Patient is a 58 year old male who was admitted with a primary diagnosis of oral cancer on 01/01/2010. Patient’s chief complaint was chronic sore throat and voice change. Leukoplakia are evident upon assessment. Furthermore, patient’s body weight and BMI are below the recommended average, which stipulates imbalance nutritional intake. Common clinical manifestation of oral cancer patient is dysphagia (difficulty swallowing), and difficulty in moving the jaw (e.g., chewing and speaking). Primary treatments are to maintain functional oral feeding, balanced nutritional intake, prevent aspiration, and maintain swallow function.
Assessment of patient’s learning needs, abilities, and readiness should be made at time of admittance to when the patient is discharged. Teaching plan should be done in environment that was quiet and ambient, with minimal distractions. It should also be simple and easy to understand, and should always include a family or caregiver, if applicable. Although patient’s pharmacologic treatment may hinder the patient’s ability learn, patient was alert and cooperative at time of assessment. It should be noted that there are certain factors, such as age, medications, and lifestyle changes, which may interfere with the patient’s learning ability. For example, medication, such as opioids, will decrease patient’s concentration and increase confusion. Emphasis should be made on positive results (e.g., improvement on oral strength, increase in recovery time, and decrease in infection) and risk factors (e.g., malnutrition, decrease recovery time). (Lewis et. Al, 2008).
Identification of learning and/or discharge goals for patient and patient’s caregiver concerns nutritional diet preparation for the patient. Patient’s dietary plan should avoid mixing consistency. Mixing consistency have both solid and thin liquid consistency (e.g., canned fruit in its juice or cereal with milk). The consistency of patient’s diet should be softened or modified pureed consistency to reduce risk of aspiration and improve oral control. Patient and patient’s caregiver should be able to demonstrate the types of diet the patient should avoid, such as raw fruits and vegetables, nuts, tougher meats, sticky breads, and foods that break apart easily in the mouth (e.g., cornbread, rice). The expected outcome of the learning and/or discharge goals for the patient and family are considered met if the patient and patient’s caregiver are able to demonstrate the types of diet that is allowed and types that should be avoided until oral control or overall strength (e.g., oropharyngeal swallow) has improved. (Brady, 2008).
Intervention that should be implemented to attain stated learning and/or discharge goals are, for example, encouraging patient participation in recording food intake using daily log. The rationale for encouraging recordation of daily food intake facilitates accurate documentation to type, amount, and pattern of food or fluid intake. It also encourages the patient to adhere to the diet regiment. Furthermore, a dietician may be referred or consulted to ensure proper nutritional diet is prepared for the patient by either the patient or patient’s caregiver. Furthermore, supplemental information (e.g., pamphlets and instructional aides in meal preparation for dysphagia patients) may be provided to ensure patient’s adherence to his/her diet.
The teaching plan should be reviewed and reassessed during patients stay and after discharge to ensure compliance. Goal achievements are considered met if they are able to return demonstration and verbalization of their comprehension of teaching prior to discharge, particularly risk factors associated with dysphagia.