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Difficulty: Very hardCollaboration with Interdisciplinary Team

A nurse is preparing an SBAR (Situation, Background, Assessment, Recommendation) report for interdisciplinary rounds regarding a client who recently suffered an acute cerebellar infarction. The client exhibits severe appendicular ataxia, dysmetria, and bilateral intention tremors. The nurse reports that the client is consuming less than 25% of their meals because they become exhausted trying to manipulate standard utensils, frequently spilling hot food. The attending provider suggests delegating total feeding assistance to the unit's Unlicensed Assistive Personnel (UAP) for all meals to ensure adequate nutritional intake. Which statement by the nurse in the "Recommendation" phase demonstrates the most appropriate clinical judgment and interdisciplinary collaboration?

  1. I recommend an Occupational Therapy consult to evaluate the client for weighted utensils and to teach energy conservation techniques for activities of daily living.Answer
  2. B
    I will delegate meal assistance to the UAP and instruct them to evaluate which types of adaptive feeding utensils the client tolerates best.
  3. C
    I recommend a Physical Therapy consult to initiate an intensive upper extremity strengthening program to improve the client's fine motor control.
  4. D
    I recommend consulting a Medical Social Worker to initiate discussions about transitioning the client to a skilled nursing facility due to this decline in self-care.

Answer

The most appropriate recommendation is to consult Occupational Therapy to evaluate the client for weighted utensils and teach energy conservation techniques.
The most appropriate interdisciplinary collaboration is to consult Occupational Therapy (OT). Occupational therapists specialize in rehabilitating fine motor skills and helping clients master Activities of Daily Living (ADLs), such as self-feeding. For a client with cerebellar ataxia and intention tremors, an occupational therapist can prescribe adaptive equipment, such as weighted utensils, which help dampen tremors and improve coordination. Furthermore, OT can teach energy conservation techniques to address the client's exhaustion, thereby promoting functional independence rather than relying completely on total care from the nursing staff.

Step-by-Step Solution

1
Analyze the client's clinical presentation and the root cause of the nutritional deficit.
The client has an acute cerebellar infarction causing ataxia and intention tremors, leading to exhaustion and an inability to use standard utensils.
Identifying the specific neurological deficit determines which rehabilitation discipline is appropriate.
2
Evaluate the attending provider's suggestion to delegate total feeding to the UAP.
While delegating feeding is acceptable, doing so without attempting adaptive interventions promotes learned helplessness and ignores rehabilitation potential.
The goal of post-stroke care is to maximize functional independence, not simply to provide basic care.
3
Differentiate the scopes of practice for interdisciplinary team members.
Occupational Therapy (OT) specializes in fine motor skills, Activities of Daily Living (ADLs) like self-feeding, and prescribing adaptive equipment.
Selecting the correct discipline ensures the client receives targeted interventions to overcome specific physical barriers.
4
Assess the remaining options for safety and scope of practice violations.
Delegating evaluation to a UAP violates scope of practice. Physical Therapy focuses on gross motor skills. Prematurely suggesting a skilled nursing facility ignores rehabilitation potential.
Ruling out options with delegation errors or inappropriate referrals isolates the safest clinical judgment.

Key Concept

Interdisciplinary collaboration involves accurately matching a client's specific functional deficits to the correct allied health discipline's scope of practice, while maintaining strict adherence to safe delegation principles.
Estimated Time:1m 30s
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Collaboration with Interdisciplinary Team

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