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Client information.
Name: Ruby Jane Smith
Age: 86 years old
Past…
Client information.
- Name: Ruby Jane Smith
- Age: 86 years old
- Past Medical History: GERD
- Current medical History:
- Social History and living environment: 30 years of smoking. She lives with her daughter and son-in- law.
- Clients goals: She wants to return to playing bridge with her friends without chronic pain from swallowing, bloating, and abdominal pain. She complain of tiredness because her stomach pain doesn't let her sleep.
Problems and strengths
Problems
- painful swallow
- current smoker
- dyspepsia symptoms; stomach pain,and bloating.
Occupation performance deficits
- decreased social participation and leisure activity by no longer attending her weekly bridge meetings
- Decreased self-feeding and swallowing
- decreased sleep particpation.
Strengths
- family support system
- Leisure interests
- intact functional mobility
Assessments
Clinical Observation
- clinical observation is used to detect orientation, cognitive status, motor control, posture, positioning, ability to self-feed, oral and pharyngeal movement without test foods (saliva), and ability to talk.
Katz ADL Index
- this assessment is used to see if she is having difficulty with completing her ADLs independently.
Feeding Trial: used to test which foods or drinks are causing them pain. This can be done because the client, caregiver, and nurse has not indicated any aspiration problems.
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COPM
- to measure the occupations affected by his injury and his satisfaction with his occupational performance.
Interventions
Positioning during feeding . OT will position client with verbal and physical cues.
- chin tucked to neutral
- slightly reclined
- stable trunk with symmetry
- sititng up in a chair as opposed to laying down
-
Grade up
- Client will independently follow the correct posture
Grade down
- client will be provided with a back and head support to ensure she is sitting upright to provide safe and easy movement of the bolus (Toussaint, Davidson, Bouvoie, Evenepoel, Haan, & Soudon, 2016)
Education
- Client will be given education on GERD and Barrett's esophagus.
- Lifestyle changes can be made to prevent painful symptoms that include avoiding sleeping or laying down after a meal(Ness-Jensen, Hveem, El-Serag,& Lagergren, 2016).
- Smoking is a risk factor for GERD (Ness-Jensen, Hveem, El-Serag,& Lagergren, 2016), 175-182.. She can be set up with resources if she chooses to quit
Grade up
- Client will create a list of changes to her lifestyle that can improve her Burrett's esophagus. Possible changes can include exercise, eating healthy, reduction or absence of smoking (Ness-Jensen, Hveem, El-Serag,& Lagergren, 2016).
Grade down - Client will give the caregiver the same information to have her support her mother during the lifestyle changes she chooses to make
Swallow Techniques to produce a smoother swallow. OT will sit in during clients mealtime to facilitate the Masako swallow.
- The client will practice holding the tongue slightly foward with teeth gently holding tongue in place during the swallow (Heemskerk, 2016) .
- A drink will be given in between swallows.
Grade up.
- Client will independently follow the Masako swallowing instruction indepdently.
Grade down
- Client and caregiver can work on demonstrating and reminding client to practice Masako swallowing during mealtimes.
Menu Planning and Meal Prep
- OT will assist client with meal prep.
- eating slowly
- Avoiding foods that trigger her dyspepsia symptoms such as coffee, chocolate, alcohol, mint, or any acidic foods ( Haruma, Kinoshita, Sakamoto, Sanada, Hiroi & Miwa, 2015)
Grade up
- Client will independently choose her meals following the instruction given by the OT and other health care staff
Grade Down
- Client will be set up with small plates to ensure small portion sizes.
- Food can be cut into small sizes to control the time spent eating
- Client can eat in a quite and calm environment to ease her eating
- A visual aid with foods to avoid will be given to be placed in her kitchen as a reminder
Texture Modifications
- Food will be modified to be soft foods that are moist such as ravioli, rice, and beans. This will improve her ability to swallow without pain from the changes to her esophagus from barrett's esophagus
Grade Up
- Client will choose foods that ease her swallow such as soft food and bite sized
Grade down: Food can be pureed to be a softer pureed consistency to reduce the painful swallow (Steele et. al., 2015)
Goals
Long Term Goals
- In 10 days, client will independently follow the correct positioning during mealtime to ensure safe swallow to avoid dyspepsia symtoms.
Short Term Goal
- In 3 day, Client will be able to repeat verbal instructions pnn correct positioning during mealtime
Long term goal
- In 10 days, client will independently prepare her meals in small cut portion and eat food in slow paced safe swallow
Short term goal
- In 3 days, client will prepare meals with small cut portions and eat food in a slow safe pace, with less than 3 verbal cues, 4 out of 5 times.