Mrs. A

This patient had a stroke a couple years back with weak right side and has been living with her husband. She had a recent decline in function and presented with increased dysphagia. Her husband is elderly and has a bad back and doesn't seem fit to take care of her at the present time. They have declined the suggestion of a board and care facility and he had requested to have her go home with him. I have been working with the two of them on patient/family training in the following areas:

-toileting routine (toilet transfer with quad cane; clothing management and hygiene)
-shower level ADL (seated in shower)
-seated-pivot tub transfer with tub transfer bench
-meal preparation (pt must have all foods pureed and liquids nectar thick)

This has been tricky as the patient's husband is not in the best health- he has a bad back, uses a cane and his vision is poor. Today I had him demonstrate how to make a drink nectar thick for his wife. he practically poured the whole container of 'thick-it' in the tea. This has been the third time we have worked on preparing nectar thick liquids. there was chunks of the white 'thick-it' in the drink which he clearly was unable to see due to his eyesight. i had to explain that it was too thick and re-explain the proper amount of 'thick-it' to add and have him perform attempt #2. Luckily it was a success. Another element to this scenario which poses a limitation to this collaboration for food preparation is that the patient has expressive aphasia as a result of her prior stroke and thus demonstrates difficulty expressing herself in words. Whereas, if she were more vocal she might be able to assist her husband in the meal preparation. it has been adventure working with her and her husband to prepare pureed meals and nectar thick drinks. To be continued.