Ruby's Feeding Intervention

Problem List

Strength List

Occupational Performance Deficits

Assessments

Intervention Strategy 1

Intervention Strategy 2

Intervention Strategy 3

Intervention Strategy 4

Intervention Strategy 5

GOALS

LTG: In one week, client will grocery shop for herself at randalls, requiring less than 2 verbal cues, to improve independence in meal preparation.

LTG: In one week, client will swallow and eat 3/4 of her meal independently by pacing herself while eating to improve independence in swallowing/eating.

STG: In 3 days, client will create a grocery list with minimal assistance via google by looking up less then 3 pictures of ingredients, to improve independence in meal preparation.

STG: In 3 days, client will eat breakfast in a timely manner of only 3 bites per minute with minimal verbal cues to improve independence in time managment with feeding.

STG: In 3 days, client will swallow and eat 4 bites of her meal in a row without experiencing regurgitation, with less than 3 verbal cues from therapist to improve efficiency in independent swallowing and eating.

ST: In 3 days, client will feed herself 1/2 of her meal and keep a clean environment using the assistance of a plate guard, to improve independence in feeding.

Client Priorities

Diaphragmatic crura, phrenoesophageal musculature, and squamocolumnar junction are normal in appearance and function

Does not present with inflammatory esophagogastric polyp

Client has lived with this diagnosis of GERD for 2 years now and is aware of her condition

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Loss of intrinsic tone of muscle or extrinsic cholinergic innervation

Ineffective LES contraction

Edema and inflammation of mucosa

Granularity of mucosa

Be able to eat independently

Be able to return to normal sleeping pattern

Return home

Find a healthy diet in regards to GERD

Swallowing/eating

Sleep participation

Meal preparation

Feeding

FEES

Clinical obervation

Meal preparation: This intervention will follow the grocery trip as the client will learn and become educated on how to prepare her new healthy meals

Grocery trip: In this intervention, the client will participate in a grocery shopping trip with the therapist to be educated on the less acidic food to buy

Feeding: The client will participate in preparatory activity for feeding, This activity will promote time management and cleanliness in the act of feeding

Swallowing/eating: The client will participate in therapeutic activity that simulates the process of eating and taking her time with it

Sleep participation education: Client will be educated by therapist of efficient ways to sustain a sleep state without disruption from the symptoms of GERD

VFSS

Thickened folds

Discomfort with GERD symptoms

Advanced age and comorbidities

Worsening GERD and dyspepsia symptoms

Quality of life is being affected by condition

pain is not being relieved with medications

Dysphasia

Therapist will observe client participating in daily activities and will take not of any deficits/ strengths noticed.

Evaluates a patient's ability to swallow safely and effectively via swallowing various different textures and consistencies.

Swallow exam concluded via endoscope that is introduced transnasally to the hypopharynx

COPM

Client centered outcome measure that captures the client's self perception of his/her performance

Grade up: Client will perform nightly tasks and procedure to prepare efficient sleeping environment independently

Grade down: Client will have assistance from caregiver of proper order of preparation for efficient sleep

Grade up: If the client is exceeding greatly in this task, she can incorporate her meal preparation and prepare her own meal before the eating/swallowing process

Grade down: If client is having a hard time with this task and eating too quickly, a stopwatch will be provided to remind the client of the pace at which she should intake her food.

Grade up:If the client exceeds greatly in this activity, the therapist can add a cognitive aspect to the activity by having the client create their own feeding schedule according to the normal times of meals

Grade down: If the client is having a hard time with time management or keeping her area clean while feeding herself, the caregiver can provide adaptive equipment such as plate guards to prevent the feed from falling off the plate.

Grade up: If the client is doing well and needs another step to this activity the therapist can require the client to complete the grocery trip without any verbal cues

Grade down: If the client is having trouble with this activity it can be made easier by giving the client a list of what she needs to buy and having her become familiar with the store and finding the items she needs

Grade up: When the client is doing well with this task it can be made more challenging by providing new recipes for the client to prepare in her meal

Grade down: The activity can be made less challenging by giving the client verbal cues along with supervision