Rehabilitation

Question 1

Outline the swallow test

Answer 1

1. Make sure patient is sat upright and is alert
2. Give one teaspoon of water, feel for movement in the larynx as they swallow
3. Give second teaspoon of water, feel for movement in the larynx as they swallow
4. Give third teaspoon of water, feel for movement in the larynx as they swallow
5. Give a half-full glass of water, feel for movement in the larynx as they swallow

If they fail (don’t swallow/choke/cough/SOB/gurgling) then NBM and IV fluids, consider NG tube

If they fail on day 3 then commence enteral feeding

Question 2

What screening tool can be used for malnutrition?

Answer 2

MUST

Question 3

When should fine bore NG tube feeding be commenced?

Answer 3

If safe swallow hasn’t been established within 24 hrs

Question 4

What are the risk factors for re-feeding syndrome?

Answer 4

Patient has 1 or more of the following:
BMI < 16kg/m^2
>15% body mass loss in <6 months
V. low (or no) nutritional intake for >10 days
Low levels of potassium, phosphate and magnesium

Patient has 2 or more of the following:
BMI < 18.5kg/m^2
>10% body mass loss in <6 months
Hx of alcohol abuse or drugs (including insulin, antacids, diuretics, chemo)

Question 5

What electrolytes should be carefully monitored in patients at risk of referring syndrome?

Answer 5

potassium, magnesium and phosphate (low levels indicate risk of reseeding syndrome)

Question 6

What do all patients who are nill by mouth regularly require?

Answer 6

Artificial saliva and chlorhexidine mouthwash

Question 7

Upon review of medication when re-feeding a patient, what do you do when drugs cannot be stopped safely?

Answer 7

give by feeding tube or parentally

Question 8

What can be done to stop patients pulling out a NG tube?

Answer 8

Nasal loop device

Question 9

What additional treatment do re-feeding patents require?

Answer 9

Thiamine 100mg, TDS and vit B co strong 2, TDS