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NUTR 344 > Dysphagia > Flashcards

Dysphagia Flashcards

1
Q

What kind of reflex is swallowing? When do humans develop it?

A

Primitive Reflex:

• Human fetus can swallow at 12 weeks gestation; before CNS has completely developed

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2
Q

What are the functions of swallowing?

A

Serves 2 Functions:

  1. Nutrition
  2. Protects from aspiration
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3
Q

What components do we swallow?

A

Saliva
Food
Fluids

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4
Q

What are the components of saliva?

A

water, electrolytes and proteins

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5
Q

What are the functions of saliva?

A 
1-2L produced each day
• Moistens food
• Digestion
• Antibacterial protection • Enhances taste
• Oral hygiene
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6
Q

WHat are the locations of muscles involved in swallowing?

A

25 muscles involved: mouth, pharynx, larynx, esophagus

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7
Q

Swallowing & breathing co-ordinated by __ nerves

A

Swallowing & breathing co-ordinated by cranial nerves

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8
Q

What are the 5 cranial nerves?

A 
V: Trigeminal 
VII: Facial Nerve
IX: Glossopharyngeal
X: Vagus
XII: Hypoglossal
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9
Q

Describe V: Trigeminal nerve

A

Oral preparatory and oral transit phases
• Motor: mastication
• Sensory: taste and touch

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10
Q

Describe VII: Facial Nerve function in taste

A

Taste on anterior 2/3 of tongue

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11
Q

Describe IX: Glossopharyngeal nerve

A

Pharyngeal & esophageal phases
• Motor: swallowing, gag reflex
• Sensory: palatal, glossal & oral sensations

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12
Q

Describe X: Vagus nerve

A

Pharyngeal and esophageal phases
• Motor: GI activity
• Sensory: Cough reflex, taste on posterior 2/3 of tongue

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13
Q

Describe XII: Hypoglossal nerve

A

All phases

• Motor: Tongue movement

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14
Q

What are the 4 phases of swallowing?

A
  1. Oral preparatory phase
  2. Ora ltransit phase
  3. Pharyngeal phase
  4. Esophageal phase
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15
Q

Which swallowing phase is the initial phase?

A

oral preparatory phase

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16
Q

What type of control is oral preparatory phase under?

A

voluntary

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17
Q

What are the nerves involved in oral preparatory phase?

A

CN: V, VII, XII

• Trigeminal, facial & hypoglossal

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18
Q

What happens in the oral preparatory phase?

A
  • Food & drink enter mouth
  • Saliva secreted
  • Lips seal mouth
  • Soft palate drop to base of the tongue
    * Protects the airways from food spillage
  • Tongue moves food around the mouth, mixes with saliva
  • Mastication, physical breakdown of food
  • Bolus formed and between tongue and soft palate
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19
Q

When/why is saliva secreted?

A
  • Response to food entering mouth

* Visual response to food “mouth waters”

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20
Q

What are the consideration for oral preparatory phase?

A
  • Sight
  • Ability to self feed
  • Hand mouth coordination
  • Lip seal
  • Tongue control / strength
  • Oral sensation
  • Dentition / chewing difficulty
  • Cognition
  • Positioning
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21
Q

What type of control is oral transit phase under?

A

voluntary

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22
Q

What are the nerves involved in oral transit phase?

A

CN: V, VII, XII

• Trigeminal, facial & hypoglossal

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23
Q

What happens in the oral transit phase?

A

Soft palate raises to seal nasal cavity from oropharynx
• Important for pressure to help propel bolus to pharynx
• Prepared bolus propelled to the oropharynx
• Anterior and lateral edges of tongue are raised and contact alveolar ridge
• Blade of tongue is pressed against hard palate and moves in a wave like motion (front to back)
• Posterior tongue is depressed and velum is elevated propelling bolus into oropharynx

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24
Q

Considerations: Oral Transit Phase

A
  • Foods that don’t form cohesive bolus, might get stuck (• Honey, peanut butter; • Saltine crackers)
  • Pocketing
  • Tongue strength
  • Oral hygiene
  • Oral sensation
  • Energy level of individual
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25
Q

What type of control is pharyngeal phase under?

A

Autonomic control (involuntary)

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26
Q

How long does pharyngeal phase last>

A

about 1 sec

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27
Q

What are the nerves involved in pharyngeal phase?

