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Dysphagia Quiz/Exam > clinical decision making & managementof swallowing > Flashcards

clinical decision making & managementof swallowing Flashcards

1
Q

treatment of dysphagia

A
  • positioning
  • strategies
  • diet
  • exercises
  • stimulation
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2
Q

tx of dysphagia: positioning

A
  • head turns
  • head tilt
  • recline
  • list (leaning) to L or R
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3
Q

positioning: most of the time, _____ is best

A

upright 90 degrees

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4
Q

positioning, which tx?

lack of tongue movement to propel bolus into pharyngeal area

A

recline

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5
Q

positioning, which tx?

unilateral oral weakness with pooling

A

tilt head to strong side during chewing

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6
Q

positioning, which tx?

premature spillage in pharyngeal area while chewing

A

leaning forward, chin tuck, head down

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7
Q

positioning, which tx?

unilateral pharyngeal weakness

A

head turn… during swallow turn to weak side, after swallow turn to strong side

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8
Q

tx of dysphagia: strategies

A
  • small bites/sips
  • chin tuck
  • hard/effortful swallow
  • repeat/extra swallows
  • alternate solids with liquids
  • periodic throat clears
  • super supra-glottis swallow
  • Mendelsohn maneuver (more of an exercise)
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9
Q

what is the Mendelsohn maneuver

A

where you try and hold your larynx in upright position in the middle of a swallow

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10
Q

why may using a straw be dangerous to use as a strategy?

A

it is difficult for some pts to control the amount they get

-bionix reusable safestraw can be used to control the amount of liquid that can be sucked through the straw at a controlled pace

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11
Q

if a pt is supposed to be performing a chin tuck, drinking from a cup can be dangerous, why? what could you use in replace of a real cup

A

because they have to tilt their head back to drink from a cup

-nosey cup

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12
Q

strategies, which tx?

swallow delay

A

chin tuck

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13
Q

strategies, which tx?

decreased posterior tongue retraction

A
  • hard effortful swallow

- after swallow: repeat extra swallows, or alternate solids with liquids to wash residue on posterior tongue down

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14
Q

strategies, which tx?

decreased pharyngeal wall contraction

A
  • during swallow: hard swallow, repeat swallow

- after: alternate swallow with liquids

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15
Q

whenever you see residue, you always want to recommend these 2 strategies:

A

hard swallow

repeat swallow

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16
Q

strategies, which tx?

decreased laryngeal elevation

A

Mendelsohn maneuver

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17
Q

strategies, which tx?

residue on valleculae

A
  • head turn during and after swallow
  • repeat extra swallows
  • alternate swallows with liquids
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18
Q

strategies, which tx?

paralyzed VF

A
  • super supra-glottis swallow

- periodic throat clears

19
Q

strategies, which tx?

residue on pyriform sinuses

A
  • head turn during and after swallow
  • repeat extra swallows
  • alternate swallows with liquids
20
Q

TX of dysphagia: diet

-NPO options

A
  • orogastric (OG)- very rare
  • nasogastric (NG)- very common
  • percutaneous endoscopic gastronomy (PEG)
  • gastronomy (G tube)
  • jejunostomy (J tube)
  • total parenteral nutrition (TPN): directly into veins
21
Q

NG tubes are associated w/ colonization & aspiration of pharyngeal secretions & gastric contents leading to a high incidence of Gram ___ pneumonia.

A

negative

22
Q

mechanisms responsible for aspiration in pts bearing an NG tube are…

A
  • loss of anatomical integrity of the UES and LES
  • increase in the frequency of transient LES relaxations (results in GERD)
  • desensitization of pharyngoglottal adduction reflex (reduced reflex to react if going down the wrong way)
23
Q

studies show feeding tubes are NOT effective in…

A
  • preventing aspiration PNA
  • preventing malnutrition
  • providing comfort
24
Q

what is the theory behind the Frazier Water Protocol?

A

allowing oral water safely to pts with dysphagia or chronic dehydration

25
Q

dominant risk factors for PNA

A

1: dependent on others for feeding

  1. dependent on others for oral care
  2. number of missing teeth
26
Q

_____ is the most common fluid and electrolyte disturbance in the geriatric population, with high rates of morbidity and mortality

A

dehydration

27
Q

what will happen if a drink of water is aspirated?

A

it will be absorbed by the lungs tissues without harm

28
Q

what do aquaporins allow to happen?

A

they permit water that has been aspirated to be rapidly absorbed from the airspaces

29
Q

who can benefit from the FWP

A
  • pts who have thickened liquids as part of their diet
  • pts who are NPO
  • pts with chronic dehydration problems
30
Q

who may not be appropriate for the FWP

A

-“super coughers”

31
Q

what are the rules of FWP

A
  • oral water is permitted until the FIRST bite of a meal
  • no water unless it is thickened as prescribed, is allowed during the meal or until the mouth is cleaned
  • the prescribed thickened liquid is used during meals
32
Q

always remember… the best way to improve a swallow is to ____

A

swallow!

33
Q

FWP: following a bedside swallow eval or MBS, what would the SLP need to do?

A

recommend the FWP to the MD and obtain an order

34
Q

what is ventilator-associated pneumonia (VAP)

A

PNA that arises more than 48-72 hours after endotracheal intubation

35
Q

three risk factors of hospital-acquired pneumonia

A
  1. colonization of dental plaque with respiratory pathogens
  2. bacterial colonization of the oropharyngeal area
  3. aspiration of subglottic secretions
36
Q

mechanical cleansing with an oral antiseptic helps what?

A

kill and remove biofilms

37
Q

oral debridement helps what

A

lift and remove inactive biofilms that are left behind

38
Q

FWP conclusion: when used within FWP, water is safe and effective for pts on ___ or ____

A

tube feedings or dysphagia diets

39
Q

tx of dysphagia: exercises

A
  • oral motor exercises
  • laryngeal elevation exercises (MM)
  • VF closure exercises
  • shaker exercise
  • masako maneuver
40
Q

tx of dysphagia: exercises

-VF closure

A
  • shouting
  • ah-ah-ah
  • holding your breath
  • bear down onto chair without voicing
41
Q

tx of dysphagia: exercises

-shaker

A

-stretch out on floor, on back, raise head up w/arms at your side. keep feet back, and shoulders down, look at toes x30, then hold head up for 1 min

42
Q

tx of dysphagia: exercises

-masako

A
  • exercise for posterior tongue retraction & post wall contraction
  • pt or therapist anchors tongue tip and performs a dry swallow
43
Q

tx of dysphagia: stimulation

A
  • thermal-tactile stimulation
  • deep pharyngeal neuromuscular stim
  • myofascial release
  • neuromuscular electrical stimulation
44
Q

treatment rationale for myofascial release

A

there is an expectation for functional success i:

  • fascial mobility
  • muscular range
  • muscular strength

Dysphagia Quiz/Exam (7 decks)

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