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Nursing Manual
Working with
consultants
The registered nurse in the community works closely with consultants.
Often the initial determination of the need to see a consultant comes from
the nurse's
assessment, or treatment.
Consultants may have a private contract
with the group home agency. At other times consultant services may
be purchased though the Oregon Health Plan or other health insurance.
Once the
need for
a consultant has been established the consultant is contacted by the
group home agency (it
may be the RN's responsibility) and an appointment is set. (If purchased
through the medical card/insurance a physician's order is necessary.)
It is very important that the appointment be set at a time when the RN
is available to attend. This will save numerous phone calls for clarification.
Any
recommendation from a consultant
that involves active treatment or therapy or a change in diet order/texture
will require a physician's order before it is implemented.
The following
listing describes some of the services available from consultants:
Physical Therapist
- Assesses body movement and posture.
- Provides therapy or assists in
training the individual and others in proper positioning, range of motion
and proper body mechanics to maximize mobility and flexibility.
- Determines the need for and design
and repair of adaptive equipment.
Occupational Therapist
- Assesses overall motor skills
needed to carry out activities of daily living. Including but not limited
to:
- Hand-to-mouth and grasp/release
patterns necessary for eating.
- Determines adaptive equipment
needs and functional arm positioning to facilitate eating and other fine
motor skills.
- Body positioning and physical
endurance during feeding.
- Promotes cognitive and socialization
skills around social eating.
- Teaches others to facilitate
appropriate hand-to-mouth patterns, use of adaptive equipment and proper
body positioning methods.
- Depending on their training they
may also assess swallowing.
Registered Dietitian
- Assesses and monitors nutritional
needs, adequacy of nutrient intake, and food preferences and tolerances.
- Screens for history of weight
loss/gain or aspiration pneumonia.
- Ensures that proper consistency,
temperature, and food choices are selected, and that adequate nutrition
is provided. This may involve recommendations regarding maintenance of
non-oral feeding, or use of nutritional supplements.
- Works with other professionals
to determine appropriate eating method and diet consistency.
- Assists with menu planning.
Speech-Language Pathologist
- Oral-motor skills and swallowing
status
- Assess and performs ongoing determination
of oral-motor function and swallowing status.
- Recommends, assists and interprets
results of videofluoroscopy studies when indicated.
- Develops and manages exercises
for swallowing.
- Works with other professionals
to determine the appropriate eating method.
- Recommends diet consistency and
degree of supervision required. (Remember that a physician's order is needed
to permanently change the texture.)
- Assists the individual and trains
others in compensatory swallowing techniques.
- Recommends aspiration precautions
as indicated.
- Language and Communication
- Evaluates language and
communication skills.
- Assesses language comprehension
and overall responsiveness.
- Develops and manages exercises
for speech and communication.
- Develops, recommends, implements,
teaches the use of, and provides maintenance and upkeep of alternative
communication devices.
- Develops visual communication
systems.
Respiratory Therapy
- Assesses and monitors pulmonary
status.
- Assists in management of oxygen
use and in other respiratory treatment techniques.
- Provides consultation on choices
of tracheostomy tubes.
- Makes recommendations for the
removal of tracheostomy tubes.
Orthotist
- Makes splints, braces, etc. as
directed by physician, physical therapist or occupational therapist.
- Modifies equipment as needed
to assure a therapeutic and comfortable fit.
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