Abnormal narrative bank — focused / at-risk
Six focused abnormal narratives carrying the full necessity chain — finding, severity, comparison, risk, action, notification, and reassessment.
A1 New aspiration signs with thin liquids | Skilled swallow assessment revealing a new wet, gurgly voice and coughing after each sip of thin liquid, with a low-grade fever and post-meal shortness of breath — a change from baseline and concerning for aspiration. Thin liquids were held pending evaluation; the provider was notified at 12:40 and an SLP re-evaluation and texture-modification orders requested. The caregiver was re-taught aspiration precautions, and the swallow and respiratory status will be reassessed next visit (cross-reference Respiratory, Nutrition). |
|---|---|
A2 Acute choking with airway obstruction | Skilled assessment during a meal when the patient began choking with an inability to speak or breathe — an acute airway obstruction. Abdominal thrusts were performed and the obstructing bolus cleared, after which the airway and breathing were reassessed; EMS was activated for evaluation given the event. The provider was notified at 13:15; the meal was stopped, an SLP re-evaluation requested, and the diet held pending assessment of ongoing safety. |
A3 Sudden dysphagia with neurologic signs | Skilled assessment of sudden difficulty swallowing with new slurred speech and a facial droop — findings concerning for stroke rather than the patient’s baseline. BE-FAST was applied and positive; EMS was activated immediately and oral intake stopped; the time of onset was documented and the provider notified at 09:35. Neurologic status and the airway were monitored pending transport (cross-reference Neurological). |
A4 Developing aspiration pneumonia | Skilled assessment of a patient with a wet voice, post-meal shortness of breath, a productive cough, and a low-grade fever over several days — a pattern concerning for silent aspiration with developing aspiration pneumonia. The diet was held per order; vital signs and lung sounds were assessed and the provider notified at 10:25; orders for evaluation and a chest assessment were received. The caregiver was re-taught aspiration precautions, and respiratory status and the swallow will be reassessed (cross-reference Respiratory). |
A5 Texture advanced beyond the ordered level | Skilled assessment finding the patient being given a regular-texture diet and thin liquids rather than the ordered IDDSI minced-and-moist diet with mildly thick liquids — an unsafe deviation from the protective diet. The diet was corrected to the ordered level immediately and the reason explained; the provider and SLP were notified at 14:10. The IDDSI preparation and the danger of advancing the texture were re-taught, with the caregiver return-demonstrating correct preparation (cross-reference Nutrition). |
A6 Weight loss from dysphagia | Skilled assessment of a patient with worsening dysphagia and a five-pound unplanned weight loss over two weeks, with meals now prolonged and often unfinished due to swallowing difficulty — a decline requiring nutritional and swallow re-evaluation. The provider and SLP were notified at 11:00; orders for a swallow re-evaluation and a nutrition review were received. Safe-swallow strategies and calorie-dense options within the ordered texture were reinforced, and intake and weight will be reassessed (cross-reference Nutrition). |