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ECU Dysphagia > 7.1 CLINICAL BEDSIDE SWALLOWING EXAM > Flashcards

7.1 CLINICAL BEDSIDE SWALLOWING EXAM Flashcards

1
Q

What are the two types of swallowing assessments?

A

Subjective

Objective

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2
Q

What are three subjective assessments of swallowing?

A

CSE (Clinical Swallowing Evaluation)

CBS (Clinical Bedside Swallow)

BSE (Bedside Swallow Evaluation)

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3
Q

Are subjective assessments of swallowing the same as screenings?

A

No - screenings check to see if more intensive assessment is required

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4
Q

What are we looking for in subjective assessments of swallowing?

A

Visible signs of aspiration

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5
Q

What can we not evaluate in subjective assessments of swallowing?

(2)

A

Silent aspiration

Root cause of swallowing issues (no visibility)

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6
Q

What are two objective measures of swallowing?

A

MBSS

FEES

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7
Q

What three things do we perform during the first swallowing exam?

A

Patient History (we want to know everything

Cranial Nerve Evaluation

Trial Swallows (What happens when pt. swallows?)

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8
Q

What is the purpose of a swallowing exam?

5

A

Determine candidacy for an instrumental evaluation

Detect possible laryngeal penetration/aspiration (Cough, Wet Voice, etc.)

Detect which textures are safe for the patient to swallow.

Monitor progress of therapy

Determine the possibility of upgrading recommendations.

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9
Q

What are the three major concerns in a Clinical Swallowing Evaluation?

A

Mental status

Nutritional status

Respiratory status

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10
Q

What do we want to make observations about during a swallowing evaluation?

(2)

A

Alertness (i.e., wakefulness and initial communication attempts)

Posture of the patient

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11
Q

In a swallowing evaluation, what would the presence of a feeding tube indicate?

A

At least partial alternative nutritional support

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12
Q

In a swallowing evaluation, what would the presence of suction equipment and/or drooling trigger?

A

Concerns regarding secretion management.

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13
Q

What is always a concern if the patient has a tracheostomy tube or labored breathing patterns?

A

Respiratory status

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14
Q

What kind of swallowing assessments are trach patients always referred to?

A

Objective swallowing assessment

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15
Q

What four things are we looking for when we ask for the patient’s history?

A

Patient symptoms

Past + current medical history

Previous swallowing assessments

Socio-cultural status

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16
Q

What Patient Symptoms do we want to know about in the history portion of a swallowing assessment?

(4)

A

Specific symptoms of ‘choking’ (Residue vs. Penetration)

Weight loss

Food going down the ‘wrong pipe’

Feeling of food getting stuck

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17
Q

What parts of the patient’s past and current medical history do we want to know about in the history portion of a swallowing assessment?

(5)

A

Neurological

ENT

GI exam

VF paralysis

GERD

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18
Q

Why do we want to know about Socio-Cultural Status for the history portion of a swallowing assessment?

A

To make sure we understand what the patient normally eats

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19
Q

What is our job to determine during a swallowing assessment?

A

What consistency patient can eat - everything else goes to the nutritionist

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20
Q

What facial nerves do we test during a swallowing examination?

A

Trigeminal

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21
Q

How do we test the Trigeminal Nerve (V) during a CN Examination?

(3)

A

Test facial sensation

Test corneal reflex

Feel the masseter muscles during jaw clench

22
Q

How do we test facial sensation?

2

A

Use a cotton wisp and a sharp object to test sensation

Can use objects of different temperatures to test perception

23
Q

How do we test the corneal reflex?

What are we observing?

A

By touching each cornea gently with a cotton wisp

Any asymmetries in the blink response

24
Q

What nerves are involved in the the corneal reflex?

2

A

CN 5 (Trigeminal)

CN 7 (Facial)

25
Q

How do we test the masseter muscles during jaw clench?

What are we observing?

A

By gently tapping on the jaw with the mouth slightly open

Symmetry of jaw opening.

