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Difficulty: HardCollaboration with Interdisciplinary Team

A nurse is preparing an SBAR (Situation, Background, Assessment, Recommendation) report for interdisciplinary rounds regarding a client recovering from a craniotomy for a right frontal lobe tumor. The client exhibits left-sided hemiparesis and has severe baseline rheumatoid arthritis in the unaffected right hand. The nurse's assessment notes continuous coughing when drinking thin liquids, food pocketing in the left buccal cavity, and an inability to firmly grasp standard silverware. Which statement by the nurse represents the most appropriate "Recommendation" to the interdisciplinary team?

  1. I recommend consulting a speech-language pathologist for a comprehensive swallowing evaluation and an occupational therapist to provide adaptive eating utensils.Answer
  2. B
    I recommend delegating feeding assistance to the unlicensed assistive personnel during all meals and consulting a registered dietitian to increase caloric density.
  3. C
    I recommend immediately involving the medical social worker to arrange for home-delivered pureed meals and physical therapy to improve bilateral upper body strength.
  4. D
    I recommend maintaining the client in a semi-Fowler's position during meals and requesting a physical therapist to evaluate the client's chewing and swallowing coordination.

Answer

The statement recommending a consultation with a speech-language pathologist for a swallowing evaluation and an occupational therapist for adaptive eating utensils.
The client exhibits classic signs of dysphagia (coughing, pocketing) requiring a speech-language pathologist (SLP) to evaluate the aspiration risk and recommend safe swallowing strategies. Additionally, the client's inability to grasp utensils due to rheumatoid arthritis and hemiparesis requires an occupational therapist (OT), who specializes in fine motor skills, activities of daily living (ADLs), and the provision of adaptive eating equipment.

Step-by-Step Solution

1
Analyze the clinical findings presented in the Assessment phase of the scenario.
The client is experiencing coughing with liquids and food pocketing (indicating dysphagia/aspiration risk) and an inability to grasp silverware (indicating a fine motor/ADL deficit).
Identifying the specific functional deficits is required to determine which interdisciplinary team members have the appropriate scope of practice to intervene.
2
Identify the correct interdisciplinary scope for managing the dysphagia.
A speech-language pathologist (SLP) is the specialist responsible for evaluating swallow function, diagnosing dysphagia, and recommending safe diet textures.
Airway protection is the highest physiological priority. The SLP possesses the specialized training to conduct comprehensive swallowing evaluations.
3
Identify the correct interdisciplinary scope for the fine motor deficit.
An occupational therapist (OT) specializes in activities of daily living (ADLs) and fine motor skills, and can provide adaptive equipment (e.g., built-up handles) for the arthritic hand.
Physical therapy focuses on gross motor mobility, whereas occupational therapy focuses on the fine motor coordination required for self-care tasks like eating.
4
Select the SBAR recommendation that integrates these specialized referrals.
The statement requesting both an SLP and an OT directly addresses the client's immediate nutritional, safety, and self-care needs.
Effective interdisciplinary collaboration requires the nurse to advocate for referrals that precisely match the client's clinical presentation.

Key Concept

Interdisciplinary Team Scopes of Practice (SLP for dysphagia, OT for fine motor ADLs)
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Topics

Collaboration with Interdisciplinary Team

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