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Homer Xiang, Sr. 82 yo M (Occupational Performance Deficits (Dependent…
Homer Xiang, Sr. 82 yo M
Problems/Strengths
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Strengths
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Patient is married, therefore has a support system
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Assessments
Observations
OT will observe client during PEG feeding, supplemental/hydration, and performance of ADLs
FIM
Functional Independence Measure will be used to score the patient in levels of performance in multiple functional areas/tasks that essential in every day life
COPM
Canadian Occupational Performance Measure will be used to better understand how the patient perceives and performs occupations. This will be used to compare throughout treatment
BEDQ
Brief Esophageal Dysphagia Questionnaire is self reported questionnaire to determine the severity, symptom frequency, and impacts of dysphagia (Taft et al, 2016).
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Interventions
- Caregiver education on infection control/prevention. Teaching his wife the signs of infection as well as the proper way to clean the insertion site, by cleaning once a day with tap water and making sure it is fully dried.
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- Caregiver education on the use/need/complications/procedures for the use of the PEG to ensure proper care when discharged into home for home health care. It is important that the caregiver can identify how the machine is used as well as precautions and complications that could arise while using the PEG.
Up: Caregiver uses daily checklist of proper use/possible complications/etc of PEG to ensure proper functioning to prevent complications that can be otherwise avoided
Down: Wife has a brochure and contact number of a home health nurse that can walk her through a routine check and inspection of PEG on her husband
- Working on proper body positioning to ensure safety when feeding through the PEG tube. Patients body should be sitting upright during and after feeding, allowing the body to digest properly and help prevent blocking or leaking will occur.
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Down: Using verbal cues before, during, and after to feeding time to ensure the patient reminds upright while feeding
- Using modified swallowing techniques during feeding to help facilitate and regain swallowing function. Chin tuck and Masako techniques will be used.
Up: Having patient use the effortful swallow technique to engage and strengthen the muscles required to swallow
Down: Use of the NMES unit to help facilitate muscles to allow the patient to strengthen and use the muscles required to swallow properly
- Caregiver education on administering supplemental nutrition and proper hydration cycle. Ultracal HN Plus at 80mL per hour along with 250mL of water bolus every 6 hours.
Up: Caregiver uses timer and reminder notes to ensure proper timing and amounts are given to her husband
Down: Uses a step by step pamphlet guiding and directing the proper amounts, times, etc of the given water and supplements
Goals
STGs
In 30 days, client will sit up right for a 15 mins of the feeding/digesting time via PEG, with less than 2 rest breaks, while the other 45 mins, client reclined with back support form bed.
In 30 days, client will swallow a bolus of pudding, with use of NMES and chin tuck.
LTGs
In 60 days, client will sit up right for 30 mins of the feeding/digesting time via PEG by himself, with 0 rest breaks, while the other 30 mins, client reclined with back support from the bed.
In 60 days, client will swallow a bolus of pudding with less than 2 verbal cues on technique to swallow properly.