Dysphagia

Swallowing safety changes the plan before a meal tray arrives. In acute stroke, injury can disrupt the cortical-subcortical-brainstem network that coordinates the oral, pharyngeal, and esophageal phases. The patient may be awake, conversational, and asking for water while still being unable to protect the airway. Food, fluids, and oral medications all count as oral intake. A patient who coughs with water should not receive a tablet simply because it is small. Aspiration can occur with little or no cough when laryngeal sensation is impaired, so the absence of a dramatic choking episode does not establish safety. For an RPN, the first decision is whether oral intake has been cleared—not which diet texture seems easiest. In Canada, an acute-stroke patient is screened before any oral intake by an appropriately trained health professional using a validated dysphagia screen. Within the RPN’s education, competence, employer policy, and provincial scope, the RPN may perform the screen; otherwise, a trained assessor must be obtained. A screen is a safety gate, not a diagnosis. A failed result means NPO, including no routine oral medications, until the...