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dysphagia > Bedside Swallow Eval 1 > Flashcards

Bedside Swallow Eval 1 Flashcards

1
Q

Symptoms of Dysphagia

A

*Cannot get swallow started
*Coughing
*Choking
* Sticking
*Bolus comes back up

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2
Q

Types of Evaluation Procedures

A
  • Swallowing Screening
    *Bedside/Clinical Swallow Exam
    *Instrumental Swallow Exam
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3
Q

Swallowing Screening: Purpose

A

-Identify highest risk patients who
- require further assessment with full bedside exam
- instrumentation to assess swallow physiology

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4
Q

Swallowing Screening: pass/fail procedure

A

-Brief chart review
≫Look for factors indicative of dysphagia
≫If in-pt setting, look for nursing daily report
−Brief pt observation
»Brief cognition/following simple command/swallowing function

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5
Q

Screening: Observation (during mealtime)

A

(Observation)
* Reaction to food/self-feeding skills
* Oral movements in chewing
* Coughing, clearing throat or struggle behaviors
* Changes in breathing
* Co-ordination of breathing and swallowing
* Secretion levels through meal
* Duration of meal and total intake

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6
Q

[Screening] Signs suggesting a need for a referral
for a further evaluation

A
  • Decreased alertness/cognitive dysfunction
  • Inappropriate approach to food
  • Manifestations of impaired oropharyngeal function
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7
Q

[Screening] Signs suggesting a need for a referral: Pt Complaints

A
  • Pt complaints or observations of…
    -Difficulty initiation swallow
    -Long oral transport time (holding/pocketing food in mouth)
    -Sensation of obstruction of bolus in chest/throat
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8
Q

Swallowing Screening Tools

A

By trained nursing staff or medical professionals
* Selected Swallow Screening Tests
* Yale Swallow Protocol
* Toronto Bedside Swallowing Screening Test (TOR-BSST)
* EAT-10 (Patient questionnaire)

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9
Q

[Screening] Water-Swallow Test/ 3 oz water Test

A

(Controversial) NOT a standardized procedure
* (Suiter &
Leder, 2008)
-pt is given 3 oz. of water in a cup, and told to drink it all without stopping
-An abnormal response would be coughing during or after the exam, or a
change in vocal quality, to wet or hoarse

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10
Q

[Screening] Water-Swallow Test/ 3 oz water Test

A
  • High false positive rate
    -Pts who fail the test may not dysphagic
    -May result in over-referral
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11
Q

Bedside Swallow Exam

A

FIRST, obtain physician’s approval/referral before
proceeding to the exam

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12
Q

Bedside Swallow Exam: Purposes (1-2)

A

1) Determine physiologic factors contributing to the dysphagia
≫Focus of the pt’s dysphagia (oral, pharyngeal..)
2) Make recommendations for safest means of intake
≫Recommend diet
≫Selection of optimal swallow strategies

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13
Q

Bedside Swallow Exam: Purpose (3-5)

A

3) Make determination for need for other tests
* Pharyngeal dysphagia: instrumental exam is required
4) Management/Treatment decision
* Exercises & practice the compensatory strategies
5) Educate (Providing in-service) healthcare staff & family
* Assisting to ensure swallowing safety for pt

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14
Q

Swallowing Exam: Clinical Questions

A
  • Is there a h/o aspiration pna?
  • What is the anatomical/functional status of the oral
    mechanism?
  • Is there a risk for aspiration given the current diet?
  • Is the pt improving or maintaining nutritional status on
    current diet? Significant weight loss?
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15
Q

Swallowing Exam: Clinical Questions

A
  • Should the pt be referred for an instrumental swallow
    eval?
  • Is the pt cognitively able to participate in an
    instrumental eval or follow swallow
    recommendations/participate in tx?
  • What are the diet and/or therapy recommendations?
  • PO or NPO?
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16
Q

Components of Bedside Exam:

A
  • /History/Chart review/: Medical report and Pt’s complaints
  • Physical exam:
  • Oral mechanism exam
    -Test swallows (Trials of Swallow)
17
Q

Components of Case Hx: Medical Chart

A

Medical Chart: Recent hospitalization –
reasons
* Past medical history
* History of PNA? causes?
* History of swallowing problem
−Onset/progression
* Medication
* Respiratory status
* Current nutritional status
* Associated symptoms - e.g.
voice changes, weakness

18
Q

Components of Case Hx: From Pt

A
  • Identify complaints
  • Define cognitive status
    −Alert/oriented, follow direction,
    etc.
  • Pt/caregiver’s descriptions of
    the problem
    −Onset of the problem
    −Course of the problem
    −Presence of coughing
    −Difficulty with any types of food
    » Management of various food
    consistencies
19
Q

When to NOT perform the eval?

A
  • Pt is not alert
  • Pt refuses
20
Q

Oral Mech Exam

A

5 areas:
− Oral
structures/functions/
sensation
− VP mechanism
− Laryngeal function
− Respiration
− Observation of reflexes

Exam the sensory/motor
functions of cranial nerves V, VII,
IX, X, XI and XII.

  • Variables of interest
    −Size, position, strength, speech,
    ROM, steadiness, tone, accuracy
    −Examine structures at rest
    during sustained postures, and
    during repetitive movements
21
Q

Bedside exam> Physical Exam

A

Oral Hygiene
Oral Mech Exam:
- Cheeks, lips, jaw, tongue, dentition
- sensation
CN V, VII (tongue ,lips, cheeks, gums, floor of mouth)
CN IX : posterior tongue

Sensory provides info if delayed triggered.

22
Q

Oral mech: Sensory:

A

Check quality/ quantity of secretions:
Reduces intra oral sesnation or alertness may result in pooling
or drooling
* Dry mouth may be due to meds, x-ray tx, tube fed, pts on
supplemental O2 or ventilation

23
Q

Velopharyngeal (VP) Mechanism

A
  • Palate at rest
  • Palatal elevation with phonation (motor)
    *Resonance during nasal/non-nasal sentences (motor)

Palatal reflex and Gag reflex

24
Q

VP mechanism: *Palatal reflex:

A

*Palatal reflex: (elevation of the soft palate without pharyngeal wall
contraction) is elicit by stroking the soft palate (sensory) à motor response

25
Q

VP Mech: Gag reflex

A

(sensory: CN IX) ?? - Look for asymmetrical sign
- No one-to-one correspondence btw gag reflex and dysphagia

26
Q

Laryngeal Function

A

*Voice quality (vocal fold closure): Vocal fold closure and respiration. Say “ahh”

*Quality of cough:
* Strength of voluntary cough/throat clearing
* Poor quality of cough could be due to weak expiratory muscles

Being able to cough volitionally does not ensure a
normal cough reflex

27
Q

Protective Cough Reflex

A

*Reflexive cough: CN X. Material entering into the laryngeal vestibule

*Delayed cough reflex: Commonly seen in pts with neurological impairments

*An absent / a delayed reflexive cough indicates a high risk of silent aspiration.

dysphagia (3 decks)

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