Dysphagia Flashcards by Sydney Perry

what is the definition of dysphasia

difficulty or inability to swallow properly

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symptoms of dysphagia include ?

choking, coughing, drooling
multiple swallows for one bite
pocketing food
gurgle voice
frequent respiratory infections

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what neurologic disorders can cause disphagia

stroke
dementia

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what neuromuscular disorders can cause dysphagia

ALS
MS
parkinsons

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trauma that can cause dysphagia

brain injury

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cancer in which areas can cause dysphagia

oral cavatiy
pharynx
esophagus

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medications that cause dysphagia

sedation
dry mouth

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biological causes of dysphagia

advanced age and frailty

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what are the three swallowing phases and are they voluntary?

oral phase - Voluntary
pharyngeal phase - Involuntary
Esophageal phase - Involuntary

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In the oral phase food is introduced to the ______, then it is chewed and mixed with _______.

Tongue presses against ______ which forms a bolus of food and forces it toward the _________.

oral cavity
saliva

hard palate
pharynx

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In the Pharangeal Phase the ______ raises and this causes the _______ to _________.

________ elevated causing ______ to move over the _____ and the _____ close to prevent food from entering the trachea

______ contracts while the _______________ relaxes allowing food to pass into the esophagus

soft palate
nasopharynx
seal off

Larynx
epiglottis
glottis
vocal cords

Pharynx
upper esophageal sphincter

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In the esophageal phase the bolus moves through the ______ into the _______

esophagus
stomach

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To identify Dysphagia, you should start with a _______, and provide _______________.

diet interview
observation during mealtime

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If dysphagia is suspected, recommend a _______ consult for a swallowing evaluation. They will perform a clinical exam and a ___________

SLP

video fluoroscopy/modified barium swallow

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Oral phase swallowing problems can include drooling and food spillage caused by the ____________. Food pocketing and difficulty forming a bolus can occur from ________

weakened lip muscles
weakened or poorly coordinated movements of the tongue

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Pharyngeal phase complications can cause ________, _______, and _______.

nasal regurgitation
choking
aspiration

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esophageal phase issues often are caused by _______ or _________

mechanical obstruction
neuromuscular disorder (achalasia)

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Consequences of dysphagia include

inadequate _____, ________ and ______ leading to weight loss
Increased ______, _____, and increased risk of ________

intake, nutrient deficiencies, and malnutrition
frailty, dehydration, aspiration pneumonia

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MNT for Dysphagia include proper ________
consistency modification as per ____
______,______ meals
minimize _______
Foods that are ______ or ____ help stimulate swallow reflex

positioning HOB above 30 degrees
SLP
small frequent
distractions
flavorful or cold

MNT for dysphagia also includes avoiding _____, _____ the patient, including ____ if needed, and also including _______ if oral intake in inadequate

alcohol
educating
MVI with minerals
Enteral nutrition

Textures that pose a choking risk include…

_____, ____ or ______ (nuts, raw carrots)
_____ or _______ (steak, pineapple)
_____, ______ or ______ (nut butter, cheese chunks)
________ (bacon)
_______ (dry cakes or cookies)
______, _____, and _____ (peas shells, grape skins)
_____ shaped foods
_________ (soup, bubble tea)

hard, dry, or crunchy
fibrous or tough
sticky, gummy, or chewy
crispy
crumbly
seeds, skins, and husks
round
mixed thin-thick textures

Standardized diet released in 2017 by a multidisciplinary, multinational taskforce for dysphagia

International Dysphagia Diet Standardisation Initiative (IDDSI)

The International Dysphagia Diet Standardisation Initiative (IDDSI) was developed to provide _______________ terminology &
definitions to describe texture modified food &
thickened liquids.

Also to Improve patient_______ by increasing consistent
communication & standards

standardized, international
safety

What is IDDSI …
level 0 ?
level 1?
level 2?
level 3?
level 4?
level 5?
level 6?
level 7?

Thin liquids
Mildly thick liquids
Moderately thick liquids/liquidized foods
Extremely thick liquids
minced and moist foods
soft and bite sized
easy to chew

IDDSI level 0 Thin Liquids flow like _____ flow test should be ___ ml residue remaining in syringe include most _______ thin liquids are easily _________

water <1 ml liquids aspirated

other than most liquids, _______ is also a thin liquid

ice cream, frozen yogurt, sherbet, milk shakes, and gelatin

IDDSI Flow test measures how thick a liquid is by how much flows through a ____ syringe in ____

10 ml 10 seconds

Slightly thick liquids IDDSI level 1 should be thicker than _____, but thin enough to ______ used when thin drinks flow _____ flow test leaves _____ml

water, flow through a straw too fast to be controlled safely 1-4 mL

IDDSI level 2 mildly thick liquids pours _____ from a spoon but slower than slightly thick mild effort is needed to _________ indication when ________ flow test should be _____ mL

quickly drink through straw tongue control is slightly reduced 4-8 mL

IDDSI level 3 Moderately thick liquid/liquidised food _______ from fork with _____ texture with _____ ______ effort to drink out of straw indications include ______________ and __________ flow test should be _____ mL

drips slowly smooth texture with no lumps moderate difficulty controlling tongue and pain with swallowing >8 mL

IDDSI level 4 extremely thick liquids ________ when falls off a spoon ______ with a straw or cup allow more time for ________- indications include _________, _________, and __________

falls off in a single hold cannot drink oral control significant loss of tongue control, pain when chewing and swelling, aspiration risk

If thin liquids are not permitted Thickened liquids can meet the ___ requirements

fluid

thickening agents include ?

cornstarch flour infant rice cereal pureed fruits or veggies commercial products

commercial instant thickeners examples? (3)

thickenUp simply thick thick it

Pre thickened products examples

juice, milk, water, coffee

Adequate fluid intake can be difficult to achieve for people receiving thickened liquids Provide _______ An alternative approach to using thickened liquids=> _________

education Frazier Free Water Protocol

Frazier Free Water Protocol

consume bacteria free water not at times of meal to prevent infection

IDDSI Level 4: Pureed Foods Indications=> _______________ Foods are pureed to a “_______” texture Food are easy to swallow because they are smooth, lump-free, homogenous, cohesive, & not sticky No _______required Add gravy, sauce, vegetable juice, cooking water, fruit juice, milk, or half-and-half to pureed foods to prevent lumps and provide moisture

unable to bite or chew food, tongue control is significantly reduced, or aspiration pudding-like chewing

There are ______ to make food resemble food it was and look more appetizing

molds

IDDSI Level 5: Minced & Moist Foods For patients who are unable to ______, have pain or difficulty chewing foods, or easily ______ when chewing foods _________ all foods into pieces no larger than __mm width lump size Soft & moist with no separate thin liquid

bite foods tire Mince or mash 4 mm

IDDSI Level 6: Soft & Bite-sized For patients who are unable to _______ but are able to _____ Indications: ________ with chewing, _________ Cut all foods into pieces no larger than _______ Add gravy & sauces to keep food moist

safely bite off pieces chew the food into pieces that can be swallowed pain or fatigue missing teeth, poorly fitting dentures 1.5 cm x 1.5 cm

IDDSI Level 7: Easy to Chew Normal, everyday foods of _______ For people who find hard &/or chewy foods difficult or painful to chew and swallow Avoid foods that are hard, tough, chewy, fibrous, stringy, crunchy, or crumbly

soft texture

trigeminal nerve

chewing

hypoglossal nerve

tongue

glossopharangyl nerve

structures of swallowing