Chapter 5 Flashcards
Why study Clinical Assessment: to define to establish a ? to establish a tentative? to find potential ? to establish ?
potential cause (medical Hx)
working hypothesis that defines the disorder
treatment plan
questions that need further investigation/assessment
pt’s readiness
Enables SLP to: integrate information from: the review of standardized observations from collaboration with ?
interview/case history medical/clinical records protocols physical examination physicians and other caregivers
observe and assess function during ?
speech and swallowing tasks
- face
- jaw
- lips
- oral mucosa
- tongue
- teeth
- hard palate
- soft palate
Purpose of the clinical assessment:
identify the? and ? based on ?
this may include identifying factors that may affect swallowing function such as: - - - - - - - -
presence and observe the characteristic of dysphagia /clinical s/s.
bolus size bolus consistency bolus temperature bolus taste (sensory responses) -fatigue during a meal -posture -positioning -environmental conditions
Identify clinical signs and symptoms of ? in order to ?
determine need for an ?
esophageal dysphagia, gastroesophageal reflux, or laryngeal deficits/ make appropriate referrals to another specialty
instrumental eval. following clinical examination
determine if the patient is an appropriate candidate for ? based on clinical examination findings such as - - - - -
make clinical ? - - - -other ?
treatment or management
- medical stability
- cognitive status
- nutritional status
- psycho-social environmental factors
- behavioral factors
recommendations:
- positioning
- food and liquid consistency modifications
- feeding route alterations
- other clinical strategies designed to enhance the efficiency and safety of swallowing
Medical HX: may be gathered from: - - -
should always be reveiwed with a certain level of ?
prior medical records
current medical records
conversations with: medical staff, SOs, family/caregivers, Pt directly
speculation/considerations
Obtaining Medical Hx:
considerations:
Hx of ?
Hx of ?
Hx of ? -especially significant if ? - - -
congenital disease
-CP, syndromes, etc.
neurologic disease:
CVA, head trauma/TBI, progressive neurologic diseases (MS, ALS, PD, Mg, etc)
Sx:
- received general anesthesia (ET intubation)
- fundoplication, myotomy (GI)
- H&N CA - resection, biopsy. Chemotherapy ? radiation?
- cardio pulmonary, thyroid, cervical spine, thoracic
Considerations continued: ... and ... disorders ? -disturbances in the body's? - -
systemic and metabolic disorders
- chemical balance that result from toxins (medications/intolerance)
- infections (sepsis, UTI, etc.)
- dehydration/malnutrition (undernutrition), weight loss
respiratory impairment
-COPD, ASTHMA, ETC.
ESOPHAGEAL DISEASE:
gerd, ACHALASIA, bARRETT’S ETC
Considerations continued:
advance ?
a pt may or may not have executed ?
if the pt has chosen not to be ? the need for further testing or treatment may be ?
directives
-an advance directive stating his/her preference if dysphagia is severe
tube fed under any circumstance/ contraincated
CSE also known as
bedside swallow eval
A part of the exam can be completed with ?
observations are particularly important for pts who are ?
some assumptions can be made about the ? based on?
basic observation of the pt’s medical status
bedfast and undergoing medical or surgical tx
swallowing performance based on observational data
Feeding method: non oral
enteral feeding
NG tube (nasogastric)
G-tube (gastronomy)
J-tube (jejunostomy)
IV (intravenous)
TPA (total parenteral nutrition)
Both NG and PEG tubes may be either
continuous
bolus
Tracheostomy tubes:
inserted through ? to allow access to the lungs for ?
-vary in
may interfere with ?
tracheotomy site/ mechanical ventilation and or pulmonary toilet
lumen (size)
vocal fold closure