deck 1 Flashcards
etiologies of GERD
- esophageal influences
- trauma/surgeries
- infectious
- food/liquid
- other
assessing GER
- RSI
- VFSE/MBS
- esophagram
- UGI
- EGD
- pH monitoring
- manometry
radiation side effects (first 90 days)
- damage to skin, mucosa, vascular and connective tissues, muscles, bone, nerves
- decreased saliva production
- odynophagia
- taste changes
radiation side effects after 90 days
- fibrosis of connective tissue
- muscle necrosis
- trismus
- decreased laryngo-pharyngeal sensation
- xerostomia
effects of radiation on swallowing
- xerostomia
- pharyngeal residue
- aspiration
- GER
orotracheal intubation pros
- more common
- less traumatic
- larger diameter tube
- placement is temporary
orotracheal tube cons
- discomfort/gagging
- PO not possible
- decreased oral hygiene
- accidental extubation
nasotracheal tube pros
- more comfortable
- more stable
- PO is possible
- increased oral hygiene
nasotracheal tube cons
- more complications
- less common
- increased airway resistance
- sinusitis
- otitis media
trach tube pros
- decreased airway resistance
- decrease damage to VFs and larynx
- oral nutrition possible
- more comfortable
trach tube cons/complications
- hemorrhage
- thyroid injury
- injury to laryngeal nerves (recurrent nerve)
- air leaks
trach tub physiological changes
- humidification/filtration/warming
- bathing/showering
- phonation
- no valsalva maneuver
- swallowing– larynx is anchored down
blue-dye test
- 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
NPO diet
- orogastric
- nasogastric
- PEG
- G-tube
- J-tube
- total parenteral
treatment of dysphagia: positioning
- head turn
- head tilt
- recline
- lean (list) left or right
treatment of dysphagia: strategies
- chin tuck
- hard effortful swallow
- super-supraglottic swallow
- Mendelsohn maneuver
- small bites/sips
- alternate food/liquid
- repeat extra swallows
- periodic throat clears
mechanisms responsible for aspiration in pts bearing an NG tube are..
-loss of anatomical integrity of the UES and LES
studies show feeding tubes are not effective in…
- preventing aspiration PNA
- improving functional life
- preventing malnutrition
- providing comfort
FWP
allowing water safely to pts with dysphagia or chronic dehydration
dominant risk factors for PNA
- dependence on others for feeding
- dependence on others for oral care
- number of missing teeth
aquaporins
permit water aspirated to be rapidly absorbed from the airspaces
who can benefit from FWP
- pts with thickened liquids
- pts who are NPO
- pts with chronic dehydration problems
FWP rules
- 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
3 risk factors for HAP
- colonization of dental plaque with respiratory pathogens
- bacterial colonization of the oropharyngeal area
- aspiration of subglottic secretions
treatment of dysphagia: exercises
- OM exercises
- laryngeal elevation exercises (MM)
- VF closure exercises
- Shaker
- Masako Maneuver
- therabite jaw motion rehab system
treatment of dysphagia: stimulation techniques
- myofascial release
- neuromuscular electrical stimulation
- deep pharyngeal neuromuscular stimulation
- thermal tactile stimulation
