Background

Question 0

When is swallowing least frequent?

Answer 0

During sleep

Question 1

When is swallowing frequency greatest?

Answer 1

During eating

Question 2

A normal swallow is…

Answer 2

Quick and clean

Question 3

Dysphagia is…

Answer 3

A. A disorder involving any stage of swallowing
B. A delay in, or misdirection of, a fluid or solid bolus me as it moves from the mouth to the stomach
C. An abnormality in the transfer of a bolus from the mouth to the stomach

Question 4

A feeding disorder is…internal or external?

Answer 4

External - an impairment In the process of food transport Outside of the alimentary system
- impaired food delivery

Question 5

A cause of dysphagia is…

Answer 5

Acute or degenerative neurological injury

Question 6

A cause of dysphagia is…

Answer 6

Mechanical/structural alterations

Question 7

Dysphagia can be a sign/symptom of…

Answer 7

Pulmonary disorder/disease

Question 8

Dysphagia can be caused by…

Answer 8

Iatrogenic cause - surgery, medication, treatment

Question 9

Dysphagia can be due to…

Answer 9

Age

Question 10

Dysphagia can be caused by

Answer 10

General health problems

Question 11

Dysphagia can be the result of…

Answer 11

Stroke (CVA)

Question 12

Dysphagia can be caused when there is a breakdown in…

Answer 12

Cognitive processes - they might not understand the process

Question 13

How hospital patients are dysphagic?

Answer 13

1/4 - 1/3

Question 14

How many patients in nursing homes have dysphagia?

Answer 14

30-70%

Question 15

Dysphagia is a problem affecting both paediatrics and adults - True or. false

Answer 15

True

Question 16

Name some impacts of dysphagia…

Answer 16

weight loss
Impaired nutrition
Depression
Isolation
Anxiety
Distress

Question 17

What is the difference between aspiration and penetration?

Answer 17

Aspiration goes below vocal folds, penetration above vocal folds

Question 18

What is silent aspiration?

Answer 18

Penetration below level of vocal folds without cough or other outward sign of difficulty

Question 19

What are some signs of silent aspiration?

Answer 19

Patient presents with absence of subjective complaints

Often have associated weak cough, dysphonia, and bilateral neurological signs

Question 20

What are ways of detecting aspiration?

Answer 20

Instrumental - VFSS, FEES
Chest X-ray
Respiratory signs and symptoms?
Spike in temperature?

Question 21

Where in the lung is indicative of aspiration

Answer 21

Lower right lobe

Question 22

What factors influence aspiration pneumonia

Answer 22

Premorbidly healthy

Ambulant cope better

Question 23

According to Langmore 1998 what are the best predictors of aspiration pneumonia

Answer 23

Dependence for feeding
Dependence for oral care
Number of decayed teeth
Tube feeding
More than one medical diagnosis
Number of medications
Smoking

Question 24

What is our role in dysphagia?

Answer 24

Assessment of oral and pharyngeal stage swallowing disorder Diagnosis of oral and pharyngeal stage swallowing disorder Treatment of oral and pharyngeal stage swallowing disorder

Question 25

What do we not do?

Answer 25

Insert or reinsert Nasogastric tubes Evaluate nutritional intake plan on non-oral feeding regimes Suction via trachea Independently insert the endoscope for fibreoptic endoscopic evaluations of swallowing (FEES) assessments Diagnose and manage oesophageal disorders

Question 26

What are ways to minimise medicolegal issues?

Answer 26

Follow SPA code of ethics Follow guidelines in the SPA position paper Keep patients and family involved Maintain your professional development Refer to more experienced staff if ever in doubt Keep accurate records and documents Ensure you work in a safe clinical environment

Question 27

Where do we see dysphagic patients?

Answer 27

``` Hospitals - Acute - rehab - extended care Community health Nursing homes Education department/school settings Specialist centres ```

Question 28

What is involved in acute care?

Answer 28

Need to be aware of general medical condition Aim is to eliminate risk of aspiration through compensatory techniques Patient's role is often passive Daily visits Ongoing monitoring Bedside evaluation

Question 29

Our role in rehabilitation

Answer 29

Comprehensive instrumental evaluation Patient medically stable and able to be active in rehab Aim: rehabilitation of the swallow - active intervention using rehabilitation techniques and compensatory techniques Intensive therapy

Question 30

What is our role in long term care?

Answer 30

Optimising oral intake and quality of life relating to oral intake Sensitivity to ethical and legal issues Counselling and education of patient and carers Aim - ongoing slow stream rehab and maintenance of function Predominantly clinical reassessment/review. Review through instrumental assessment may be warranted Less frequent monitoring

Question 31

What is our role in palliative care?

Answer 31

Aim - optimising quality of life and ensuring safe oral intake Clinical evaluations only Compensatory intervention only Patient choices Counselling and support - patient and carers Consultative model - implementing appropriate response as changej in status reported

Question 32

What other professions are involved in dysphagia management team?

Answer 32

``` Medical staff Nursing Dietician OT PT Social worker Dentist The patient Family Support workers ```

Question 33

Who specifically might you meet on the medical staff?

Answer 33

``` Intensivist Respiratory Gastroenterology Radiology Gerontology General medical Otolaryngology Neurology Oncology Paediatrics Surgical - ENT, plastics, maxillofacial, cardiology ```