A

CN: IX, X, XII

• Glossopharyngeal, vagus & hypoglossal

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28
Q

Which swallowing phase is the most complex?

A

Pharyngeal Phase

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29
Q

What is the role of Pharyngeal Phase?

A
  • Ensures bolus enters esophagus and airways are protected
  • Soft palate still sealing the nasal cavity from oropharyngeal cavity
  • Respiration stops to protect airway
  • Vocal folds close, larynx elevates and epiglottis tilts backwards blocking off the larynx
  • Suprahyoid muscles elevate hyoid bone contribute to blocking the airways
  • Pressure helps pull the bolus backward toward the esophagus
  • Cricoid cartilage up & away from the posterior pharyngeal wall
  • Thereby opening the upper esophageal sphincter (UES)
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30
Q

When does pharyngeal phase begin?

A

Begins once bolus is propelled past the anterior faucial pillars which “triggers” involuntary swallow

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31
Q

When does breathing resume

A

once pharyngeal phase finishes

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32
Q

Summary of Pharyngeal Phase

A
  1. Nasal passages sealed
  2. Laryngeal muscles are involved in vocal fold closure
  3. Epiglottis drops and covers larynx
  4. Respiration stopped
  5. Bolus propelled towards esophagus
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33
Q

Considerations: Pharyngeal phase

A
  • Faucial pillars • Pharynx
  • Larynx
  • Epiglottis
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34
Q

Signs and symptoms of pharyngeal phase not going well

A
  • Gagging
  • Choking, coughing
  • Watery eyes
  • Nasopharyngeal regurgitation • “Wet” vocal quality
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35
Q

Esophagus has a __ at either end

A

Esophagus has a spinchtre at either end

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36
Q

Name sphincters of esophagus

A
  • UES: Upper esophageal sphincter

* LES: Lower esophageal sphincter

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37
Q

When does peristalsis begin

A

Peristalsis begins after swallow

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38
Q

What is the main function of esophagus

A

motility

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39
Q

How many layers does esophagus have?

A

4

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40
Q

Describe UES

A

(Upper Esophageal Sphincter):
• Mainly cricopharyngeal muscle
• AKA pharyngoesophageal junction
• Main barrier in preventing laryngopharyngeal reflux

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41
Q

WHat control type is esophageal phase under?

A

Autonomic/ involuntary

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42
Q

What are the nerves involved in esophageal phase?

A

CN: IX, X, XII

• Glossopharyngeal, vagus, hypoglossal

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43
Q

What happens during esophageal phase

A
  • Relaxation of cricopharyngeal muscles helps open UES
  • Bolus passes through the UES into esophagus
  • UES is sealed-> Prevents regurgitation
  • Peristalsis propels bolus towards the lower esophageal sphincter (LES)
  • LES relaxes & food enters the stomach
  • Secondary peristaltic waves if remnants in esophagus
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44
Q

What might difficulties at esophageal phase might be due to?

A
  • mechanical obstruction / cancer / GERD

* Not necessarily age related

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45
Q

Main function of Oral Preparatory Phase

A

Food is prepared into bolus

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46
Q

Main function of Oral transit Phase

A

Bolus propelled towards pharynx

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47
Q

Main function of Pharyngeal Phase

A

Airways are protected as bolus moves through oropharyngeal cavity towards the esophagus

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48
Q

Main function of Esophageal Phase

A

Bolus propelled through esophagus into stomach

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49
Q

What does GERD stand for? WHat happens?

A

Gastroesophageal Reflux Disease

• Reflux of gastric contents into esophagus

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50
Q

Normal functioning vs GERD

A
  • Normally;; pressure in esophagus > pressure in stomach;; keeps LES sealed.
  • When LES pressure is lowered, gastric contents can flow backwards into esophagus
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51
Q

GERD signs and symptoms

A 
Gastric acid and pepsin are found in esophagus
• Dysphagia
• Heartburn
• Increased salivation
• Belching
• Radiating pain: back, neck or jaw 
• Throat clearing / Hoarseness
• Refusal to eat (children)
• Abdominal pain
• Aspiration
• Ulceration
• Barrett’s Esophagus
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52
Q

GERD triggers

A
  • Increased secretion of gastrin, estrogen, and progesterone
  • Medical conditions: hiatal hernia, scleroderma, obesity
  • Smoking
  • Medications: dopamine, morphine, theophylline
  • Foods: high fat, chocolate, spearmint, peppermint, alcohol, caffeine
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53
Q

