Clinical Assessment of Swallowing in Adults: Bedside Swallow Eval Flashcards
What are the components of a bedside exam?
History/Chart review and physical exam
What does a physical exam include?
Oral mech exam and test swallows
In an initial test swallow, what must 1st be decided?
We must decide whether to proceed with food presentation
to feed or not to feed
If pt is PO: __________:: if pt is NPO:_____________
pt is PO: feed unless significant deficits are observed on oral-facial exam/high risk of aspiration
pt is NPO: DON’T FEED
Reduced alertness, reduced responsiveness to stimulation, absent swallow, absent protective cough, sig. reduced range and strength of oral motor and laryngeal movements, difficulty handling secretions, medical instability are all signs that indicate ???
patients at risk for aspiration
In initial test swallow, what follows whether to proceed w/ food or not?
consideration of food textures/consistencies, position changes and placement of food in mouth
What do you do if you decide not to feed (test swallows)?
you will recommend NPO and MBSS (VFSS) for follw up/further examination
What are some methods of delivery fir trials of swallows?
spoon, cup, straw.
thing liquids: _________:: thick liquids:__________
i. e., water
i. e., nectar
types of conistency: start to end
thin liquids –> thickened liquids (nectar, honey thick, pudding) –>puree –> mechanically altered foods –> solids
What is one way you can reduce chance of getting pneumonia if pt aspirates?
by performing oral hygiene before giving trials
before trials of swallow, treatment and after oral intake
Sequence of swallows
dry swallow –> swallows –> phonate ah after each swallow
What 4 things do you look for during trials of swallows?
- estimate oral transit and pharyngeal delay time
- phonate after swallow
- listen for gurgly voice, coughing
- head rotation, chin elevated, followed by phonation
During trial eating/ feeding what things do you observe?
- Reaction to food/self-feeding skills
- Oral movements in chewing
- Coughing, clearing throat or struggle behaviors
- Changes in breathing, secretion levels through meal
- Duration of meal and total intake
- Co-ordination of breathing and swallowing
____% to ____% of pts who are silent aspirators are missed.
50 to 60%
It is important to remember as you begin the feeding trial if a voluntary cough was noted previously this does NOT ensure that a reflexive cough is present. T or F?
True
the cough reflex is innervated by which CN?
CN X
using a straw requires?
may require more coordination skills
Before and after the swallow, what should the examiner be cognizant of?
the respiratory rate
marked change in the respiratory rate or an increase in respiratory congestion may be a sign of what?
aiway compromise
poor oral control, food texture is?
thicker
delayed trigger, food texture is?
thicker
poor base of tongue movement, food texture is?
thinner
reduced tongue coordination, food texture is?
thicker
reduced laryngreal closure/weak cough/grunt, food texture is?
thicker
reduced airway closure, food texture is?
thick liquid/pudding
What are some weaknesses of bedside swallow exam?
- If the person does not cough, he or she may be silently aspirating
- Although gross estimates of transit times can be made, no real informtion on the pharyngeal stage of the swallow is collected
- Since the structures cannot be seen, the most appropriate therapy cannot be determined
- If silent aspiration is suspected, further exam (instrumental exam) is recommended.
If pt is PO, what recommendations are made?
- What kind of diet? Thickened liquids?
- Aspiration precautions? What kinds?
- Any compensatory swallow postures/maneuvers?
- Therapy needed? (for safer swallow or diet upgrade)
If pt is NPO, what recommendations are made?
If pt agrees to NPO status then determine:
− How ofen/when to f/u
− Need for tx?
If non-oral feeding (NPO) is refused then the risks needed to be addressed with the pt and family
- Some hospitals will have a form to fill out
- Diet wavier
Instrument exam is a must when?
When the decision from the bedside swallow test is NPO (pt is at high risk of aspiration and previously received no MBSS)
or
Pt was admiued to the facility with NPO, and shows significant gains for possible safe oral intake ajer a course of therapy
Swallowing safety evals are for?
for pts who are unable to cooperate with a physical eval and who are suspected of dysphagic complications
What to look for in swallowing safety eval
across 3 meals you look for: enviornment posture feeding eating assistant
What are physical signs of aspiration?
- SOB w/ rapid heart rate
- Acute mental confusion (altered mental status)
- Incontinence
- Infection
- Fever and an increase in sputum with cough
There are precise mechanisms that lead to aspiration pneumonia. T or F?
False; they are unkown
Does aspiration pneumonia develop in all patients who aspirate?
No; but older adults have higher chance to develop it
Which groups are predisposed to asp. pneu?
congestive heart failure COPD use of medications feeding dependence poor oral hygiene smoking history of asp. pneu. feeding tube bedbound
At what % SpO should you stop feeding?
if below 90%
Cervical auscultaPon
monitors the sounds of the swallow using a stethoscope, microphone and accelorometer
