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Management of Daniel Thompson, Oral care nurse assessment - Coggle Diagram
Management of Daniel Thompson
Acute management
Weak, productive cough
Struggling to clear secretions
Cough Assist
Uses at home
May need home setting review to support respiratory/ bulbar weakness (15)
Check how often cough assist is used, recommend daily (15)
reduce admissions, improve secretion clearance, improve survival, improve comfort and reduce respiratory distress (15)
Check caregiver understands use
MND, recurrent chest infections, peak cough flow <160L/min, bulbar weakness, fatigue (15,16)
Face mask > mouthpiece
Suctioning if secretions moved to upper airways
Humidified o2 (14)
Confirm regular hydration with nurses
Nebulised saline (14)
Risk: choking on viscous secretions
Monitor saturations and titrate O2 as needed
≥94% (13)
Fatigue
Limited walking with stick
Ensure pressure relief equipment and regular repositioning with nurses (7,8)
Try WZF
Will need home referral
Supervised transfers
Temperature, High RR, high rHR
Pain levels
Numerical rating scale 0-10
Stronger medication for mobilisation
Risk of increased fatigue, drowsiness, respiratory depression (20)
Low saturations
Desaturates when walking.
Clearance techniques before mobilsing
Increase o2 when mobilising
Risk: O2 alone may worsen carbon dioxide retention. (17)
Oropharangeal dysphagia, Dry mouth
SLT
Polypharmacy? (4)
Reduced appetite and recent weight loss
Consult MDT for feeding tube
Dysphagia, weight loss, respiratory infections (5,6)
Preserve energy and gain nutrients for recovery (5,6)
Patient and family involved discussion
SOB and increased WOB, slumped
Sit out in tilt in space chair
Head support
Benefits to lung ventilation and secretion clearance, guideline recommended(18)
Monitor ABGs
Bed positioning
Inpatient NIV (9)
Follow up and prioritise home referral
Consult with NIV team
Cost: nurse monitoring ratios, frequent ABGs (11)
Risks: machine failure >higher mortality rates than IV (10)
Reducing risk of meeting intubation criteria (12)
Improves pulmonary oxygenation (12)
Lower pH and PcO2 (12)
Mild spasticity in LL
Splinting whilst less mobile (3)
pROM and stretching exercise (1,2)
Long- Term management
Wife concerned about managing
Partner support groups
Benefits advice service
Carers/ community nurse discussions
Cleaner services
Ensure wife is getting enough sleep
Intimacy discussions
Online food shopping/ delivery
Assistance with dressing, showering, transfers
Community OT reassessment
Adaptive equipment
Stair lift
Rails/ ramps
Commode, raised seat
Shower chair
Self care-focused maintenance exercises
Eating
choking/ coughing
Pharmacology- non-oral tablets
SLT home referral
Weight loss
Embarrassment at family dinner
poor sleep
headaches
Fatigue
Energy conservation techniques
Pacing
Optimal exercise timing
anxiety
Discuss sleep hygiene
Raised sleep positioning for orthopnea
OT equipment
Recently withdrawn
Fear of falling
balance exercises
Pull cords/ alarms
WZF over walking stick
Feelings of burdening/ frustration
Discuss house role/ contribution
Laundry folding, surface wiping
Motivational interviewing
HADS/ PHQ-9
Signposting to MND association support
sitting in one place
Pressure relief cushion and mattress to account for bad days
avoiding activities
Encourage prioritising wheelchair for engage in activities
Not completing exercise
Reassess exercises
Discuss hobbies, find a way to integrate them
Functional focus
self care
Personal goal setting
MND chat forms
Relationship with son
family support groups
Suggest accessible activities together
involve son in exercises
Gaming
Weak immune system
Vaccinations
Family and patient
Nutritionist reassessment
Home monitoring of vital capacity
Dental care
Oral bacteria
LVR exercises
bulbar decline
respiratory system compliance
Planning ahead
Upstairs bed and bathroom, entry steps
Downstairs living
Ramps
Strip wash/ shower room
Toiletry care
Hospital bed
Progressive weaking and reduced mobility
Studier/ powered wheelchair
MND association loans
OT
Spasticity
Orthotics referral
Botox and neurolysis trearment referral
TENS/ FES
Pain management
MDT
Spasticity management
Frontotemporal dementia symptoms
Personality
Behaviour
Decision making
Educating patient and family
Consent and capacity planning
Reduced bulbar symptoms
Communciation
Assistive equipment
MND association
Drooling
Gland botox
Eating
Feeding tube
End of life discussions
Cultural and spiritual beliefs
Oral care nurse assessment