[DYSPHAGIA] Adult with MR who is NPO with s/s of aspiration with saliva

[kar_44060@yahoo.com (Karen Reed)]

Hi everyone,

Thank you in advance for your responses.  This is one
of the greatest tools we have available today.  This
is my first case presentation on the listserve so
it'll be a little long.

I have a 39 year old male resident residing in an
ICFMR facility on my caseload.  

Dx: MR, CP, spastic quadriplegia, athetosis,
scoliosis, kyphosis, congenital rib anomaly,
strabismus ou, hyperopia, nystagmus ou, alternating
esotropia, possible anoxic brain damage, dysphagia,
chronic constipation, osteoporosis, astigmatism, h/o
fuo 3/98, recurrent UTI 5/99, OD subjunctival
hemorrhage with dry eyes 7/99, chronic sinusitis
12/99.

Routine meds:  beconase aq nasal, calcium carbonate
susp, diazepam, miacalcin nasal spray, mineral oil
heavy, multivitamin adult liq, styptic pencil, feet
enema after 3 days without bowel movement,
acetaminophen, guanifenesin syrup, pseudophedrine HCL
syrup, tears naturale II, trimethobenzamide supp.

Feeding via PEG tube.  NPO due to aspiration.  Chronic
drooling.  Extremely spastic at times.

Communication status:  Nonverbal with occassional
vocalizations (appropriate laughter).  Appears to have
excellent receptive skills (He finds the movie "Liar
Liar" extremely hilarious and enjoys slapstick
comedy).  Communicates yes/no appropriately via eye
gaze up/down, choices via R/L eye gaze, Step-by step
with levels for commenting, and facial expression.  

Current situation:  This resident had a virus that
went through the general population just before
Thanksgiving.  The symptoms of the virus included a
cough.  He currently coughs several times a day for
several minutes to point that he appears very
distressed by it.  The cough appears to be on his
saliva.  This has happened since the virus occurred.

Thoughts and Questions:  Would a scopalomine patch be
of benefit to dry the secretions if the PEG flush was
increased to prevent any dehydration?  Are there other
meds that could decrease the secretions?  Are there
other strategies that could be tried?  Due to extreme
spasticity, I don't think this man would be able to
complete pharyngeal exercises.   

This resident is a potential candidate for a baclophen
pump after the holidays.  Would any other meds for
controlling secretions present a problem with the
potential for the pump?

Thanks for your help!

Karen

PS I asked this resident if he would like help from
the listserve members and he responded yes. I will be
seeing him on Tuesday and will be reading this letter
with replys to him.




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