Dysphagia Flashcards
If a patient complains of food stuck at the roof of their mouth, then that indicates
tongue is not moving as much or the tongue is not making contact with the palate
If a patient complains of food stuck in their throat, then that indicates
residue on the pyriform sinus, valleculae, and posterior pharyngeal wall
Why might aspiration occur before a swallow?
The person cannot contain food or liquid in their mouth or their larynx closes after the bolus enters the pharynx
Why might aspiration occur after a swallow?
A person may have leftover residue in the pharynx after their initial swallow
Why might aspiration occur during a swallow?
The hyoid may not elevate, thereby leaving the larynx open; the vocal folds may not close completely; the epiglottis may not completely tilt as well.
What swallowing exercises can be used to address food stuck in a patient’s throat (i.e., residue in the pharynx, pyriform sinuses, and valleculae) and thereby prevent aspiration during or after the swallow?
The Shaker exercise; The effortful swallow; dry swallows; liquid washes
What swallowing exercise can be used to address aspiration before the swallow?
Chin tuck
How can a tracheostomy tube impact a patient’s ability to swallow?
Reduces or eliminates the flow of air through the glottis
Laryngeal muscles may weaken due to not being used
Glottis closure may not be coordinated as much
Larynx may not move forward and up as much
Larynx may not close as much
Esophagus may be narrowed due to the presence of the tube
Larynx may not be as sensitive to things entering it
Cough reflex reduced
Decrease in subglottal air pressure
When conducting trial swallows as part of an assessment, you can administer the following in this order:
dry swallow (if they struggle with dry swallow, as indicated by the larynx not moving up a lot, then do not give the other liquids and solids) —> thin liquid — > thickened liquids —> pudding/puree (e.g., applesauce) — > chopped/minced —- > cookie/cracker
What instructions do you give a patient to assess tongue range of motion pertaining to the tongue tip?
“Try to reach your chin with your tongue” and “Try to reach your nose with your tongue”
What are the instructions for the trial swallow?
Greet the patient — > do an OME —-> tell them that they will try food and liquid so that you can see how they swallow —> hold the food or liquid in your mouth and then swallow when I say, “Go!”
For solids, what is the order of consistencies from easiest to hardest to chew?
Puree —- > Puree with Bread – > Mechanical Soft (ground) — > regular
What is an example of pureed food?
Pudding, applesauce, yogurt, and mashed potatoes
Questions to ask before trial swallows include?
What symptoms are you experiencing? How long have you experienced those symptoms? When do you experience these symptoms? Any family history of cancer? Any previous problems with swallowing, GI, or breathing?
What kind of diet would you give to someone with difficulty swallowing?
Dysphagia mechanical soft diet (minced moist), so it is easy to chew.