26
Q

How do we test the Facial Nerve (VII) during a CN Examination?

(2)

A

Look for asymmetry in facial shape

Check taste

27
Q

How do we look for asymmetry in facial shape?

3+4

A

Examining depth of furrows such as the naso-labial fold.

Examining asymmetries in spontaneous facial expressions and blinking.

Ask patient to

- Smile
- Puff out their cheeks
- Clench their eyes tight
- Wrinkle their brow
28
Q

Why do we ask someone to puff out their cheeks?

A

To see if they can maintain adequate intraoral pressure

29
Q

How do we check taste?

2

A

Using sugar, salt, or lemon juice on cotton swabs

Apply each to the lateral aspect of each side of the tongue

30
Q

What kind of lesions cause single-sided weakness of the LOWER face?

A

Contralateral UMN lesion

31
Q

What does Bilateral UMN Lesions cause?

A

Whole body spaticity

32
Q

What kind of lesions cause weakness to one side of the face?

A

Ipsilateral LMN lesion

33
Q

What kind of lesions cause weakness of the entire face?

A

Bilateral LMN lesion

34
Q

How do we test the Glossopharyngeal Nerve (IX) during a CN Examination?

(3)

A

Palatal elevation and gag reflex

Symmetry of palate elevatation

Taste in posterior parts of the tongue

35
Q

What nerves are involved when there is impairment in palate elevation and the gag reflex?

(3)

A

CN 9 (Glossopharyngeal)

CN 10 (Vegus)

The neuromuscular junction

36
Q

Can we isolate that only the Glossopharyngeal Nerve (IX) is impaired?

A

No - too many other nerves are involved.

37
Q

How do we test the Vegus Nerve (X) during a CN Examination?

2

A

Vocal functions (pitch, loudness change, quality)

Ability to cough voluntarily.

38
Q

How do we test the Hypoglossal Nerve (XII) during a CN Examination?

(2)

A

Looking for atrophy or fasciculations (twitching)

Errors in articulation

39
Q

How do we test for atrophy?

3

A

Ask patient to stick out their tongue and see if it curves to one side

Ask patient to move their tongue from side to side

Ask patient to push tongue forcefully against the inside of each cheek

40
Q

What are atrophy or fasciculations (twitching) signs of?

A

LMN lesions

41
Q

What consistencies do we use in trial swallows?

3

A

Thin: 5 mL—3 oz

Puree or pudding 5 mL

Solid

42
Q

What are we observing during trial swallows?

5

A

Extent of laryngeal elevation (laryngeal palpitation)

Timing/completeness/number of swallows

Pre/Post voice quality

Coughing + clearing of the throat

Oral residue

43
Q

What is Test Sensitivity?

A

How accurately a test identifies a true disorder

44
Q

What is Test Specificity?

A

How accurately does test correctly identify those without a disorder

45
Q

What are 3 Standardized CSE Tests?

A

Toronto Bedside Swallowing Screening Test (TOR-BSST)

Mann Assessment of Swallowing Ability (MASA)

Functional Oral Intake Scale (FOIS)

46
Q

What does the Toronto Bedside Swallowing Screening Test (TOR-BSST) assess?

(3)

A

Voice quality

Lingual movement

Ability to manage water by teaspoon and cup.

47
Q

What are two other common procedures done in a subjective swallowing assessment?

A

Auscultation

Dye test

48
Q

What is Auscultation?

A

Placing a stethoscope over various parts of airway provide indirect evidence of aspiration

49
Q

What is a Dye Test?

3

A

A few drops of methylene blue or vegetable coloring are placed in the mouth

The tracheotomy cuff is deflated

The tracheotomy tube is deep sanctioned for secretions that may have been resting on or above level of cuff.

50
Q

What does the Dye Test do?

What is it also called?

A

Determines the presence of aspiration in a tracheotomized patient

Blue dye test

ECU Dysphagia (31 decks)

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