A 78-year-old man with Parkinson disease and stage 3 chronic kidney disease attends a nutrition follow-up. His diet order is mechanical soft with nectar-thickened liquids. His spouse reports coughing during meals. Today he weighs 68 kg, down from 71 kg six weeks ago. During the visit he consumed 4 oz (120 mL) of thickened juice and half a container of pureed food, then voided 150 mL of dark-yellow urine. Temperature is 36.8°C, pulse 88, respirations 20, blood pressure 132/78 mm Hg and oxygen saturation 95% on room air. He sits slumped in the wheelchair. What should the LPN do first?
- Independently change the order to regular food and thin liquids so he can consume more calories.
- Offer the remaining food and thickened juice now, because the prescribed thickness makes coughing less concerning.
- Record his intake as one full container and 240 mL of juice to represent the amount offered, then continue the meal.
- Pause further oral intake, assist him to a supported upright position, and promptly report the coughing and weight trend to the RN or provider for swallowing and nutrition reassessment.