A patient with a lateral medullary infarct has wet voice, poor cough and recurrent aspiration after small sips. Which immediate nutrition decision is most appropriate?
Clinical signs indicate an unsafe swallow. A feeding plan must prevent aspiration while rehabilitation and instrumental assessment clarify recovery and longer-term options.
A. Continue normal diet with thickened drinks only: A texture change without assessment is inadequate with severe aspiration signs.
B. Encourage repeated water trials to strengthen swallowing: This risks aspiration pneumonia.
C. Place a permanent gastrostomy immediately: Route and duration of enteral support require prognosis and multidisciplinary discussion.
D. Ignore wet voice if chest radiography is normal: Radiography can be initially normal despite significant aspiration.
E. Keep the patient nil by mouth pending specialist swallowing assessment and provide alternative nutrition/hydration planning: Clinical signs indicate an unsafe swallow. A feeding plan must prevent aspiration while rehabilitation and instrumental assessment clarify recovery and longer-term options.
If assessment demonstrated a safe modified oral intake, a supervised texture and rehabilitation plan could replace full nil-by-mouth status.
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