Assessment Flashcards
When do you start the Clinical Swallow Eval Review?
after your bedside swallow, case history review, etc
What do you do with a patient who is NPO?
start “easy” (like with ice chips), gradually increase bolus size
How often do you ask for an “ah” from the patient?
after each swallow
Why do you ask for an “Ah” from your patients?
to check vocal quality for wet voice due to possible aspiration
When do you schedule your eval for patients eating orally?
near mealtime if possible
What are you noting in a food assessment during the oral pre/oral stages?
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
What are you noting in the pharyngeal stage?
coordination of breathing and swallowing, coughing, throat clearing, struggling behaviors, laryngeal elevation, timing of the swallow, watching oxygen level, vocal quality
How can you palpate the swallow?
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
T/F you palpate the swallow for every swallow; why or why not?
F; it is very annoying to the patient, just use it for 1-2 swallows
How long of a delay in a swallow should tip the clinician off to non-function?
10 seconds
What do multiple swallows indicated?
oral weakness, poor tongue strenghth, pharyngeal residue
How should you report multiple swallows in your note?
“patient required 4 swallows to clear a bolus of puree”
T/F you can make compensations at the bedside to figure out what might work for patients
T
What are you looking for in food assessment?
best posture, optimal food position in mouth, selection of possible food consistencies, possible swallowing instructions
Why do you need to know what a patient eats at home?
to give you a jumping off point in the food assessment
What do you do after the food assessment?
make the recommendation for diet, NPO, or further assessment
How do you decide what a patient can eat after an assessment?
swallow physiology
If there is weakness what do you do?
softer food
What do you do with a throat clearer?
possible aspiration
What do complaints of coughing NOT related to the swallow suggest?
they have a cold, secretion management, dry air, medication, allergies, pneumonia
What are other things to consider with a food assessment?
Should the patient attempt oral eating? Do you think the patient is aspirating? Do you need additional instrumental assessment?
What things do you consider when deciding on oral eating?
length of stay, NG/PEG tube (is there already nutrition in place), IV hydration, patients could be tired/hangry
What do you do if you suspect aspiration?
determine if you need to do an instrumental assessment, modify diet, etc.
Why would you call for an instrumental eval?
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
What do you consider when making a hypothesis?
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
What can indicate something esophageal?
when patients complain that things aren’t going down
T/F there is no such thing as “conservative” in dysphagia
T; and you will be more so as a beginning clinician
What is the point of instrumental assessment?
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
Reasons for an instrumental
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
Reasons you don’t need instrumental
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)
What concerns merit a FEES?
alternations in nasopharyngeal oropharyngeal or laryngeal anatomy
Why would you choose a FEES?
patient can’t leave the floor, you want to assess symmetry of pharyngeal constriction or affects of various strategies
What is a limitation of FEES?
you can’t see oral phase or how they form bolus or during the swallow
What is another name for MBS?
MBSS/VFSS/VFSE/rehab swallow/cookie swallow
What does a barium swallow test?
the entire system; the patient needs to drink a gallon of barium
Who is involved in the MBS?
radiologist, radiology tech, SLP, nurse, etc
What is the apron that you wear in radiology suite made of?
lead
What is the name of the badge that tracks the radiation?
Dosimetry badge
T/F There is only one order of operations
F; use clinical judgement
How long should the study last?
120 seconds
What do you do if aspiration occurs?
wait to see patient response without cueing- Is there a cough? Can a patient clear with a cough? rescan the image
Which instrumental test is usually done first?
fluoroscopy
