A Guide To Speech Language And Swallowing Disorders Flashcards
Dysphagia
Difficulty swallowing
May affect any stage (oral , pharyngeal , esophageal )
Caused by structural , functional or cognitive factors
Cam affect persons of age
Structural etiologies of Dysphagia
Oral cancer -glossectormy
Poor dentition or ill fitting dentures
Throat cancer -laryngectomy
Tracheostomy
Diverticulum
Other esophageal patho
Cognitive functional etiologies of Dysphagia
CVA , head injury
PD,Tumors,MS
General weakness ,
REFLUX, motility disorders
Cognitive Dysphagia
Dementia
Head injury
Lethargic or obtunded pt
May affect feeding efficiency , adequacy of PO intake
Nurses role in Dysphagia
Good history (RN assessment form)
Good oral mechanism exam
Observation with meals and medications
Assistance with oral care **
Assistance with feedings **
Hasten referrals to other professionals
S/s of Dysphagia
Cannot manage oral secretions
Difficulty chewing, prolonged chewing
Pocketing of food in Buccal cavities
Holding food in mouth for long periods
Excessive drooling during meals
Absent swallow ( know how to palpate )
Coughing / choking or throat clearing after swallowing
Wet,gurgly voice after swallowing
Pain with swallowing
Swelling many times for bolus
What can indicate Dysphasia
Aspiration pneumonia
Recurrent pneumonia
Weight loss
Chronic dehydration or malnutrition
Feeding/swallowing precautions
Tucking chin before swallowing
Thickened liquids
Straws v no straws
Follow-up swallows (swallow 2x to make sure it all went down)
Throat clearing
One med at a time
Purée last resort for meds
General precautions
Top 3 risk for aspiration pneumonia
Dependence on others for feeding
Dependence on others for oral care
Missing or decaying teeth
Other indicators for Dysphagia
Tube feeding
Multiple medical diagnosis
Chronic reflux
DYSPHAGIA IN COMBINATION OF OTHER RISK FACTORS
Fiber optic endoscopic evaluation of swallowing
Tube camera used down pt nose
Referral to other professionals if normal and seems like esophagus is still bugging them
Ex. GI
Silent aspiration
No reflexive cough is triggered to protect air way
Results in false negative bedside swallow eval
If suspected an MBS or FEES study would be better able to identify the aspiration
Special diets
Clear liquid (easiest2move)
Full liquid (pudding,yogurt)
International Dysphagia diets
Regular
Restrictions as prescribed by RD or MD (heart healthy)
Using simply thick
One entire pack to 4 oz liquid
Shake for 5 seconds in mixing cup with lid or stir with a for for 20 seconds
The Frazier water protocol
A tool that allows and encourages pt at high risk of aspiration to have ice and water throughout the day
Research and years of clinical application have proven that oral bacteria is the source of aspiration pneumonia not water
Benefits of the Frazier water protocol
NPO pt increased opportunities to swallow hastens a return to safe PO intake
Increases hydration especially orally to reduce bacterial growth
Has the potential to improve a pt psychological starte of mind
Requirements of oral Frazier
Pt are able to swallow water without demonstrating excessive coughing and discomfort
Maintain alertness and arousal
Oral hygene
Make sure it gets done daily
So important
Communication disorders
Motor speech disorder
Language
Cognitive communicative disorder
Motor speech disorders
Dysarthria
Voice
Disorders
Apraxia
Often seen with CVA PD ALS MS MG , other
Dysarthria
Drunk speech something wrong with tongue muscles
Voicedisorders
A persons focal folds causing whispers
Apraxia
Unable to perform task of movement
Typical with stroke pt CVA Parkinson’s ALS MS MG or other
Expressive aphasia
Can read the word house but can’t tell the picture
Know what you want to say, but can’t find the word for it
Receptive aphasia
Difficulty processing what pt is telling you
Mixed aphasia
Combo of both
Language disorders are usually caused by
Left brain injury
Cognitive communities disorders
Head injury
Right brain CVA
Dementia
Anoxic brain injury
Toxi metabolic encephalopathy
May affect pregmatic social skills, problem loving and memory
Strategies for communicating with aphasia patients
Using hearing aides and or glasses
Speak slowly directly and keep sentences short
Allow plenty of time for responses
Give two choices rather than asking open ended questions if possible
Use word boards only if directed
Do not talk to to pt plz
Communicating with hearing impaired pt
Using hearing aids and glasses
Stand /sit close to pt
Speak slowly and low pitch
Keep sentences short
Rephrase rather than just yelling louder
Patsy Muir speaking valves
Teach cuff must be deflated
