clinical bedside swallow basics

Question 1

purpose of clinical beside swallow (4)

Answer 1

to screen for dysphagia; to determine contributing physiologic factors, if any; to determine need for other tests; to recommend safest means of intake / diet

Question 2

components of dysphagia case hx (8)

Answer 2

identify complaints / status; onset / progressions; hx of PNA and cause(s); reasons for recent hospitalization; associated symptoms; medical hx; medications; social hx

Question 3

coughing / choking while eating / drinking; frequent throat clearing; multiple swallow pattern; wet vocal quality; edentulous; drooling SOB; weight loss

Answer 3

common clinical findings

Question 4

increased time to complete meal; spiking a temperature; pulmonary infiltrate on CXR; resistance to eating / drinking; oral residue / pocketing; odynophagia

Answer 4

common clinical findings

Question 5

PO or NPO; history of aspiration pneumonia; risk of aspiration with current diet; anatomical / functional status of the oral mechanism; is the pt improving or maintaining nutritional status on current diet?

Answer 5

clinical questions

Question 6

should the pt be referred for an instrumental swallow eval; is the pt cognitively able to participate in an instrumental eval or follows swallow recommendations / participate in tx; what are the diet and / or tx recommendations

Answer 6

clinical questions

Question 7

DO NOT exam if… (5)

Answer 7

the patient is: not alert, refuses, is NPO (not by mouth), cannot manage saliva; their pulse oximetry indicates that movement or raising the head may cause a drop in blood sats

Question 8

true or false: clinical bedside swallow evaluations may include an oral-facial examination

Answer 8

true

Question 9

if the patient is already PO, then you will feed unless ___

Answer 9

you observe deficits on oral-facial exam and poor mental status / alertness

Question 10

if the patient is already NPO, then you will not feed if ___ (3)

Answer 10

there are severe oral-facial deficits, mental status / alertness issues, OR severe respiratory disease (such as pna)

Question 11

if you decide not to feed, you will recommend ___

Answer 11

NPO or MBSS (VFSS)

Question 12

if the patient is acutely ill and you recommend NPO and no MBSS, you will want to ___

Answer 12

follow daily

Question 13

when you begin a feeding trail, and a voluntary cough was previously notes, this does not insure that ___

Answer 13

a reflexive cough is present

Question 14

the size of feeding you should start with is ___ of water

Answer 14

a teaspoon

Question 15

when you begin feeding, take note of ___ (6)

Answer 15

lip closure, presence of drooling, delay of initiation of the swallow, overt coughing or choking before / during / after the swallow (not the strength of the cough), extent of laryngeal elevation, presence of wet-gurgly voice after the swallow, oral residue after the swallow (check oral cavity)

Question 16

coughing / throat clearing during or immediately after a swallow probably represents penetration / aspiration, BUT ___

Answer 16

their absence does not rule it out

Question 17

wet vocal quality during or immediately after a swallow (given the voice quality is new) probably represents ___

Answer 17

penetration / aspiration

Question 18

how a straw may facilitate swallowing*

Answer 18

by placing the bolus more posteriorly and bypassing oral control / initiation issues, if any

*however, if there is a delay, it may be more difficult to tolerate because it allows the bolus to enter the hypo pharynx sooner

Question 19

different that when observing swallowing of liquids, for solids, you must also observe ___

Answer 19

mastication and pocketing of food

Question 20

if coughing / choking/ throat clearing occurs with purees and solids, ___

Answer 20

discontinue trail feeding

Question 21

if the patient has tracheostomy tubes, you will perform this instead of a regular clinical / bedside swallow*

Answer 21

blue dye swallowing test

*feed then suction so check for aspiration; silent aspiration is ruled out after 2-3 teaspoon trails

Question 22

when making recommendations / referrals, the SLP must decide ___ (4)

Answer 22

PO or NPO; if PO, what type of diet and consistency of liquid; precautions during feeding; tests or evaluations needed

Question 23

patient refuses non oral feeding (NPO) : ___ :: patient agrees to non oral feeding : determine how often / long

Answer 23

discuss risks with the patient and the family; fill out forms if required by the hospital

Question 24

this alternative to clinical / bedside swallow eval involves listening to airflow (no wetness should be heard) with the stethoscope placed onto the lateral side of the larynx*

Answer 24

cervical auscultation; there is a characteristic click / clunk sound during a normal swallow

*not fool proof

Question 25

penetration

Answer 25

entrance of food / liquid into the larynx that does not extend beyond the true vocal cords (TVC)

Question 26

aspiration

Answer 26

entry of food / liquid into the airway below the level of the true vocal cords (TVC)

Question 27

“factors that influence the tolerance to ___ include: amount, frequency, type, oral hygiene, pulmonary conditions, and immune function of the host”

Answer 27

aspiration

Question 28

“the definition of what constitutes significant ___ should be individualized”

Answer 28

aspiration

Question 29

aspiration pneumonia (PNA)

Answer 29

results from foreign materials (food, water, vomit) into the lungs with resultant infection