Chapter 1 : Dysphagia unplugged

Question 1

What Is Dysphagia?

Answer 1

a disorder of or difficulty with swallowing

Dysphagia is a symptom of a disease, not a primary
disease. It is characterized by a delay or misdirection
of something swallowed as food moves from the mouth to the stomach. It has both medical and psychosocial consequences on a patient’s quality of life.

Question 2

when used properly the term “dysphagie” should refer to a swallowing disorder that involves any one
of the three stages of swallowing. Name the 3 stages.

Answer 2

1. oral,
2. pharyngeal,
3. esophageal

Question 3

Remplir le trou. The prevalence of dysphagia is highest in patients with _____________ disease.

Answer 3

neurologic disease (i.e. stroke)

Question 4

What are some signs a patient might have dysphagia?

Answer 4

1. coughing and choking during or after a meal,
2. food sticking,
3. regurgitation,
4. odynophagia (pain on swallowing)
5. drooling,
6. unexplained weight loss,
7. nutritional deficiencies

Question 5

What are the two hall-marks of dysphagia?

Answer 5

1. Delay in the propulsion of a bolus as it transits from the mouth to the stomach
2. Misdirection of a bolus.

Question 6

In acute stroke (less than 5 days after onset) the prevalence of dysphagia may be as high as 50% whereas 2 weeks after stroke, the prevalence is (higher or lower)?

Answer 6

lower

Question 7

Give two examples of medical consequence of dysphagias.

Answer 7

1. aspiration pneumonia
2. malnutrition

2. dehydration

Question 8

Name a psychosocial consequence of dysphagia.

Answer 8

Social interactions often revolve arround shaing a meal. Swallowing difficulty may limit the extent to which a person might socialize, leading to major changes in a normal lifestyle.

Question 9

Is a clinical characteristic a sign or a symptom?

Answer 9

A sign

Question 10

2 ways the bolus can be misdirected :

Answer 10

1. the bolus enters the upper airway or lungs,
2. the bolus enters the mouth, pharynx, or esophagus during swallowing attempts but fails to reach the stomach

Question 11

When is a patient classified as having dysphagia? (2 points)

Answer 11

When physiological changes in the swallowing muscles result in changes in eating habits that lead to:

1. undernutrition or
2. aspiration pneumonia

Question 12

Describe two normal changes in the swallowing muscles that are age-related.

Answer 12

1. a reduction in tongue strength
2. a reduction in the movement of food through the esophagus. (Normally, coordinated muscle contractions in the esophagus move the swallowed food toward the stomach in one direction.)

—both of which may delay the delivery of food or liquid to the stomach as a result of his advanced age.

Question 13

What is the textbook definition of dysphagia?

Answer 13

“Dysphagia: [an] impairment of emotional, cognitive, sensory, and/or motor acts involved with transferring a substance from the mouth to stomach, resulting in failure
to maintain hydration and nutrition, and posing a risk of choking and aspiration”

Question 14

What is the difference between a swallowing disorder and a feeding disorder (3 points)?

Answer 14

A feeding disorder usually refers to the process of food transport.

A feeding disorder usually is the result of weakness or incoordination in the hand or arm used to move the food from the plate to the mouth.

An eating disorder may not be related to a swallowing disorder

Question 15

What is the difference between a swallowing disorder and an eating disorder?

Answer 15

Anorexia and bulimia are eating disorders. Dysphagia is a swallowing disorder.

Question 16

Which patients in the hospital are most likely to experience swallowing difficulties?

Answer 16

1. older adults (stroke unit)
2. premature babies

Question 17

5 days after the stroke, what is the prevalence of dysphagia?

Answer 17

50%

Question 18

Why do some patients begin to eat without screening?
For example : me after the volvulus?

Answer 18

Some patients begin to eat without screening because the risk factors for dysphagia are not present. An example might be a patient who has not had any swallowing difficulty in the past but required a feeding tube immediately after an operation for medical purposes and who has been cleared by the physician to return to oral ingestion.

Question 19

What are the steps to do a clinical evaluation of dysphagia?

Answer 19

1. Anamnèse : review the medical and psychosocial history
2. Screening of mental status
3. Evaluation of the head and neck muscles
4. If appropriate, trial swallows of liquid, semisolid, and solid materials.

Question 20

If the clinical examination fails to adequately explain the patient’s symptoms, then what?

Answer 20

Videofluoroscopy

Question 21

What is the goal of most treatment plans?

Answer 21

1. Ensure that the patient can consume enough food and liquid to remain nourished and hydrated aka prevent malnutrition
2. Ensure that eating / drinking does not pose a threat to airway safety resulting in aspiration pneumonia aka prevent aspiration

Question 22

Name 4 treatment options for dysphagia.

Answer 22

If treatment is indicated, four main areas are considered: behavioral, dietary, medical, and surgical.

Question 23

Give one example of a behavioral change for the management of dysphagia.

Answer 23

Changes may take the form of simple compensations, such as a change in posture or eating rate; in rehabilitative strategies, such as teaching a patient a new way to swallow; or in strengthening muscles.

Question 24

Give one example of a dietary change for the management of dysphagia.

Answer 24

Dietary interventions might include modifications of texture, taste, or volume.

Question 25

Give one example of a medical intervention for the management of dysphagia.

Answer 25

Medical interventions may include a change in medication negatively affecting mental status and swallow or the placement of a nasogastric feeding tube.

Question 26

Give one example of a surgical intervention for the management of dysphagia.

Answer 26

Surgical interventions might include mobilization of a weak vocal fold or the placement of a gastrostomy tube.

Question 27

Name 3 considerations for dysphagia in an acute care setting.

Answer 27

1. Patients have multiple medical complications (require intubation tubes connected to ventilators, have tracheostomy tubes in place, require feeding tubes for nutrition)
2. Frequent changes in physical and mental status.
3. Stay in the hospital may be short (2 to 5 days), therefore swallowing needs must be addressed rapidly.

Question 28

In an acute care setting, frequently there is not sufficient time or patient cooperation because of mental status to order sophisticated laboratory tests. How do you establish a diagnosis and establish a treatment plan?

Answer 28

You have to rely on the history and clinical evaluation to establish a diagnosis and establish a treatment plan.

Question 29

What is aspiration (2 points)?

Answer 29

Aspiration of liquid and food is the consequence of those materials entering the airway below the level of the vocal folds.

Aspiration of liquid or food may or may not produce a lung infection known as aspiration pneumonia.

Question 30

What is the link between respiratory difficulty and dysphagia?

Answer 30

Respiratory problems requiring an endotracheal tube or tracheostomy tube also interfere with swallowing.