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

[THAMMERLE@PARTNERS.ORG (Hammerle, Terese)]

Hi, 

This posting may not relate to the 39 y/o male with CP b/c it seems as that
is new onset of cough, but I'd like to get feedback from other readers on my
view of saliva aspiration.  In general, my understanding is that the harm
from saliva/water aspiration comes from the bacteria carried into the lungs
with the aspirate.  I reason that when you decrease the amount of saliva,
you increase concentration of bacteria for a variety of reasons.  My
emphasis would be on oral care if concerned re. pneumonia.  How do other
members approach saliva aspiration either in chronic care populations, acute
stroke/TBI, neuromotor?   

Terese  


> -----Original Message-----
> From:	Karen Reed [SMTP:kar_44060@yahoo.com]
> Sent:	Thursday, December 06, 2001 9:21 PM
> To:	dysphagia listserve
> Subject:	[DYSPHAGIA] Adult with MR who is NPO with s/s of aspiration
> with saliva
> 
> 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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