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Advanced Medical Nutrition Therapy > Dysphagia > Flashcards

Dysphagia Flashcards

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USMLE® Step 1 flashcards
1
Q

_____ is the difficulty or inability to swallow properly

A

Dysphagia

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2
Q

Symptoms of dysphagia include…

A

-Choking

-Coughing

-Drooling

-Multiple swallows for one bite of food

-Pocketing food

-Gurgly voice

-Absent gag reflex

-Frequent upper respiratory infections

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3
Q

What neurological disorders can cause dysphagia?

A

-Stroke

-Dementia

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4
Q

What neuromuscular disorders can cause dysphagia?

A

-ALS

-MS

-Parkinson’s disease

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5
Q

A _____ _____ injury may also cause dysphagia

A

Traumatic brain

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6
Q

What types of cancer may cause dysphagia?

A

-Oral cavity

-Pharynx

-Esophagus

-Treatment modalities (surgery, radiation)

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7
Q

Medications may also cause dysphagia by causing side effects like…

A

-Sedation

-Dry mouth

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8
Q

Advanced _____ and frailty may also cause dysphagia

A

Age

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9
Q

What are the three phases of swallowing?

A

-Oral phase (voluntary)
-Pharyngeal phase (involuntary)
-Esophageal phase (involuntary)

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10
Q

In the oral phase, food is introduced into the ____ ____, chewed, and mixed with saliva

A

Oral cavity

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11
Q

During the oral phase, the tongue pressed food against the ___ ____, forming a bolus and forcing it toward the pharynx

A

Hard palate

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12
Q

In the pharyngeal phase of swallowing, the soft palate raises to seal off the _____

A

Nasopharynx

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13
Q

During the pharyngeal phase, the ____ elevates causing the epiglottis to move over the glottis and the vocal cords close to prevent food from entering the trachea

A

Larynx

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14
Q

The last step of the pharyngeal phase is that the ____ contracts while the ____ ____ ____ relaxes, allowing food to pass into the esophagus

A

Pharynx; upper esophageal sphincter

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15
Q

In the esophageal phase of swallowing, the bolus moves through the esophagus into the ____

A

Stomach

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16
Q

Steps to identify dysphagia:

A

-Diet interview
-Observation at mealtime
-If dysphagia is suspected, recommend a SLP consult for swallowing evaluation (done with clinical exam and/or videofluoroscopy, Modified Barium Swallow)

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17
Q

Oral phase swallowing problems include…

A

-Weakened or poorly coordinated movements of the tongue
-Difficulty forming a bolus
-Food pocketing
-Weakened lip muscles cause an inability to seal the lips-> drooling, food spillage

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18
Q

Swallowing problems in the pharyngeal phase can cause…

A

-Nasal regurgitation
-Choking
-Aspiration

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19
Q

Swallowing problems in the esophageal phase are often due to mechanical obstruction, but may also be due to a neurologic disorder called _____, which causes decreased peristalsis so it feels like there is food stuck in the chest

A

Achalasia

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20
Q

Consequences of dysphagia:

A

-Inadequate intake
-Weight loss
-Development of nutritional deficiencies and malnutrition
-Dehydration
-Increased risk of aspiration pneumonia
-Increased frailty

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21
Q

MNT for dysphagia:

A

-Proper positioning (elevate HOB to >29 degrees)
-Consistency modification as per SLP
-Small, frequent meals
-Minimize environmental distractions and conversations during mealtime
-Foods that are flavorful or cold help stimulate the swallow reflex
-Avoid alcohol
-Patient education
-MVI with minerals if needed
-Enteral nutrition may be necessary if aspiration risk is too great or oral intake is inadequate

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22
Q

The ____ ____ ____ ____ ____ is a multidisciplinary taskforce

A

International Dysphagia Diet Standardisation Initiative (IDDSI)

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23
Q

What are the goals of IDDSI?

A

-Develop standardized, international terminology and definitions to describe texture-modified food and thickened liquids
-Improve patient safety by increasing consistent communication and standards

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24
Q

IDDSI Level 0 includes ____ ____ that flow like water

A

Thin liquids

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25
Q

To classify as level 0, use the flow test: < ____ mL of residue remains in syringe after 10 seconds of flow

A

1

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26
Q

What types of beverages classify as level 0, thin liquids?

A

-Water, fruit juice, milk, soda, tea, coffee
-Liquid oral nutrition supplements
-Broth
-Ice cream, frozen yogurt, sherbet, milkshakes, and gelatin

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27
Q

Thin liquids are easily ____

A

Aspirated

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28
Q

The IDDSI Flow Test measures how thick a liquids by how much flows through a 10 mL syringe in ___ seconds

A

10

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29
Q

IDDSI level 1 is ___ ____ ____

A

Slightly thick liquids

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30
Q

IDDSI level 1 (slightly thick liquids) are thicker than water, but thin enough to flow through a ____

A

Straw

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31
Q

IDDSI level 1 is used when thin drinks flow too ____ to be controlled safely

A

Fast

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32
Q

The IDDSI flow test for level 1 that that there should be __-__ mL left in syringe after 10 seconds

A

1-4

33
Q

IDDSI level two is ___ ____ ____

A

Mildly thick liquids

34
Q

IDDSI level 2 (mildly thick) liquids pour ____ from a spoon but slower than “slightly thick” drinks

A

Quickly

35
Q

____ effort is needed to drink mildly thick liquids through a straw

A

Mild

36
Q

When are IDDSI level 2 (mildly thick) liquids indicated?

