We had a patient ( 66yr old male) admitted here at NCNR w/ the diagnosis of dysphagia, and status post CVA, COPD, Respiratory MRSA. He was dehydrated and receiving G-tube feedings. He had not been out of bed in weeks and had not been walking so he had an abnormal gait and was extremely weak.
The therapy department went in for evals and we thought “prognosis negative”.
He was not motivated and did not want to participate in therapy.
As a speech therapist, I would begin therapy sessions with oral care to stimulate the oral cavity for sensory purposes to encourage the need to swallow and for education on good oral hygiene. The residents mouth was showing signs of dehydration and his tongue was actually cracking and peeling. The resident was not willing to eat or drink at all at this time. Nursing administered swish and swallow as the resident developed thrush. I encouraged small sips of thin water as the resident had not shown any signs or symptoms of outward aspiration. If the resident was willing to participate, I would have him complete Oral Motor exercises for strengthening of labial and lingual musculature as well as laryngeal elevation exercises. As the resident became more willing to participate and was tolerating thin water and cold puree bolus’, I recommended a MBSS to be completed to determine the current status of swallowing. Once completed the resident was cleared for PO intake of thin liquids and a slow restart of foods (all liquid, puree, mech. soft, regular). Nursing and staff were educated on residents swallowing status at his point. Due to lack of PO intake the resident continued to need encouragement to eat a PO diet and also for attention to tasks due to some continued orientation deficits due to the CVA and MRSA infection. I continued to encourage PO intake, use of compensatory skills (safe swallow techniques) and attention to task to include: time of day, as He would say I have already ate. SLowly he improved and as deemed appropriate his diet was upgraded. The residents MRSA slowly cleared and the resident was safe to participate in a Rehab dining setting. This seemed to really motivate him to want to eat and be able to participate in every day activities once more.
When given a lot of encouragement and dedication from the therapy department he started to improve and is now independent in the facility w/ a rolling walker and the G-tube is long gone!
Don’t Judge a Book by Its Cover!