Dysphagia 3 - Clinical Evaluation Flashcards
Identify the following medical abbreviations:
(b/s)
(b/se)
Bedside / Clinical exam
Identify the four main components of a swallow exam.
Chart review/Medical History
Patient interview
Physical Inspection
Test swallows
Why would a swallow exam be used as a screening device?
What is the purpose of an instrumental exam?
What type of instrumental swallow exam is considered the “gold standard”?
To determine whether a patient required post-treatment/prevention planning.
To evaluate patients.
Barium Swallow Study
The purpose of a clinical exam is to determine whether a patient can . . .
Safety (i.e. w/out aspiration)
Maintain appropriate Nutritional intake (i.e. calories)
Continuation or modification of diet (i.e. up/downgrade)
Need for treatment (I.e. strategies to allow patient to eat at highest diet level possible).
Referrals
Establish medical diagnosis (dx)
(Most important aspect of a chart review *)
What is the purpose of a medical chart review?
Preparation before seeing patient
Take note whether there is any mention of Advanced directive
Get an update on their current Medical status
NPO (Nothing Per Oral) status (e.g. fasting for an upcoming procedure)
Name some of the elements of a chart review. (i.e. type of info)
Sources of Info Patient Illness (medical diagnosis) Surgical procedures Respiratory status Esophageal disease Feeding / Nutrition / Hydration Prior test results
What type of feeding tube is meant for short term use?
If a patient developed an infection during use of this type of tube, what structure would it develop inside of?
NG tube
Oropharynx
What type of feeding type in inserted by surgery under anesthesia?
What type of tube is inserted under local anesthesia?
Are these tubes meant for short or long term use?
Gastronomy tube
PEG tube
Long term use
Where is a jejeunostomy inserted?
What is the purpose of this procedure?
The top part of the intestine
To minimize a patient experiencing reflux
Which type of feeding tube is preferred in newborns?
Although it is similar to a NG tube, it differs b/c it is inserted into the (?).
This type of tube keeps which passage open?
What is the downside of using this tube?
Orogastric
Same tube as NG but inserted into the mouth
Preferred in newborns
Keeps nasal passage open
Interferes w/ lip closure & tongue function
Identify the three types of food levels SLPs use to treat dysphagia patients.
Name some examples of each level.
What is the purpose of establishing diet levels?
Puree: blended veggies, meat, apple sauce, pudding, yogurt, cream of wheat, mashed potatoes, hummus
Mechanical soft: grits, oatmeal, scrambled eggs, stuffing
Regular
Diet levels relate to chart review & everything you will do in swallowing.
Identify the four levels in the national dysphagia diet.
Puree
Mechanically Altered - uses semi-solid, solid food; something that requires them to chew
Mechanically Advanced Uses soft solid foods that require quite a bit of chewing.
Regular - They can have whatever they want.
Provide some examples of a thin liquid.
Identify the 3 types of “thickened” liquid levels.
Why type of thickness is not recommended due to low levels of dehydration?
Water, tea or soda
Nectar, honey & pudding thick
Pudding
T/F - Foods that melt to a liquid are NOT considered thin liquids.
If so, identify some examples.
False
Ice cream or Jello
Identify the seven objectives of a patient interview.
Discuss patient’s chief complaint
Patient perception of problem
SWAL-QOL
SWAL-CARE
Determined Onset** (i.e. when did this problem occur?)
Determine consistency of food associated w/ swallow event (e.g. liquids vs solids)
Frequency, timing of occurrence, and duration**
Globus sensation (i.e. full sensation in throat)
Compensations (What does the patient do?)
Identify the objectives of a physical inspection for a patient w/ dysphagia.
Mental status & cognitive screening
Language & articulation
Oral-Motor/Cranial nerve exam
What structures does the oral-motor & cranial nerve exam look at during a physical inspection?
Face Jaw (Fig. 9-5) Tongue Pharynx/Larynx Velum Gag Reflexes
What areas are examined during a physical inspection of the face?
Evaluate at rest & w/ movement
- Left vs right asymmetry
- Upper vs Lower assymetry
Upper Motor Neuron vs Lower Motor Neuron symptoms
Identify Upper motor neuron symptoms.
Identify Lower motor neuron symptoms.
UMN symptoms: spastic, hyperreflexia
LMN symptoms: flaccid, hyporeflexia, tongue fasciulations/atrophy
Identify the three areas a SLP would examine during a physical inspection of the pharynx/larynx.
During this inspection, a patient w/ a wet, gurgly voice indicates something has entered the (?).
What should you ask the patient to do before presenting food?
What should the patient do for a SLP to get a status of their VFs & larynx?
If the patient aspirates, what may be the reason for this action?
Phonation
Volitional cough
Dry swallow
A wet voice indicates something has entered the airway.
Cough
Produce a “ah”, “ee” or “count”
It may be due to the type of food/liquid consumption.
What is the purpose of estimating a patient’s oral transit time?
How is OTT conducted appropriately?
Describe an OTT procedure.
OTT looks at the time a patient stops moving their tongue.
During MBS study.
You feel & observe when a patient stops moving their tongue, start counting until you feel the larynx move
Describe how crvical auscultation is conducted.
What type of damage might a patient have if tongue atrophy is detected during an oral cavity inspection?
Uses stethescope to listen to swallow acoustics
LMN damage
Identify the four points of an oral inspection.
Describe the four objectives during an oral cavity inspection.
Oral inspection, positioning, self-feeding & environment (distractions).
Lesions Candida Xerostomia (dry mouth) Hygiene Odynophagia (painful)
What is the general rule for conducting a test swallow?
When in doubt, what should you use as a guide? (HINT: DAPPCAP)
If Risk is high, benefit is low = DO NOT ADMINISTER A TEST SWALLOW!!!
Directions (Can they follow directions?) Acutely ill (Are they medically stable?)
Protocol/procedure
Pulmonary significant (Do they have COPD? )
Cough weak (Can they protect themselves?)
Age (>80 y/o)(Risk Increases w/ age)
Pharyngeal dysfunction (Unknown w/out MBS, but look for indicators)
Identify the basic procedure in conducting a test swallow.
Gather Basic supplies
Explain procedures in clear, concise manner
Follow proper Protocol/procedure
Describe the ideal procedure/protocol to follow during test swallows.
Crushed ice (least harmful if aspiration occurs)
Use other consistencies such as:
Food - puree, soft solid, ground, regular
Liquids - thickened, thin
Increase in volume before texture (5ml, 10ml, 20ml)
cup, straw
What might a dietary tray for a test swallow consist of?
A tray might consist of foods at every level, ice, emissary basin, tongue depressors, & towels
What type of information is visible on a bedside monitor?
- Sats, RR, BP, HR
- Feeding pump monitor
- Ventilator monitor
Identify a normal vital sign for the following: O2 Sats RR HR BP
T/F - Vital signs are the same for infants & adults
O2 Sats 99 – 100%
RR 12 – 20
HR 80 – 100
BP
False
Name three other types of bedside procedures that can be used for test swallows.
3oz H20 swallow test - Ask patient to drink it w/out interruption.
Pulse Oximetry/Oxygen saturation - measures oxygen saturation level in the blood (usually at 99%)
Blue dye test
Be sure to review the last five slides in this powerpoint.
Yes!!!