Gerd: Treatment goals

A

3 major treatment goals:

  1. Increasing LES competence
  2. Decreasing gastric acidity, decreasing symptoms
  3. Improving clearance of the esophagus
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54
Q

GERD treatment methods

A
  • Medical Management
  • Nutrition Therapy
  • Lifestyle Intervention
  • Surgery
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55
Q

GERD medication classes

A 
Antacids
Foaming agents
H2 antagonists
Proton pump inhibitors
Prokinetics
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56
Q

Antacids- description and precautions

A

combination of 3 basic salts: Mg, Ca, and aluminium- with hydroxide or bicarbonate ions to neutralize HCl
May have side effects
Mg salt can lead to diarrhea. Aluminium salt can cause constipation
These two can be combined to eliminate their effects

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57
Q

Foaming agents- description and precautions

A

Combination of Al, Mg, and sodium bicarbonate. Reduce the symptoms associated with reflux

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58
Q

H2 antagonists - description and precautions

A

Block histamine receptors that are components of acid secretion stimulation
These drugs provide short-term relief, but should not be used for more than a few weeks at a time
Effective for 50% of patients with GERD

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59
Q

Proton pump inhibitors

A

Block H+ K+ ATPase enzyme necessary for HCl production

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60
Q

Prokinetics- description and precautions

A

Help strengthen pyloric sphincter and increase speed of gastric emptying
May have frequent side effects that can limit their usefulness in treatment of GERD

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61
Q

Lifestyle Intervention for GERD

A
  • Weight loss if necessary
  • Avoid:
    • Eating within 3-4 hours of going to sleep
    • Lying down after meals
    • Tight fitting clothing
    • Smoking
  • Elevate head of bed while sleeping
62
Q

When would surgery be used for GEDR

A

As a last resort/ complications

63
Q

What are the GERD surgeries

A
  • Laparoscopic Nissen fundoplication: Fundus of the stomach is wrapped around the lower esophagus, giving the LES more strength and helps to avoid reflux
  • Stretta Procedure: balloon is inflated with electrodes, radiofrequency is applied, tightened junctions prevent reflux
64
Q

What is Barrett’s esophagus?

A

Barrett’s esophagus is a condition in which the lining of the esophagus changes, becoming more like the lining of the small intestine rather than the esophagus. This occurs in the area where the esophagus is joined to the stomach.

65
Q

WHat is the prevalence if Barrett’s esophagus ?

A

• Found in 10% of patients undergoing endoscopy

66
Q

What are the changes that occur in barret’s esophagus condition

A
  • Persistent abnormal pH in esophagus despite medical management
  • Change in the esophageal mucosa’s epithelial cells:
    • Squamous cell-> metaplastic columnar cells
    • Precursor for esophageal cancer
67
Q

What are the symptoms of Barrett’s esophagus

A

• No specific symptoms

68
Q

What are the nutritional concerns of Barrett’s esophagus

A

No specific nutrition concerns unless diagnosed with cancer

69
Q

What is the treatment for Barrett’s esophagus?

A

Treatment is relieving GERD symptoms
• Chronic disease prevention
• Reduce long term health care costs

70
Q

What are the nutrition-related problems associated with GERD nutrition therapy?

A
  • Excluding food groups may lead to nutritional deficiencies

* Long-term medication use may impair B12, Ca2+, and Fe absorption

71
Q

What is the nutrition intervention for GERD?

A
  • Decrease exposure to gastric contents
    • Small frequent meals
    • Low fat foods, chocolate, mint
    • Avoid alcohol
  • Reducing gastric acidity:
    • Avoid: coffee, (decaf and regular)
    • Fermented alcoholic beverages
  • Prevent pain and irritation
    • Avoid any foods causing pain
72
Q

Foods that may relax the lower esophageal sphincter (foods to avoid durign GERD)

A 
Peppermint or spearmint
Chocolate
Fried foods or those with high amounts of added fat 
Alcohol
Coffee (decaffeinated and caffeinated)
73
Q

II. Foods that may increase gastric acid secretion (avoid with GERD)

A

Coffee (decaffeinated and caffeinated)
Alcohol
Pepper

74
Q

Name alternative medicine remedies used in diseases of upper gastrointestinal system

A 
bitter orange
butterbur
chamomile
Chinese rhubarb
Curcumin 
Ginger
Goldenseal
Nutmeg
Peppermint
Probiotics
Self-heal
Turmeric
75
Q

Dysphagia from greek

A
  • dys-> disordered

* phagia-> eating

76
Q

What is the definition of dysphagia?