A

When tongue control is slightly reduced

37
Q

IDDSI flow test for level 2 is that ___-___ mL are left after 10 seconds

A

4-8

38
Q

IDDSI level 3 is ___ ___ ___/___ ___

A

Moderately thick liquids/liquidized food

39
Q

Moderately thick liquids drip ____ through the slots of a fork

A

Slowly

40
Q

Moderately thick liquids/foods have a smooth texture with no ____

A

Lumps

41
Q

IDDSI level 3 requires ____ effort to drink through a straw

A

Moderate

42
Q

Indications of IDDSI level 3:

A

-Difficulty with tongue control
-Pain on swallowing

43
Q

IDDSI flow test for level 3:

A

Leaves >8 mL after 10 seconds

44
Q

Examples of level 3/moderately thick liquids and blenderized foods:

A

-Runny pureed fruit
-Some sauces and gravies

45
Q

IDDSI level 4 is ____ ___ ____

A

Extremely thick liquids

46
Q

Extremely thick liquids fall off a spoon in a single spoonful and ___ ___ ___

A

Hold its shape

47
Q

Can you drink extremely thick liquids from a straw?

A

No (usually eaten with a spoon)

48
Q

Extremely thick liquids have a smooth texture with no lumps and are not sticky; this allows more time for ___ ____

A

Oral control

49
Q

Indications of extremely thick liquids:

A

-Significantly reduced tongue control
-Pain on chewing and swallowing

50
Q

What is an example of a food that is extremely thick?

A

Pudding

51
Q

If thin liquids are not permitted, fluid needs can be met with ___ ____

A

Thickened liquids

52
Q

Thickening liquids allow for better control over the ____

A

Swallow

53
Q

Examples of thickening agents:

A

-Infant rice cereal
-Pureed fruits or vegetables
-Pudding
-Commercial products
-Corn starch, flour

54
Q

Commercial instant thickeners include…

A

-Resource ThickenUp Clear
-SimplyThick
-Thick-It

55
Q

___-____ products are used for convenience and include things like juice, water, milk, and coffee

A

Pre-thickened

56
Q

Adequate ____ ____ can be difficult to be achieved for people receiving thickened liquids (high risk of dehydration)

A

Fluid intake

57
Q

Two methods of helping to increase fluid intake:

A

-Provide education
-Frazier Free Water Protocol

58
Q

Frazier Free Water Protocol:

A

-No use of thickened liquid
-No beverages during meals
-Water in between meals
-Crucial to maintain very good oral care so that if/when they aspirate, it won’t have any bacteria in it

59
Q

IDDSI level 4 also include ____ _____

A

Pureed foods

60
Q

Indications of pureed food:

A

-Unable to bite of chew food
-Tongue control is significantly reduced

61
Q

Pureed foods have a “____-____” texture

A

Pudding-like

62
Q

Pureed foods are easy to swallow because they are…

A

-Smooth
-Lump-free
-Homogenous
-Cohesive
-Not sticky

63
Q

When pureeing foods, what can you add to prevent lumps and provide moisture?

A

-Gravy
-Sauce
-Vegetable juice
-Cooking water
-Fruit juice
-Milke
-Half and half

64
Q

IDDSI fork drip test for level 4:

A

-Pureed foods/extremely thick liquids sit in a mouth or pile above the fork
-Liquid does not dollop or drip continuously through the fork prongs
-A small amount may flow through and form a tail below the fork

65
Q

IDDSI spoon tilt test:

A

-Sample holds its shape on the spoon and falls off fairly easily if the spoon is tilted or flicked
-Sample should not be firm or sticky

66
Q

Pureed foods must pass ____ the fork drip test and the spoon tilt test

A

Both

67
Q

IDDSI level 5 is ____ and ____ ____

A

Minced and moist

68
Q

IDDSI level 5 is used for…

A

-Patients who are unable to bite foods
-Patients who have pain or difficulty chewing foods
-Patients who easily tire when chewing foods

69
Q

Level 5 foods should be minced into pieces no larger than ___ mm width lump size

A

4

70
Q

Minced and moist foods should be soft and moist with no separate ___ ___

A

Thin liquid

71
Q

IDDSI level 6 is ___ and ___-___

A

Soft and bite-sized

72
Q

IDDSI level 6 is used for patients who…

A

Are unable to safely bite off pieces but are able to chew the food into pieces that can be swallowed

73
Q

Level 6 foods should be cut into pieces no larger than ___cm x ___cm

A

1.5 x 1.5

74
Q

Add ___ and ____ to level 6 foods to keep food moist

A

Gravies and sauces

75
Q

IDDSI level 7 is ___ ___ ____

A

Easy to chew

76
Q

Easy to chew food is normal food of ___ texture

A

Soft

77
Q

IDDSI level 7 is used for people who…

A

-Find hard and/or chewy foods difficult or painful to chew and swallow

78
Q

With easy-to-chew foods, avoid things that are…

A

-Hard
-Tough
-Chewy
-Fibrous
-Stringy
-Crunchy
-Crumbly

Advanced Medical Nutrition Therapy (14 decks)

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