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Difficulty: MediumCollaboration with Interdisciplinary Team

An adult client with progressive multiple sclerosis is admitted to the medical-surgical unit. During mealtime, the nurse observes the client dropping eating utensils due to severe finger weakness and exhibiting a wet, gurgling vocal quality after sipping water. The client begins to cry and states, "I am so scared that I am going to choke." Which action represents the most appropriate interdisciplinary collaboration for this client?

  1. Use the SBAR communication framework to report the swallowing difficulties to the healthcare provider and recommend a speech-language pathology evaluation.Answer
  2. B
    Instruct the unlicensed assistive personnel to feed the client slowly using thickened liquids to prevent aspiration.
  3. C
    Prioritize an urgent consultation to physical therapy to help the client regain hand grip strength for independent feeding.
  4. D
    Reassure the client by stating, "You are in a safe place and we will not let you choke," prior to contacting the medical social worker.

Answer

The most appropriate action is to use the SBAR communication framework to report the swallowing difficulties to the healthcare provider and recommend a speech-language pathology evaluation.
Using the SBAR framework to notify the provider and recommend a speech-language pathology evaluation directly addresses the highest priority issue: the client's compromised airway. The wet, gurgling voice indicates potential aspiration, making an SLP evaluation critical. SBAR is the gold standard for escalating such concerns effectively.

Step-by-Step Solution

1
Analyze the client's clinical presentation to identify the highest priority need.
The client has two distinct physical issues: fine motor weakness (dropping utensils) and potential dysphagia (wet vocal quality after drinking).
Applying the ABCs (Airway, Breathing, Circulation) is essential to prioritize care.
2
Determine the appropriate interdisciplinary team member for the priority issue.
The priority is airway protection due to the risk of aspiration from dysphagia. The speech-language pathologist (SLP) is the expert in swallowing evaluations.
Collaboration with the correct allied health professional ensures safe and targeted interventions.
3
Select the correct communication strategy to initiate the collaboration.
The nurse must contact the healthcare provider to obtain the referral, using the SBAR (Situation, Background, Assessment, Recommendation) framework.
Standardized communication tools prevent errors and clearly convey the need for interprofessional support.

Key Concept

The nurse must prioritize airway and breathing (ABCs) when multiple deficits arise, utilizing standardized communication (SBAR) to request the appropriate interdisciplinary specialist (SLP for swallowing, OT for fine motor skills).
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Collaboration with Interdisciplinary Team

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