dysphagia, especially if new-onset or progressive, is a red flag symptom and should always be taken seriously as it may represent a neoplasm of the upper aerodigestive tract (UADT). A thorough medical history including focused closed
The primary diagnosis associated with these participants dysphagia is stroke in three out of the six participants , and all participants were under the age of 90 (Carnaby-Mann and Crary, 2008). The investigation was about whether NMES was effective treatment for swallowing disorders. The participants had to obtain a score of 23 or greater on the mini mental state examination (MMSE) and a score of 5 or less on the Functional Oral Intake Scale (FOIS), and lastly the participants could not have received swallowing therapy within the last three months (Carnaby-Mann and Crary 2008). Before therapy began baseline scores were collected including clinical and instrumental swallowing evaluation, documentation of weight and the participants of self perception of swallowing ability. The Mann Assessment of swallowing ability (MASA) was used to assess swallowing ability. A videofluoroscopic swallowing evaluation was conducted to confirm the presence of pharyngeal dysphagia (Carnaby-Mann and Crary 2008). Materials used in this examination were thin liquid, nectar thick liquid, and pudding in both 5ml-10ml amounts, and modified per participant. Effort was made to present each material to each participant, but if participant aspirated in large quantities the
A supraglottic swallow is a technique used to help someone who has problems swallowing (dysphagia).
And by drinking water to ensure you stay living well, you will have some extra money to spend on things in your life that you can enjoy.
My parents always told me to “drink milk” at meals, so I grew up thinking water was something one only drank at restaurants to save money. It’s flavorless, not delicious, and lacks and nutritional value. I have learned the necessity of water the difficult way. Safe to say, I did not care about drinking water the majority of my life. I only drank approximately twenty-four ounces of water a day, on a good day, if even that, and that’s just in the past three years. The past two years I have fainted, blacked out, and become dehydrated because I did not drink enough water,
Therefore drinking more water a day will aid in flushing toxins, avoiding dehydration, and improving various bodily functions. Nevertheless, a study about the myth or reality of drinking eight glasses of water a day to ensure proper skin hydration, conducted by members of the Dermatology Unit at Kaplan Medical Center, had results showing no impacts of hydration on skin quality. Second, there are some studies that show the effects of fluid intake on mortality. For instance, after a study that involved following 20,000 Seventh-Day Adventists for six years in order to look at the impact of fluid intake on mortality; researchers from the American Journal of Epidemiology, found that drinking more water can help lower the risk of dying. The risk for women decreased after having three or more cups per day, as opposed to drinking fewer than three cups. As for men, research suggested that three to four cups was much better than having fewer than three, and five or more cups is even better. Another study on the “Fluid Intake and the Risk of Bladder Cancer in Men,” found in the New England Journal of Medicine, shows that more than six cups of water a day lowers bladder cancer risk compared to drinking less than one
Dehydration is a problem that can be fixed easily through self-awareness and a conscious effort to drink. Many techniques exist to help facilitate and encourage water consumption: making drinking water a habit; keeping a liquid journal; and making water more appealing. Although the topic of water consumption and drinking eight glasses of water appears to be such a simple element of health, it is key to effective body function, and optimal health.