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Clinical decision making, reporting - Coggle Diagram

- - - - No aspiration risk, with oral
      - Able to manage an oral diet, be able to get enough intake to meet hydration, nutritional needs, alert, takes <10 seconds for every mouthful, no need supplementation
      - Consider
        
        What textures do you want them to have?
        
        Any special conditions/instructions for HPs to note: nurse feed, fluids on spoon bcos pt might be impulsive, remind them to do chin tuck
        
        Amount of intake: Full diet (>50% of amt brought to them), or do we want to order small portions (eg. pt placed on trials of 3-4 spoonfuls per time, 2-3 times a day, only order desserts), can the kitchen do this? Depends on person's capability, fn, preference
        
        Nature of intake: Timing only when awake and alert or only at lunch, independent or supervised (requires nurse staff assistance). Need to keep deciding on spot if we are going to continue feeding and how many trials), positioning only when out of bed, only in upright position, any compensatory posture/strategies that must be done (eg. pillows)
        
        Medications: can they swallow their medication? Liquid form? Smaller tablet, crushed? Not possible for all medications.
        
        Mouth care: is oral residue an issue? cleaning prior to/after meals managed by nurse. General cleaning w swabs, special toothbrushes that suction out to prevent aspiration risk
        
        Circuit breakers: Alerting nursing staff when to stop oral trials "if any signs of coughing or distress during meals, stop oral intake, contact SLP, also monitor if you are worried about silent aspiration or if you see any other signs of breathing difficulty, monitor for any changes in medical condition also" If pt placed on modified diet, plan must be in place to continue to review this if change/recovery is anticipated, daily 1/7 (good progress, medical status changing fast), 2-3 days (poor progress but still need to check), In a week 1/52, month 1/12.
        
        Compliance: difficult for pts w cognitive issues, pts have preference, they dont like modified fluids and foods. Family, carers X unds why it is necessary-done out of pure love, care. Reduced or incorrect oral intake-leads to issues of aspiration, hydration, nutrition. Pts X follow thru w Tx exercises, delays to rehab, so need to educate on how to impv health state
    - - Need to consider how they will receive nutritional intake
      - Will you use partial or non-oral feeding? Work w medical staff, alert them. NOT just our decision alone.
      - Roles of HPs
        
        SLP: Identify if there is going to be any issues w pt managing a full meal (normal vs. modified textures)
        
        Dietician: will determine nutritional needs (consider existing weight, condition) may monitor intake using food, fluid chart for 1-2 days to see
        
        Medical team-final say. May need increased nutrition for medical mgm
    - - Completely oral intake
      - Oral + non-oral: Combine partial oral intake w supplementation eg. pt on small oral trials of thickened fluids while still receiving non-oral feeding OR pt on full oral feeding but w nutritional supplements bcos not eating enough. Cycle of get hungry--> eat--> satiated then supplement with what is not enough thru non-oral means
      - NBM-completely non oral
    - - Amt of aspiration, freq of aspiration
      - Secretion mgm-if they can swallow their own saliva
      - Pt diagnosis-severity of condition,prognosis
      - History of pneumonia, respiratory status, cough
      - Alertness, ability to complete compensatory postures
      - Pt's wishes-must be based on informed choice-need pt and fam to unds the risk, problems they have, power of attorney, case conference, ultimately dr's decision
    - - As swallow, medical state improves, need for non-oral feeding is reduced, can transition
      - Start w small oral trials w full non-oral support
      - Increase size, amts of oral trials- discuss w dietician to start to change bolus feeds (more motivated) and/or reduced amts of non-oral feeds to increase appetite for oral intake.
      - Monitor oral intake-once enough, dietician, medical HP, SLP determine non-oral can be removed