Assessment

Question 1

When do you start the Clinical Swallow Eval Review?

Answer 1

after your bedside swallow, case history review, etc

Question 2

What do you do with a patient who is NPO?

Answer 2

start “easy” (like with ice chips), gradually increase bolus size

Question 3

How often do you ask for an “ah” from the patient?

Answer 3

after each swallow

Question 4

Why do you ask for an “Ah” from your patients?

Answer 4

to check vocal quality for wet voice due to possible aspiration

Question 5

When do you schedule your eval for patients eating orally?

Answer 5

near mealtime if possible

Question 6

What are you noting in a food assessment during the oral pre/oral stages?

Answer 6

attention to process, appropriate selection of bolus size, ability to retrieve food from utensil, patient’s reaction to food (awareness of it in the mouth), oral movements in food manipulation and chewing

Question 7

What are you noting in the pharyngeal stage?

Answer 7

coordination of breathing and swallowing, coughing, throat clearing, struggling behaviors, laryngeal elevation, timing of the swallow, watching oxygen level, vocal quality

Question 8

How can you palpate the swallow?

Answer 8

index finger behind mandible, middle finger on the hyoid bone, fourth finger on top of the thyroid cartilage, little finger on the bottom of thyroid cartilage, swallow and feel the movement of the structures

Question 9

T/F you palpate the swallow for every swallow; why or why not?

Answer 9

F; it is very annoying to the patient, just use it for 1-2 swallows

Question 10

How long of a delay in a swallow should tip the clinician off to non-function?

Answer 10

10 seconds

Question 11

What do multiple swallows indicated?

Answer 11

oral weakness, poor tongue strenghth, pharyngeal residue

Question 12

How should you report multiple swallows in your note?

Answer 12

“patient required 4 swallows to clear a bolus of puree”

Question 13

T/F you can make compensations at the bedside to figure out what might work for patients

Answer 13

T

Question 14

What are you looking for in food assessment?

Answer 14

best posture, optimal food position in mouth, selection of possible food consistencies, possible swallowing instructions

Question 15

Why do you need to know what a patient eats at home?

Answer 15

to give you a jumping off point in the food assessment

Question 16

What do you do after the food assessment?

Answer 16

make the recommendation for diet, NPO, or further assessment

Question 17

How do you decide what a patient can eat after an assessment?

Answer 17

swallow physiology

Question 18

If there is weakness what do you do?

Answer 18

softer food

Question 19

What do you do with a throat clearer?

Answer 19

possible aspiration

Question 20

What do complaints of coughing NOT related to the swallow suggest?

Answer 20

they have a cold, secretion management, dry air, medication, allergies, pneumonia

Question 21

What are other things to consider with a food assessment?

Answer 21

Should the patient attempt oral eating? Do you think the patient is aspirating? Do you need additional instrumental assessment?

Question 22

What things do you consider when deciding on oral eating?

Answer 22

length of stay, NG/PEG tube (is there already nutrition in place), IV hydration, patients could be tired/hangry

Question 23

What do you do if you suspect aspiration?

Answer 23

determine if you need to do an instrumental assessment, modify diet, etc.

Question 24

Why would you call for an instrumental eval?

Answer 24

to obtain info regarding anatomy/physiology, evaluate ability of a patient to swallow various materials, assess secretions and patient’s reaction to them, document the adequacy of airway protection and the coordination between respiration and swallowing, and help evaluate effect on compensatory maneuvers on swallowing function and airway protection

Question 25

What do you consider when making a hypothesis?

Answer 25

coughing and when, has an easier time with liquids vs solids or solids vs liquids, loses food anteriorly, laryngeal elevation looks reduced, always look for evidence of reflux

Question 26

What can indicate something esophageal?

Answer 26

when patients complain that things aren’t going down

Question 27

T/F there is no such thing as “conservative” in dysphagia

Answer 27

T; and you will be more so as a beginning clinician

Question 28

What is the point of instrumental assessment?

Answer 28

identifying aspiration and penetration, as well as getting the larger clinical picture of what worked well and what didn’t work well as well as how I will manage

Question 29

Reasons for an instrumental

Answer 29

bedside assessment was inconclusive, nutritional or respiratory issues indicate aspiration, direction for swallow rehab needed, help is needed to assist in underlying medical problem contributing to dysphagia symptoms, patient has a medical condition placing him/her at high risk

Question 30

Reasons you don’t need instrumental

Answer 30

too medically compromised (Airway, Breathing, Circulation), patient is too uncooperative to complete the procedure, patient no longer has dysphagia complaints, if exam would not alter the clinical course or management plan (i.e. hospice, end of life, refuse feeding tube)

Question 31

What concerns merit a FEES?

Answer 31

alternations in nasopharyngeal oropharyngeal or laryngeal anatomy

Question 32

Why would you choose a FEES?

Answer 32

patient can’t leave the floor, you want to assess symmetry of pharyngeal constriction or affects of various strategies

Question 33

What is a limitation of FEES?

Answer 33

you can’t see oral phase or how they form bolus or during the swallow

Question 34

What is another name for MBS?

Answer 34

MBSS/VFSS/VFSE/rehab swallow/cookie swallow

Question 35

What does a barium swallow test?

Answer 35

the entire system; the patient needs to drink a gallon of barium

Question 36

Who is involved in the MBS?

Answer 36

radiologist, radiology tech, SLP, nurse, etc

Question 37

What is the apron that you wear in radiology suite made of?

Answer 37

lead

Question 38

What is the name of the badge that tracks the radiation?

Answer 38

Dosimetry badge

Question 39

T/F There is only one order of operations

Answer 39

F; use clinical judgement

Question 40

How long should the study last?

Answer 40

120 seconds

Question 41

What do you do if aspiration occurs?

Answer 41

wait to see patient response without cueing- Is there a cough? Can a patient clear with a cough? rescan the image

Question 42

Which instrumental test is usually done first?

Answer 42

fluoroscopy