A

Any difficulty in swallowing or inability to swallow

  • at 4 swallowing phases
  • of Solids / liquids
77
Q

Is dysphagia a disease?

A

• Not a disease, rather a symptom caused by a variety of disorders

78
Q

WHat are the medical conditions associated with dysphagia?

A

Stroke
Various neurological causes
Nead and neck cancer

Results from diseases: 
• Neurological
• Physical barriers
• Less common:
      • Developmental disabilities 
      • FAS
      • Injury
79
Q

Which sex experiences dysphagia more frequently?

A

Women report them more often then men

80
Q

What is the etiology of dysphagia?

A

highly variable

81
Q

What is the extent of recovery from dysphagia depend on

A

Extent of recovery depends on the etiology • Permanent / transient

82
Q

Neurological conditions associated with dysphagia

A
  • Stroke
  • MS
  • Alzheimer’s disease, Huntington’s Disease, Parkinson’s Disease
  • Cerebral palsy
  • ALS
83
Q

Conditions associated with transient Dysphagia?

A
  • Chronic Anemia-> Esophageal webs
  • Bell’s palsy-> Cranial nerve pressure, infection
  • GERD
  • Cancer: Esophageal; Tumors (Head & Neck); Treatment side effects; Chemo/radiation
  • Intubation
84
Q

What are the 2 main types of dysphagia?

A
  1. Oropharyngeal Dysphagia

2. Esophageal Dysphagia

85
Q

What are the subclasses of oropharyngeal Dysphagia

A

i. Oral
a. Preparatory
b. transit
ii. Pharyngeal

86
Q

What is Oropharyngeal dysphagia characterized by?

A

Oropharyngeal or transfer dysphagia is characterized by difficulty initiating a swallow.

87
Q

Oral Dysphagia bases

A
  • Weak tongue and lip muscles,
  • Difficulty propelling food to throat
  • Difficulty initiating a swallow
  • Weakness
  • Decreased oral sensation
88
Q

Oral Dysphagia Signs

A
  • Reduced lip seal
  • Food pocketing
  • Drooling
  • Food/ liquid spillage (anterior loss)
  • Repetitive rocking of tongue from front to back (lingual pumping)
  • Reduced range of tongue motion, shape and coordination
89
Q

Pharyngeal dysphagia Symptoms

A
  • Delayed swallowing reflex
  • Swallow does not clear bolus from the throat
  • Bolus may penetrate into the larynx
90
Q

Pharyngeal Dysphagia Signs:

A
  • Repeated swallowing
  • Frequent throat clearing
  • Wet vocal quality
  • Complaints of food stuck in throat (globus sensation)
  • Repeated pneumonia
  • Fever
  • Chest/lung congestion
91
Q

Causes and symtomps of esophageal dysphagia

A
  • Structural blockages
  • Stenosis
  • Strictures due to:
    • GERD
    • Esophageal dysmotility
  • Pressure or discomfort in the chest • Chronic heartburn
92
Q

Complications of Dysphagia

A
  • Inadequate oral intake
  • Weight loss
  • Malnutrition
  • Choking
  • Aspiration Pneumonia
  • Dehydration
  • Decreased rehab potential
  • Depression
  • Decreased QOL
  • Increased length of hospital stay
  • Increased costs
93
Q

What is aspiration?

A

The accidental inhalation of food or particles or fluids into lungs

94
Q

What is silent aspiration?

A

• No signs of aspiration present, no coughing or choking, but food or liquids are entering the lungs

95
Q

What is aspiration pneumonia?

A

Results from aspirated contents causing inflammation in the lungs

96
Q

Techniques to prevent aspiration

A
  • Upright positioning for feeding
  • Chin down when swallowing liquids
  • Small quantities
  • Dry swallow to clear pharyngeal cavity
97
Q

What is a drw swallow?

A

A dry swallow is generally regarded as a voluntary swallow carried out at the request of the medical or technical attendant during a manometric examination. The swallow is therefore unstimulated by the presence of fluid, saliva or a bolus in the mouth or esophagus.

98
Q

What is often overlooked but is a risk factor for aspiration

A

Dental Care / Oral Hygiene

99
Q

Why is poor oral hygiene a risk factor for aspiration? What does it increase the risk of?

