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Dysphagia > Chapter 4, Class 6 > Flashcards

Chapter 4, Class 6 Flashcards

1
Q

Which of the following cases below illustrate maternal conditions could impact the health of an infant or lead to premature delivery? (Choose all that apply.)

A

1) This mother is a smoker, drinks alcohol daily and has a history of cocaine abuse. (YES)

XNO2) This mother has waited until she was 33 years old to start a family. She is concerned because she is a bit overweight (about 175 lbs.) already.

3) This mother has had Diabetes (Type I) since her teens but watches her diet closely. She has been diagnosed as having low iron content during a recent blood tests. (YES)

XNO4) This mother had rubella (measles) as a child as well as several bouts with strep throat when she was in grade school.

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2
Q

What does the acronym GERD stand for?

A

Gastro-esophogeal reflux disease

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3
Q

Unresolved GERD can lead to recurrent aspiration and pneumonia in an infant and impair ability to thrive.

A

True

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4
Q

What is meant by the term “hematemesis” ?

A

Blood that is noted in the material that is spit up by an infant who has chronic reflux with complications.

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5
Q

According to your textbook, cleft palate is a rare disorder occurring in only 1 out of 100,000 live births.

A

False

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6
Q

Which of the following syndromes can be associated with cleft palate? (Choose all that apply.)

A 
Pierre Robin syndrome
Down syndrome
Mobius sequence (syndrome)
Fetal alcohol syndrome
XXHirschsprung's Disease
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7
Q

You are working with an 8 year old child who has a diagnosis of mild Autism Spectrum Disorder. His mother is very concerned because he will not eat raw vegetables or fruits and refuses to drink milk. His favorite foods are mashed potatoes and gravy, vanilla pudding and oatmeal. How would you describe his problems?

A

Oral hypersensitivity with problems concerning textures of foods and strong flavors.

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8
Q

Although adults with TBI exhibit a high incidence of swallowing and feeding problems, infants and children with TBI do not usually have feeding problems.

A

False

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9
Q

In their article regarding the impact of NG tubes on dysphagia, Leder & Suiter (2008) found that ________.

A

the presence of an NG tube did not effect swallowing success of lead to increase aspiration events.

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10
Q

According to Langmore, et al. (1998), the top three predictors of aspiration pneumonia are_____.
(select three)

A

number of decayed teeth the patient exhibits

whether or not they can perform oral care procedures independently.

whether or not they are dependent on someone to help feed them or can the person feed himself/herself.

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11
Q

According to Ault (1998), which of the following symptoms are commonly seen in older children with unresolved GER? (Choose all that apply.)

A

Heartburn

Recurrent respiratory infections (like pneumonia)

Regurgitation of stomach contents

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12
Q

Ault calls the ______test the ‘gold standard’ for diagnosis of GER in infants.

A

pH monitoring probe

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13
Q

Maternal Conditions

A 
–	Poor diet
–	Multi-parity (+3 living children)
–	Abnormal weight (200 lbs.)
–	Smoking
–	Alcohol or drug abuse
–	Medical disorders:  
•	Diabetes 
•	Cardiac disease  
•	Preeclampsia
–	Corticosteroids 
–	Anemia
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14
Q

• Maternal effects, cont.

– Infections:

A
  • Toxoplasmosis
  • Rubella
  • Cytomegalovirus
  • Herpes
  • Sexually transmitted diseases
  • Streptococcus
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15
Q

• Intrapartum:

A 
–	Preterm labor
–	Medications
–	Abruptio placentae,
–	Placenta previa,
–	Umbilical cord prolapse
–	Breech delivery
–	Shoulder dystocia
–	Ceasarian delivery
–	Obstetric analgesia
–	Obstetric anesthesia
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16
Q

• Prematurity

A
  • Before 37 weeks- preterm
  • 12% of all US births are premature
  • 2% less than 32 weeks
  • Often multiple births are premature
  • 57% twins; 93% triplets
  • Viable at 23 weeks
  • Low weight (normal weight 2500-3999 grams)
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17
Q

• Potential Problems in Newborns

A 
–	Respiratory
–	Cardiovascular
–	Neurologic
–	Hematologic
–	Nutritional 
–	Gastrointestinal
–	Metabolic
–	Renal
–	Temperature regulatory
–	Immunologic
–	Opthalmalologic
18
Q

• Special Problems

– Necrotizing Enterocolitis (NEC)

A
  • Infection or decreased blood supply to the intestine
  • Variable severity
  • Causes not well known
  • Restricted from oral feedings
  • Signs and symptoms
  • Long-term effects
19
Q

• Special Problems

– Gastroesophogeal Reflux/ Disease (GER/GERD)

A
  • Flow of stomach contents back into esophagus
  • GER Common in premature infants and others
  • GERD = pathological or complicated
  • Respiratory compromise
  • Treatments
  • Positioning
  • Medications
20
Q

• Fistulas

A 
–	Tracheoesophageal Fistula and Atresia (TEF)
–	Esophageal Fistula
•	Occur early in first trimester
•	Five variants
•	Clinical signs
•	Requires surgical intervention
•	Post operative concerns
21
Q

• Respiratory Disorders

A

Respiratory Distress Syndrome- RDS (Hyaline Membrane Disease)
• Usually seen with prematurity
• Treatment:
• Continuous positive airway pressure (CPAP)-can’t feed
• Positive end-expiratory pressure (PEEP)
• Surficant replacement tx, oxygen, ventilation
• Complications long-term: bronchopulmonary dysphasia
• Oral and pharyngeal abnormalities
• Long-term tube feeding

