deck 1

Question 1

etiologies of GERD

Answer 1

• esophageal influences
• trauma/surgeries
• infectious
• food/liquid
• other

Question 2

assessing GER

Answer 2

• RSI
• VFSE/MBS
• esophagram
• UGI
• EGD
• pH monitoring
• manometry

Question 3

radiation side effects (first 90 days)

Answer 3

• damage to skin, mucosa, vascular and connective tissues, muscles, bone, nerves
• decreased saliva production
• odynophagia
• taste changes

Question 4

radiation side effects after 90 days

Answer 4

• fibrosis of connective tissue
• muscle necrosis
• trismus
• decreased laryngo-pharyngeal sensation
• xerostomia

Question 5

effects of radiation on swallowing

Answer 5

• xerostomia
• pharyngeal residue
• aspiration
• GER

Question 6

orotracheal intubation pros

Answer 6

• more common
• less traumatic
• larger diameter tube
• placement is temporary

Question 7

orotracheal tube cons

Answer 7

• discomfort/gagging
• PO not possible
• decreased oral hygiene
• accidental extubation

Question 8

nasotracheal tube pros

Answer 8

• more comfortable
• more stable
• PO is possible
• increased oral hygiene

Question 9

nasotracheal tube cons

Answer 9

• more complications
• less common
• increased airway resistance
• sinusitis
• otitis media

Question 10

trach tube pros

Answer 10

• decreased airway resistance
• decrease damage to VFs and larynx
• oral nutrition possible
• more comfortable

Question 11

trach tube cons/complications

Answer 11

• hemorrhage
• thyroid injury
• injury to laryngeal nerves (recurrent nerve)
• air leaks

Question 12

trach tub physiological changes

Answer 12

• humidification/filtration/warming
• bathing/showering
• phonation
• no valsalva maneuver
• swallowing– larynx is anchored down

Question 13

blue-dye test

Answer 13

• deflate cuff
• use finger or valve during swallowing
• bedside swallow eval, dye everything blue or green
• suction immediately, 10 mins, and 20-30 mins after
• do MBS or FEES if able

Question 14

NPO diet

Answer 14

• orogastric
• nasogastric
• PEG
• G-tube
• J-tube
• total parenteral

Question 15

treatment of dysphagia: positioning

Answer 15

• head turn
• head tilt
• recline
• lean (list) left or right

Question 16

treatment of dysphagia: strategies

Answer 16

• chin tuck
• hard effortful swallow
• super-supraglottic swallow
• Mendelsohn maneuver
• small bites/sips
• alternate food/liquid
• repeat extra swallows
• periodic throat clears

Question 17

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

Answer 17

-loss of anatomical integrity of the UES and LES

Question 18

studies show feeding tubes are not effective in…

Answer 18

• preventing aspiration PNA
• improving functional life
• preventing malnutrition
• providing comfort

Question 19

FWP

Answer 19

allowing water safely to pts with dysphagia or chronic dehydration

Question 20

dominant risk factors for PNA

Answer 20

• dependence on others for feeding
• dependence on others for oral care
• number of missing teeth

Question 21

aquaporins

Answer 21

permit water aspirated to be rapidly absorbed from the airspaces

Question 22

who can benefit from FWP

Answer 22

• pts with thickened liquids
• pts who are NPO
• pts with chronic dehydration problems

Question 23

FWP rules

Answer 23

• water is permitted until the first bite of a meal
• prescribed thickened liquids are permitted during meal
• water cannot be given to pt until oral cavity is cleaned and disinfected
• I & O should be recorded

Question 24

3 risk factors for HAP

Answer 24

• colonization of dental plaque with respiratory pathogens
• bacterial colonization of the oropharyngeal area
• aspiration of subglottic secretions

Question 25

treatment of dysphagia: exercises

Answer 25

• OM exercises
• laryngeal elevation exercises (MM)
• VF closure exercises
• Shaker
• Masako Maneuver
• therabite jaw motion rehab system

Question 26

treatment of dysphagia: stimulation techniques

Answer 26

• myofascial release
• neuromuscular electrical stimulation
• deep pharyngeal neuromuscular stimulation
• thermal tactile stimulation