A

Aspiration of saliva from poor oral hygiene increases risk of aspiration pneumonia

100
Q

What are the special tools for oral hygiene for aspiration?

A
  • Suction toothbrushes
  • Curve toothbrushes
  • non-foaming toothpaste
101
Q

Which approach should be used for dysphagia screening

A

Multidisciplinary approach:

• Physician, nurse, SLP, Pdt, OT, Psychologist, PT • THE INDIVIDUAL, and/or family members

102
Q

• Initial screening for dysphagia can be done using:

A
  • Pts history & physical
  • Bedside screening
  • Observing patient while eating
103
Q

Who is at risk for dysphagia?

A
  • Stroke (CVA)
  • Alzheimer’s
  • Parkinson’s
  • Multiple Sclerosis
  • Sjogren’s syndrome
  • Head & Neck cancers
  • Radiation to head, neck or thoracic regions
  • EN
  • Zenker’s Diverticulum
  • Esophageal Strictures
  • Achalasia
  • Scleroderma
  • Amyloidosis
  • Diabetic neuropathy
  • Xerostomia
  • Mucositis
  • Post-extubation
  • Tracheostomy
104
Q

SYMPTOM screening for dysphagia

A
  • Drooling, excessive secretions
  • Pocketing of food
  • Poor tongue control/ movements
  • Facial weakness
  • Difficulty chewing
  • Slurred speech (dysarthria)
  • Frequent throat clearing
  • Complaints of food getting “stuck”
  • Mucositis or xerostomia
  • Weight loss
  • Coughing before, after or during swallowing
  • Delayed swallow reflex
  • Poor control of head or body
  • Bad positioning
  • Nasal regurgitation
  • Presence of oral lesions
  • Wet or “gurgly” voice
  • Absent swallow reflex
  • Pneumonia
105
Q

How cariess out bedside swallow? What does it involve?

A
  • Performed by OT, SLP or Pdt
  • Ask a series of questions
  • Monitor eating
106
Q

What is assessed during bedside swallow?

A
  • Tongue strength & mobility
  • Lip seal, food pocketing
  • Coughing or choking
  • Voice changes post swallow
  • Repeated swallowing
  • Mechanical factors that impair swallowing • Symmetry of jaw and facial muscles
  • Presence of oral lesions
107
Q

What is the procedure of modified barium swallow?

A
  • Patient given a barium sulfate “milkshake” to drink
  • Drinking is visualized by fluoroscopy or x-ray
  • Used for video fluoroscopic swallow study (VFSS)
108
Q

What does modified barium swallow permit to see?

A
  • Physician or SLP can monitor swallow, from mouth through the stomach into duodenum
    * Degree of aspiration, bolus transit time, integrity of swallow, presence of dysphagia, motility problems
  • Can determine other abnormalities: • Ulcers, tumors, inflammation
109
Q

What is FIBEROPTIC ENDOSCOPIC EVALUATION OF SWALLOWING (FEES)? What is assessed and how>

A
  • Long flexible tube with a lens, and a light
  • Passed through the nose until the hypopharynx
  • Clinician has a view of larynx, epiglottis, vocal folds
  • Swallowing function is assessed while patient eats foods of different consistencies, each with a different food dye color
  • Looks for different color residue on the vocal folds after swallow
110
Q

Downsides of FEES?

A

• White out period prevents from seeing the actual swallow

111
Q

Where can FEES be done?

A

• Can be done at bedside, or in a clinic

112
Q

Dietitian’s Assessment components of patients with dysphagia

A
  • Weight, weight changes
  • Height
  • BMI
  • Swallowing problem history
  • Recurrent pneumonia
  • Slurred speech
  • Presence of GI bleeds
  • Diet history
  • Blood pressure
  • Dental Care
  • Positioning
  • Results of swallowing tests
113
Q

What does the Assessment By Dietitian try to determine?

A
  • Cause of dysphagia
  • Determine consistency of food able to swallow
  • Tolerance to foods
  • Food intake (supplements ?)
  • Fatigue with eating
  • Medications
  • Lab results/ biochemistry
114
Q

What techniques can be used to determine consistency of food able to swallow

A

Bedside evaluation or MBS

115
Q

Chewing difficulty- nutrition interventions

A
  • Physical assessment of oral cavity—need for mouth care or dentures.
  • Adjust texture of foods according to need.
  • Provide adequate moisture.
  • Adaptive equipment as needed.
116
Q

Inability to maintain adequate oral intake- nutrition intervention

A
  • Determine energy and protein requirements.
  • Establish food preferences.
  • Increase nutrient density.
  • Adjust size and timing of meals.
  • Maximize environmental support: lights, noise, odor.
  • Allow for extended eating times.
  • Trial of high-kcalorie, high-protein supplement.
  • Determine need for other nutrition support routes.
117
Q

Inadequate fluid intake- nutrition intervention

A
  • Determine fluid requirements and establish method to track intake.
  • Assess side effects of medications that might interfere with adequate fluid intake.
  • Schedule small, frequent amounts of fluid.
  • Determine need for other nutrition support/hydration routes.
118
Q

Purpose of Nutrition Care For Dysphagia

A
  • Provide appropriate nutritional and fluids to patient
  • Progress meal plan to a greater variety of foods as swallow function improves
  • Provide foods that stimulate the swallow reflex
  • Support independent eating
  • Improve nutritional deficiencies
  • Reduce risk of aspiration/choking
  • Teach
  • QOL
119
Q

What if there’s inadequate oral intake in dysphagia?

A
  • Supplements

* EN as a last resort

120
Q

Which foods should be omitted in dysphagia?

A
  • Stringy fruits/ vegetables
  • Nuts, seeds, coconuts
  • Foods that crumble easily
  • Popcorn, potato chips, muffins, cakes, cookies and biscuits
121
Q

__ agents may help with swallowing

name such agents

A

Moistening agents may help with swallowing

• Gravies, sauces, butter, margarine, mayonnaise, sour cream

122
Q

• __ or __ foods stimulate swallowing best

A

• Hot or cold foods stimulate swallowing best

123
Q

• High __ or high _- diet to ensure adequate intake

A

• High protein or high energy diet to ensure adequate intake

124
Q

Should we maintain single consistency in diet of patient with dysphagia

A

no.

we should provide mixed consistencies

125
Q

Describe NDD diet

A

NDD (National Dysphagia Diet)
• Regular, soft, minced, puree
• Nectar, honey, pudding

126
Q

OPDQ Guidelines on modifying food textures and fluid consistencies based on __

A

OPDQ Guidelines on modifying food textures and fluid consistencies based on APNED

127
Q

What are the categories of food with altered textures? Liquid?

A

Foods: tender-> soft-> minced-> pureed
Liquid: clear-> nectar-> honey-> pudding

128
Q

Describe tender menu. Which foods are not permitted?

A

A regular menu
Everything is allowed EXCEPT hard or raw foods (nuts, no breads with seeds or dry nuts, no hard veggies such as carrots, celery, broccoli; no dry prunes, dates, popcorn, nachos, crunchy peanut butter
Most vegetables are cooked

129
Q

Describe soft menu. Which foods are not permitted?

A

• Chewing is possible, but more difficult •
Can separate foods with a fork

Foods Not Permitted
Soup: All allowed.
Protein: Tender restrictions + No tough seafood, grilled seafood. No melted cheese topping.
Starches: Tender restrictions + No whole wheat or large pasta, no brown or wild rice. No Melba toast, tough breads.
Vegetables: Tender restrictions + No bean sprouts, snow peas, lettuce, corn, sauteed mushrooms. (Creamed corn OK)
Desserts: Tender restrictions + No crisp toppings or tough pastries.
No grapes, very fibrous fruits and fruits with peel, canned whole pineapples (crushed is OK)

130
Q

Describe soft menu. Which foods are not permitted?

A
  • Can be eaten with a spoon or fork
  • Requires minimal chewing
  • Finely cut (5mm or less) with sauce • Can be reshaped or reformed

Foods Not Permitted
Soup: Creamed
Protein: Soft restrictions + Meats must be minced. Sauce obligatory. NO Peanut butter.
Starches: Soft restrictions+ No Bread.
Vegetables: Soft restrictions + Cooked vegetables that are pureed or very finely minced.
Desserts: Soft restrictions + No cake
*Smooth puddings, mousses, yogurts, applesauce.

131
Q

Describe pureed menu

A
  • Foods are totally pureed, no lumps or coarse textures are allowed
  • Fruits must be pureed, no seeds, pulp, or skins
  • Desserts must be smooth, like custard or yogurt, no lumps
  • Cereals have to be homogeneous and “pudding” like, no oatmeal
  • Meats and substitutes must be very smooth in consistency and pureed, no peanut butter (unless in recipe and easy to swallow)
  • Soups should be strained to avoid lumps, or pureed, if thickened fluids need, should be thickened to right consistency
  • Texture is very homogeneous at this phase, gravies and sauces are added for eye appeal, palatability, and enjoyment
132
Q

What is viscosity?

A

• Internal friction of a liquid or its resistance to flow

133
Q

How is viscosity measured?

A
  • Measured in controlled condition
  • Units are cP (centipoises or milliPascal seconds)
  • Bostwick consistometer is used as QA for dysphagia thickened liquid products-> Measures distance a material flows in 30 seconds
  • Has proven clinical efficiency
134
Q

Viscosity parameters of clear liquids.

+ description

A
  • 24±1cm/30sec

* Regular liquids with no adjustments needed

135
Q

Viscosity parameters of nectar.

+ description and examples

A
  • 14 ±1cm/30sec
  • Falls slowly from spoon, can be sipped from a straw or from a cup
  • Buttermilk,tomatojuice,Yoplaitdrink,
136
Q

Viscosity parameters of honey.

+ description and examples

A
  • 8 ± 1cm/30sec
  • Drops from a spoon, but to thick for a straw
  • Tomato sauce
137
Q

Viscosity parameters of pudding.

+ description and examples

A
  • 4 ± 1cm/30sec
  • Maintains shape, to thick to use a straw or cup, need to use a spoon
  • Pudding
138
Q

Describe the IDDSI framework

A

The IDDSI framework consists of a continuum of 8 levels (0-7), where drinks are measured from Levels 0 – 4, while foods are measured from Levels 3 – 7.
https://iddsi.org/wp-content/uploads/2019/03/IDDSI-Pyramid-revised-2018-with-logo-286x300.jpg

139
Q

How can IDDSI flow rst be used to classify liquids?

A

it can be used to classify liquid thickness on a level 0-3 base on their rate of flaw when placed in a syringe

140
Q

Describe steps of IDDSI syringe flow test

A

1) remove the plunger
2) cover nozzle with finger and fill 10ml
3) release the nozzle and start timer
4) stop at 10 sec

10ml= 4
8ml= 3
4ml= 2
1ml= 1
empty= 0
141
Q

What has to be used with level 0 liquids?

A

Use iddsi fork-drip/spoon-tilt instead

142
Q

Does APNED use IDDSI?

143
Q

Name Thickening products

A
  • Mashed potatoes
  • Skim milk powder
  • Whey powder
  • Corn starch
  • Grated cheeses
  • Powdered beverages
144
Q

WHat are temperature concerns with the food served?

A
  • Separation can occur with delays between food preparation and eating
  • To prepare foods at home, should be prepared and served without delay • Requires good care-giver education
145
Q

How are temp& melting a concern for dysphagia patients?

A

Think of foods that melt in the mouth that might an issue for those with oral- pharyngeal dysphagia

146
Q

Critical points for foods in terms of Temperature, Delays & Melting
Why?

A

foods and fluids must have a stable consistency for those with oral- pharyngeal dysphagia
• No separation or thawing into thin liquid allowed
• Aspiration & Complication risk increases

147
Q

Information For Caregiver (12)

A
  1. Diet is designed to decrease choking risk
  2. Follow CFG for servings, or other guide for separate disease (QMP for diabetes)
  3. Small frequent meals: helps with tolerance/ fatigue/ frustration
  4. Small meals prior to resting;; to help minimize reflux and aspiration risk
  5. Clean mouth after eating
  6. Proper positioning of head and body
  7. Sit up for 15-30 minutes prior to rest
  8. Use best side/ coordinated side of mouth
  9. Small mouthfuls
  10. Avoid liquids to wash down food
  11. Follow “thickened” guidelines
  12. Medications consistent with swallowing abilit
148
Q

Stroke patients may feel frustrated with___

A

Stroke patients may feel frustrated with loss of skills in many aspects

149
Q

Which kinds of food should be suggested

A

• Suggest foods that do not need a lot of texture change

150
Q

Impact on Individuals & Society of dysphagia

A
  • Afraid to eat due to symptoms
  • Demands on families
  • Loss of independence can lead to depression
  • Financial, new foods and preparation techniques
  • Risk of malnutrition & dehydration, and other nutritional diseases
  • Choking is uncomfortable for individuals and others around them

NUTR 344 (22 decks)

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