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[DYSPHAGIA] Adult with MR who is NPO with s/s ofaspiration with saliva
Marie: I also work with DD adults in ICF. Can you give me info on Beckman's
protocol? How to obtain it or it the reference? I am new to DD and am
unfamiliar with it. Thanks for all the information.
Virginia Cooper, M.S., CCC
Speech-Language Pathologist
(510) 583-7754
www.AccentOnCommunication.com
----- Original Message -----
From: "Marie Isbell" <misbell@mail.state.tn.us>
To: <dysphagia@medonline.com>; <kar_44060@yahoo.com>
Sent: Friday, December 07, 2001 6:39 AM
Subject: Re: [DYSPHAGIA] Adult with MR who is NPO with s/s ofaspiration with
saliva
> Karen - I agree with everything Irene Campbell included in her response.
I work with the adult DD population in the community setting. Most have
lived in an ICFMR prior to their move into the community. In addition to
the GER information offered by Irene Campbell, I would like to suggest that
in addition to medical management of the GER, you consider working with your
Team on positioning for the gentleman throughout his day. He should never
lie flat, even during bathing or brief changes. You could consider inclined
sidelying as an alternate position to be used throughout the day as he
tolerates. You could also consider using a bedrail sidelyer attachment to
allow him to be comfortable in bed when it has been raised on blocks.
>
> Also concerning is the constipation. It is concerning that he requires a
Fleets every three days, and this could lead to bowel problems. Could it
possibly be due to some level of dehydration, muscle tone, or GI
dysmotility? Increasing fluid intake carefully, because of the GER, may
lead to a decrease in constipation. In addition, prone on forearms or
quadruped on forearms used as alternate positioning when his stomach was
empty might increase bowel motility. You might consider testing to look at
GI motility also.
>
> Also, your team might want to look at his wheelchair positioning. It
would be important for him to be in an upright, well supported position for
at least one hour following all tube feedings and med administration to
allow his stomach to empty. It is usually suggested that an individual with
GER should not have a tube feeding within 3 hours of going to bed.
>
> Oral hygiene will be extremely important if the aspiration is occurring
from the top down. We sometimes recommend that suctioning tooth brushing
occur with individuals who are NPO because of aspiration. We also recommend
more frequent brushing throughout the day, and sometimes the dentist wants
to do a cleaning quarterly when s/he knows the individual aspirates.
>
> You might also consider completing some type of oral motor assessment (I
use Beckman's Protocol) to determine his functional skills and develop an
intervention that may assist him with handling his oral secretions. This
gentleman has many needs that you and his treatment team might look at
systemically. Problems in one area flow over into other areas; he needs
more than discipline-specific intervention. When we work with people this
involved, we use physical nutritional management principles to guide our
interventions. You might also consider obtaining a PharmD assessment and a
DD MD assessment to help guide your treatment team's interventions. Hope
this helps. Marie
>
> >>> Karen Reed <kar_44060@yahoo.com> 12/06/01 08:20PM >>>
> 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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