22
Q

– More Respiratory problems

A 
Transient Tachypnia (TTN)
•	Cause unknown
•	Usually temporary with good prognosis
•	Probably poor clearance of lung fluid during birth
•	Signs:  Breathe rapidly, respiratory distress, cyanosis,
•	Subcostal retractions, nasal flaring, 
•	Treatment:  oxygen
•	Can’t feed on CPAP
23
Q

– Apnea

A
  • Cessation of breathing
  • More than 20 seconds
  • Also shows bradycardia
  • Premature infants: apneic periods of 5-10 seconds then 5-10 seconds of rapid breathing
  • At least 25% of premies (below 1800 grams/34 weeks) have at least one apneic episode; all infants less than 28 weeks)
  • Usually gone by 34-35 weeks or more
  • Causes: CNS versus obstructive
  • Immature chemocontrol
  • Also: infections, metabolic disorder, impaired oxygenation system, maternal drugs, intracranial lesions, poor temperature regulations and GERD
  • Treatment: Monitoring + stimulation
  • Medications
24
Q

– Broncho-pulmonary Dysplasia (BPD)

A
  • Inflammation and Scarring of
  • Seen in premies
  • Abnormal development of the lung tissue
  • Causes:
  • Neurological Disorders
25
Q

• Microencephaly

A 
–	Hydrocephalus
–	Intracranial Hemorrhage
–	Seizures
–	Periventricular Leukomalacia
–	Birth injuries
26
Q

• Cardiovascular Disorders

A

– Cardiac septation
– Patent ductus arteriosus
– Tetralogy of Fallot
– Truncus arteriosus

27
Q

• Congenital Anomalies

– Cleft lip and palate

A
  • Cause: Failure of mesenchymal masses in medial nasal and maxillary prominences to join
  • Incidence= 1 in 700 live births
  • More boys than girls
  • Many associated difficulties:
  • Many different syndromes Post-surgical complications
28
Q

• Pediatric Feeding disorders

A

• Inability to consume sufficient calories for optimal grown and development

29
Q

• Signs of problematic Eating

A

– Poor weight gain
– Coughing, choking, or gagging during meals
– Problems with vomiting
– History of a traumatic choking incident
– History of eating and breathing coordination problems with ongoing respiratory issues
– Inability to make the transition to baby food purees by 10 months
– Inability to accept table food solids by 12 months
– Inability to make the transition from breast to bottle to cup by 16 months
– Has not bee weaned from baby foods by 16 months
– Aversion or avoidance of all foods of specific texture or food groups
– Food range of fewer than 20 foods
– Crying or arching by the infant at most meals
– Family fighting about food and feeding
– Repeated parental reports that the child is difficult for everyone to feed
– Parental history of an eating disorder with a child not meeting weight goals
(Groher & Crary , 2008, pg. 57)

30
Q

• Typical Feeding Development/ Disorders

A

– Review from last session
– Hand-outs from The Source for Pediatrics
– Textbook; Table 4-2, Pages 58-64

31
Q

• Medical Impact on Feeding

A 
–	Prematurity
–	Gastrointestinal Disorders
–	Esophogitis
–	Eosinophilic Esophagitis (EE)
–	Celiac Disease
–	Others:	
•	Hirschsprung’s Disease, cyclic vomiting syndrome, gastroparesis,  intestinal pseudo-obstruction, irritable bowel syndrome, dyspepsia
32
Q

• Cardiac and Respiratory Conditions

A

– Disorders of the head and neck
– Allergies
• 2-2.5% of population has food allergies
• 8 foods make up 90%:
• Peanuts, tree nuts, mild, eggs, wheat, soy, fish, shellfish

33
Q

• Sensory Impact on Feeding

A

– Sensory modulation problems
– Sensory registration problems
– Sensory defensiveness/hypersensitivity
– Hyposensitivity

34
Q

– Autism Spectrum Disorders

A
  • 62% have food selectivity problems

* GERD/ Constipation

35
Q

– Cerebral Palsy

A
  • Tonic Bite Reflex

* Undernourishment

36
Q

– Brain Injury

A
  • 30-60% children with TBI have feeding problems

* Oral motor dysfunction, self-feeding problems, frontal lobe involvement

37
Q

– Down Syndrome

A
  • 80% have feeding difficulties

* Low muscle tone

38
Q

• Myofacial Anomalies

A

– Tongue Thrust

– Video Presentation

39
Q

Cleft Palate Syndromes

A 
Kabucki Syndrome
Mobius Syndrome
Pierre Robin Syndrome
CHARGE
Beckwith-Wiedemann syndrome
Goldenhar’s syndrome
Apert’s syndrome
Treacher-Collins Syndrome
Freeman-Sheldon syndrome
Down Syndrome
40
Q

– Eosinophilic Esophagitis (EE)

A

• Eosinophilic esophagitis is an inflammatory condition of the esophagus that affects both children and adults, and men more than women.
• Eosinophilic gastroenteritis may be due allergy to an as yet unknown food allergen.
• The major symptom in adults with eosinophilic esophagitis is dysphagia (problems swallowing) for solid food.
• Eosinophilic esophagitis stiffens the esophagus so that solid foods have difficulty passing through the esophagus and into the stomach.
• Other common causes of dysphagia for solid food are esophageal strictures and Schatzki rings.
• The diagnosis of eosinophilic esophagitis usually is made during an endoscopy (EGD), performed for the evaluation of dysphagia. The diagnosis is confirmed by biopsy of the esophagus.
• The treatment of eosinophilic esophagitis is with proton pump inhibitors and swallowed fluticasone propionate.
–Gentle esophageal dilatation is used when meditations fail to relieve dysphagia.

41
Q

• Hirschsprung’s disease

A

is a blockage of the large intestine due to improper muscle movement in the bowel. It is a congenital condition, which means it is present from birth

Dysphagia (8 decks)

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