Ruby's Feeding Intervention (Problem List (Discomfort with GERD…
Ruby's Feeding Intervention
Find a healthy diet in regards to GERD
Be able to return to normal sleeping pattern
Be able to eat independently
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.
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.
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.
LTG: In one week, client will grocery shop for herself at randalls, requiring less than 2 verbal cues, 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 create a grocery list with minimal assistance via google by looking up less then 3 pictures of ingredients, to improve independence in meal preparation.
Intervention Strategy 5
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
Grade down: The activity can be made less challenging by giving the client verbal cues along with supervision
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
Intervention Strategy 4
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
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: 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
Intervention Strategy 3
Feeding: The client will participate in preparatory activity for feeding, This activity will promote time management and cleanliness in the act of feeding
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 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
Intervention Strategy 2
Swallowing/eating: The client will participate in therapeutic activity that simulates the process of eating and taking her time with it
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 is exceeding greatly in this task, she can incorporate her meal preparation and prepare her own meal before the eating/swallowing process
Intervention Strategy 1
Sleep participation education: Client will be educated by therapist of efficient ways to sustain a sleep state without disruption from the symptoms of GERD
Grade down: Client will have assistance from caregiver of proper order of preparation for efficient sleep
Grade up: Client will perform nightly tasks and procedure to prepare efficient sleeping environment independently
Client centered outcome measure that captures the client's self perception of his/her performance
Evaluates a patient's ability to swallow safely and effectively via swallowing various different textures and consistencies.
Therapist will observe client participating in daily activities and will take not of any deficits/ strengths noticed.
Swallow exam concluded via endoscope that is introduced transnasally to the hypopharynx
Occupational Performance Deficits
Client has lived with this diagnosis of GERD for 2 years now and is aware of her condition
Does not present with inflammatory esophagogastric polyp
Diaphragmatic crura, phrenoesophageal musculature, and squamocolumnar junction are normal in appearance and function
pain is not being relieved with medications
Quality of life is being affected by condition
Worsening GERD and dyspepsia symptoms
Advanced age and comorbidities
Discomfort with GERD symptoms
Granularity of mucosa
Edema and inflammation of mucosa
Ineffective LES contraction
Loss of intrinsic tone of muscle or extrinsic cholinergic innervation