Transcript Continence - Palliative Care in Bradford & Airedale

What can our service offer an
individual with advanced multiple
sclerosis:
The Rehabilitation Perspective
Rory O’Connor, Jane Pearce, Carolyn Zeyrek
Specialist Rehabilitation Service
AGH and BAtPCT
Introduction
• Hypothetical case report
• Combination of real examples and
interventions
Case Report
• 53-year-old man
• Admitted to an acute medical ward with
aspiration pneumonia
Case Report
• 53-year-old man
• Admitted to an acute medical ward with
aspiration pneumonia
• 6 weeks later…
Acute Medical Care
Referral to Rehabilitation Team
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Bed bound
Incontinent
Unable to swallow
Bed sores
Demented
How do we discharge?
Taxonomy of Problems
Dysphagia:
Nutrition
Respiratory
Physical:
Tetraplegia
Spasticity
MS
Seating
Access
Cognition:
Insight
Safety
Continence:
Urinary infections
Constipation
Home:
Access
Family
Carers
Interactions of Problems
Dysphagia:
Nutrition
Respiratory
Physical:
Tetraplegia
Spasticity
Seating
Access
Cognition:
Insight
Safety
Continence:
Urinary infections
Constipation
Home:
Access
Family
Carers
Interactions of Problems
Dysphagia:
Nutrition
Respiratory
Physical:
Tetraplegia
Spasticity
Seating
Access
Cognition:
Insight
Safety
Continence:
Urinary infections
Constipation
Home:
Access
Family
Carers
Interactions of Problems
Dysphagia:
Nutrition
Respiratory
Physical:
Tetraplegia
Spasticity
Seating
Access
Cognition:
Insight
Safety
Continence:
Urinary infections
Constipation
Home:
Access
Family
Carers
ICF Model
Health Condition
Body function
Activity
Environment
Participation
Personal factors
Health Condition
Body function
Activity
Environment
Participation
ICF Model
Personal factors
Advanced Multiple Sclerosis
Tetraplegia
Dysphagia
Incontinence
Pressure sores
Dementia
Access
Cannot sit
Cannot eat
Odour
Unable to
direct care
Unable to
return home
Family and
carers’ distress
Rehabilitation Interventions
Rehabilitation Interventions
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Medical management
Quality of life issues
Family support
Discharge planning
Continence Management
• Full continence assessment
– Bladder scan
• Continence nurse referral
• First line medications and equipment
– Nurse prescriber role
• Suprapubic catheter if required
Bowel Management
• Disimpaction
• Regular bowel programme
• Referral to District Nursing team for
monitoring
Skin Care
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Pressure relief
Management of continence
Special seating and mattress
Manual handling equipment to prevent
shearing skin
• District Nurse and Community OT
support for equipment at home
Dysphagia Management
• Speech and language assessment
– Swallow assessment
– Food consistency advice
• Dietician assessment
– Macro and micronutrient advice
– Advice on food and fluid consistency
• MDT assessment for PEG
Family Support
• Explanation of impairments and
interventions
• Behavioural and cognitive issues
• Guilt and distress
• Disruption of family life
Discharge Planning
• Discharge liaison manager
• Social service referral
– Nursing needs assessment
– Level/banding for funding
– Home care package
• Specialist nursing referral
• Specialist rehabilitation team follow-up
Rehabilitation Principles
Rehabilitation Principles
• Patient at centre of care
• Management of impairments
• Promotion of independence and
quality of life