Case 20 – History


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Case 20

Elderly man with stroke


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Brief History

The patient was an elderly Latino man with stroke four months prior, recently admitted to rehab where he developed difficulty breathing.

This resolved, but there was concern for poor care, with decreased feeding as well as possible aspiration.

A nasogastric tube was ultimately inserted.

However, the tube was placed with difficulty requiring four attempts and concern for traumatic placement.

The patient subsequently decompensated.

He was admitted to hospice, put on comfort medication and died the following day.


Next: External exam

Discussion Questions

1. Summarize the history.

2. What are complications of nasogastric tube placement?

3. Based on the history, what concerns were there about the patient’s care in rehab?

4. When is decreased feeding and aspiration more related to the patient’s condition (e.g., stroke)? When is decreased feeding and aspiration more related to care? In any given case, how could you tell?