AconversationonmangementofDysphgia课件.ppt

* * * * * * * * * * * * * * * * * * * * * * Case #1 - DISCUSSION Briefly describe how you should respond to the swallowing needs of this individual. Case Study #2 DL is a 66-year-old male who presented in the emergency department after collapsing at home while digging in the garden. His wife found him unable to move his right arm or leg and unable to speak. A CT scan performed in the emergency department detected an early left middle cerebral artery (MCA) infarct. Echocardiography found a moderately enlarged left ventricle with grade II left ventricular systolic function but no clots and an elevated right ventricular systolic pressure of 88 mmHg. DL was obtunded, with no gag reflex, left deviation of the eyes, and intermittent consciousness. Case Study #2 (cont’d) DL had not seen a doctor in 15 years. Previously, he had been independent and in good health, with no history of hypertension, diabetes, hypercholesterolemia or hospitalization. He did not take any medications and had stopped smoking 18 years ago. DL lives with his wife and three children. Family members accompanied him to the hospital, and they are very anxious. DL has now been in the emergency department for two hours. His family members want him to be fed and given medication for pain, as they believe he is in pain. Case Study #2 - DL Social History 66-year-old male Lives with his wife and three children Medical History Previously independent and in good health NO history of: Hypertension Diabetes Hypercholesterolemia Hospitalization (has not seen a doctor in 15 years) Medical History (continued) Ex-smoker (18 yrs. ago) No medication Hx of Presenting Illness Found by wife after collapsing at home while digging in the garden Family members accompanied him to the hospital Case Study #2 - DL Assessment Results CT scan - early left MCA infarct Echo moderately enlarged left ventricle with grade II left ventricular systolic function no clots elevated right ventricular systolic pressure of 88 mmHg. Unable