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George Banks Chief…

- - - - Lab and Diagnostics:
        
        CBC and CMP are WNL.
        
        Lipid profile shows a mildly elevated LDL of 106 and a low HDL of 30.
        
        Triglycerides are mildly elevated at 167.0.
        
        CT of the head without contrast shows evidence of a left middle cerebral artery (MCA) infarction.
        (Kenneth Wong, History and Physical (Emergency Department), 2018)
        
        Assessments:
        
        Left-sided ischemic cerebral vascular accident with onset being greater than 3 hours prior to admission.
        
        NIH Stroke Scale = 16
        (Kenneth Wong, History and Physical (Emergency Department), 2018)
        
        Plan:
        - Admit to hospital once a bed becomes available in the Stroke Care Unit.
        
        In the meantime, keep him in the Emergency Department observation area.
        
        Control blood pressure, keep patient NPO.
        
        Neurology consult ordered.
        (Kenneth Wong, History and Physical (Emergency Department), 2018)
        
        OCCUPATIONAL THERAPY SERVICES ARE STARTED
        
        Occupational Performance Deficits:
        
        Self Feeding- Patient is having trouble holding utensil in dominant right hand due to weakness after stroke.
        
        The patient is having trouble with eating due to muscle weakness in the right side of the face.
        
        Swallow study can be done to see if the patient is having difficulty.
        
        Assessments:
        
        MMT: this would allow the occupational therapist to see the muscle strength that is available in the patient's upper extremities, and how this will affect his ability to self-feed.
        
        Monofilament Sensory Assessment: This will allow the occupational therapist to see if any sensation was lost due to the stroke, and if so where so the therapist can see if the patient is able to feel his food.
        
        Feeding Trial: The best way to see what difficulties the patient is having with feeding, eating, or swallowing would be to do a feeding trial with the patient to see what stage of feeding, eating, or swallowing the patient is having difficulty with, so further assessments can be selected.“Feeding and eating are carefully examined within the context and culture in which the activity typically takes place. In addition to individual intervention aimed directly at the specific feeding, eating, or swallowing problem, occupational therapy practitioners also adapt the environment to support safe eating habits, provide adaptive equipment, and educate families and others in the community” (The Practice of Occupational Therapy in Feeding, Eating, and Swallowing, 2017).
        
        If the patient was not just having difficulty getting the food to mouth and chewing the food due to muscle weakness in the right UE and face then a FEES, or Modified Barium swallow could be performed to see if the patient was having any trouble swallowing the food.
        
        COPM: This will allow the occupational therapist to see what is important to the patient and what he wants to work on during therapy to identify clients priorities. Providing the client with client-centered interventions has shown to increase clients overall outcomes because the client is participating in something that they want to do and is important to them. (Nilsen, Gillen, Arbesman, & Lieberman, 2015)
        
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