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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.

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
dominant risk factors for PNA
#1: dependent on others for feeding 2. dependent on others for oral care 3. number of missing teeth
26
_____ is the most common fluid and electrolyte disturbance in the geriatric population, with high rates of morbidity and mortality
dehydration
27
what will happen if a drink of water is aspirated?
it will be absorbed by the lungs tissues without harm
28
what do aquaporins allow to happen?
they permit water that has been aspirated to be rapidly absorbed from the airspaces
29
who can benefit from the FWP
- pts who have thickened liquids as part of their diet - pts who are NPO - pts with chronic dehydration problems
30
who may not be appropriate for the FWP
-"super coughers"
31
what are the rules of FWP
- 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
always remember... the best way to improve a swallow is to ____
swallow!
33
FWP: following a bedside swallow eval or MBS, what would the SLP need to do?
recommend the FWP to the MD and obtain an order
34
what is ventilator-associated pneumonia (VAP)
PNA that arises more than 48-72 hours after endotracheal intubation
35
three risk factors of hospital-acquired pneumonia
1. colonization of dental plaque with respiratory pathogens 2. bacterial colonization of the oropharyngeal area 3. aspiration of subglottic secretions
36
mechanical cleansing with an oral antiseptic helps what?
kill and remove biofilms
37
oral debridement helps what
lift and remove inactive biofilms that are left behind
38
FWP conclusion: when used within FWP, water is safe and effective for pts on ___ or ____
tube feedings or dysphagia diets
39
tx of dysphagia: exercises
- oral motor exercises - laryngeal elevation exercises (MM) - VF closure exercises - shaker exercise - masako maneuver
40
tx of dysphagia: exercises | -VF closure
- shouting - ah-ah-ah - holding your breath - bear down onto chair without voicing
41
tx of dysphagia: exercises | -shaker
-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
tx of dysphagia: exercises | -masako
- exercise for posterior tongue retraction & post wall contraction - pt or therapist anchors tongue tip and performs a dry swallow
43
tx of dysphagia: stimulation
- thermal-tactile stimulation - deep pharyngeal neuromuscular stim - myofascial release - neuromuscular electrical stimulation
44
treatment rationale for myofascial release
there is an expectation for functional success i: - fascial mobility - muscular range - muscular strength

Dysphagia Quiz/Exam (7 decks)

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