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Ruby Jane Smith, 86 y.o. F, GERD & dyspepsia (Problem list (Age will…

- - - - Upgrade: None.
      - Downgrade: If these positions are difficult to maintain, use pillows between the knees, behind the back, etc. in order to help stabilize the client's position.
  - - - Downgrade: Write down what was eaten at the end of everyday and how the client feels at the end of every day.
      - Upgrade: Track the food eaten, the amount eaten, and the how the client feels after eating after each meal.
  - - - Upgrade: Plan a week of meals in advance and grocery shop for them all at once.
      - Downgrade: Keep a list of foods that flare up the GERD and avoid those when choosing a meal.
  - - - Upgrade: Client memorizes and recites common food triggers back to therapist
        
        Downgrade: Try breaking up the information into different sessions if the client seems significantly overwhelmed
  - - - Upgrade: Deep yogic breathing in a 4-7-8 pattern. Inhale 4 seconds, hold for 7 seconds, exhale for 8 seconds.
      - Downgrade: Simply have the client close their eyes and take deep breaths in and out.
  - - - Upgrade: Use solid and more sticky or crunchy foods.
      - Downgrade: Perform exercises with auditory and tactile cues when necessary to remind the client to swallow food. Use softer foods or thickened liquids
- - - - Administering the COPM will give the therapist perspective in regards to how the client prioritizes her GERD and the treatment of it.
      - The COPM can identify areas of importance to the client that can be used when planning occupation-based intervention.