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Pt was seen in wheelchair. Primary SLP was present for exam. Pt demonstrated a moderate oropharyngeal dysphagia c/b reduced/mistimed laryngeal closure, reduced laryngeal elevation/epiglottic deflection, R sided pharyngeal weakness, and reduced BOT retraction resulting in: 1.) laryngeal penetration during the swallow with serial straw sips of thins, serial straw sips of NTL, and teaspoon of HTL, 2.) subsequent silent aspiration with thins; 3.) trace pharyngeal residue after the swallow with puree, NTL and HTL (cleared w/ subsequent swallowing) and 4.) mild vallecular residue after the swallow with solid portion of mixed consistency (cleared w/ subsequent swallowing.) Laryngeal sensation may be reduced, as no cough was elicited with laryngeal penetration, although penetration from NTL stripped out with subsequent swallowing. No penetration/aspiration occurred with single straw sips of thins. Pt had difficulty following commands during this exam. Per primary SLP, pt is extremely impulsive and has been noted to shovel food into oral cavity causing symptoms of choking. Given dementia diagnosis, swallow function is likely to fluctuate with mental status/level of alertness. Laryngeal edema was noted, which may be suggestive of laryngopharyngeal reflux (LPR).
Diet: Mechanical Soft/Thin Liquids
1. Sit upright with all intake. Remain upright for 20-30 minutes after intake.
2. Frequent oral care to minimize risk of aspiration pneumonia.
3. Single sips from cup or straw.
4. Continue reflux management.
6. Ongoing ST to monitor diet tolerance, adjusting diet, as needed and maximizing swallow function.