Dave has had some medical complications. He has had one seizure, a chest infection (likely an aspiration pneumonia) and some abnormal liver function tests.
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Dave in the acute stroke Unit
Dave in the general ward
Dave is sitting in a standard chair in the acute stroke unit.
At the MDT meeting:
Nurse: Dave has symptoms suggesting a chest infection – a sample has been sent for analysis. He is also complaining of constipation. He can be anxious during transfers from bed-chair
PT: He is finding it more difficult to put his AFO on and it does not seem to be fitting well. His tone seems to be increasing
OT: He was progressing well with washing and dressing practice but is now finding it more difficult to put on his top as his shoulder and elbow are very tight. He is finding his resting hand splint difficult to put on and uncomfortable to wear, so is using it less and less
Doctor: The medical complications that have arisen post-stroke are likely to be factors in his developing hypertonia. He is responding well to treatment of these. I will keep these under careful review, and will look out for any other possible physical or psychological triggers for high tone.At this stage, I think the risks of starting oral anti-spasticity medications outweigh any anticipated benefits. I don’t want to cause any unnecessary side-effects from tablets. And they may interfere with neuroplasticity just when he’s starting to engage well with his rehabilitation.
SLT: Dave has had a swallow assessment done and he is safely managing good amounts of texture D feed and stage 1 fluids.
Dave in bed in general ward, with physio and junior doctor who is looking through BNF: