Dysphagia PP

Question 1

What is dysphagia? What is it not?

Answer 1

a swallowing disorder that may be acute or life-long and it worsen gradually; it is not a feeding disorder-a problem with presenting food into the mouth

Question 2

What are potential causes of dysphagia?

Answer 2

congenital abnormalities, structural changes, metabolic and/or neurologic etiology, effects of medications

Question 3

What are common myths in relation to food intake?

Answer 3

liquids are easier to manage than solid foods and vice versa; eating a lot = eating well (quality vs. quantity), practice eating with a certain texture makes perfect

Question 4

Dysphagia exists on a ____ , it can range from ____ to_____

Answer 4

continuum; can’t eat or drink anything to no texture modifications

Question 5

What percentage of adults admitted into acute trauma centers have dysphagia?

Answer 5

61%

Question 6

What percentage of individuals admitted into rehab settings have dysphagia?

Answer 6

41%

Question 7

What percentage of patients in nursing homes have dysphagia?

Answer 7

30-75%

Question 8

What percentage of patients admitted into hospitals have dysphagia?

Answer 8

25-30%

Question 9

Exact prevalence of dysphagia is unknown, but may be as high as ___ in _____

Answer 9

22%; those over age 50.

Question 10

What are the 5 phases of swallowing?

Answer 10

oral acceptance, oral prep, oral, pharyngeal, esophageal

Question 11

What is the oral acceptance phase?

Answer 11

when you sense and recognize that food is approaching your mouth

Question 12

What is the oral prep phase?

Answer 12

begins when food is placed into your mouth, food/liquid is manipulated and prepared in the mouth

Question 13

What is the oral phase?

Answer 13

when tongue moves food to the back until the pharygneal swallow is triggered.

Question 14

What is the pharyngeal phase?

Answer 14

the involuntary stage of swallow, as soon as the swallowing reflex is triggered, then the bolus of food moves through the pharynx

Question 15

What is the esophageal phase?

Answer 15

when peristalsis (rhythmic contractions) moves the bolus through the cervical and thoracic esophagus and into the stomach

Question 16

How would one describe normal swallowing?

Answer 16

a fast act involving involuntary and voluntary aspects which require complex neuromotor control

Question 17

What is involved in swallow physiology?

Answer 17

bolus is sent from the oral cavity to the pharnx, airway is closed, the upper esophageal sphincter is open, and a tongue

Question 18

What must humans do in order to swallow?

Answer 18

they must hold their breath, since they cannot breathe and swallow simultaneously

Question 19

How is the airway closed during swallowing?

Answer 19

the epiglottis covers the vocal cords. Then, the whole larynx moves up and forward so that food and liquid can go into the esophagus rather than into the trachea and the lungs

Question 20

What are some signs of a potential swallowing difficulty?

Answer 20

unexplained weight loss, recurring pneumonia, lots of coughing before, during, or after a swallow, gurgly voice quality after swallowing

Question 21

What are signs/sx and/or complications of dysphagia?

Answer 21

pneumonia, malnutrition, dehydration, emotional reactions (embarassment, depression, denial), social isolation, death

Question 22

What are some disorders that put one at risk for dysphagia?

Answer 22

stroke, TBI, spinal cord injury, down syndrome, unilateral recurrent laryngeal nerve paralysis, brain tumors

Question 23

What are some additional risk factors for dysphagia?

Answer 23

older age, poor oral hygiene/dental status, drooling, AIDS

Question 24

What are risk factors in babies and children for dysphagia?

Answer 24

premature birth, unable to suck bottle or breast, syndromes, structural abnormalities, lung and/or heart conditions

Question 25

What is a tracheostomy tube and what risk can it increase?

Answer 25

faciltates breathing, it increases risk of dysphagia

Question 26

What is laryngeal aspiration?

Answer 26

when food or liquid enters the airway below the true vocal folds.

Question 27

What happens after food or liquid enters the airway?

Answer 27

coughing and/or choking

Question 28

What is overt aspiration?

Answer 28

when a person coughs or chokes because food enters the airway and they are trying to expel it. The person may appear distressed.

Question 29

What is silent aspiration?

Answer 29

food enters the airway, yet there is no obvious distress, no coughing, no choking, or other protective responses

Question 30

What are some assessment techniques used when assessing one for dysphagia?

Answer 30

clinical/bedside evaluation; videofluoroscopy, FEES

Question 31

What can aspiration do to the lungs?

Answer 31

it may lead to aspiration pneumonia

Question 32

What is the hierachy of liquid consistencies? How are liquids listed?

Answer 32

From thin to nectar-thick to honey thick; they are listed from least restrictive to most conservative.

Question 33

What defines a thin liquid?

Answer 33

anything that quickly liquefies in the mouth; it includes water, coffee, tea, soda, ices, tomato juice

Question 34

What defines a nectar-thick liquid?

Answer 34

a liquid that has been thickened to a consistency that coats and drips off a spoon, similar to unset gelatin or jello.

Question 35

What defines a honey-thick liquid

Answer 35

a liquid that has been thickened to honey consistency; it flows off a spoon, just like real honey

Question 36

What is the hierarchy of texture modifications?

Answer 36

Regular diet to a chewable diet to mechanically altered diet to creamy puree diet

Question 37

What is include in a chewable diet?

Answer 37

foods that are soft, moist, and easily chewable; foods should be cut into bite-size pieces; e.g. cooked carrots

Question 38

What foods should you avoid when on a chewable diet?

Answer 38

very hard, sticky, or crunchy foods; nuts, apples, dry fruit, coconut, raw vegetables, and corn.

Question 39

What foods are included in a mechanically altered diet?

Answer 39

foods that are moist, soft, and cohesive; recommended to add sauce or gravy to make it moist and to keep the bolus solid; ex. chopped carrots.

Question 40

What foods should you avoid when on a mechanically altered diet?

Answer 40

rice, corn, bread, soups, casseroles that have large chunks, nuts, chewy, stringy, or dry foods

Question 41

What foods are included in a creamy puree diet?

Answer 41

pureed and cohesive foods, no mixed textures, everything is pudding-like; ex. pureed carrots

Question 42

What foods should you avoid when on a creamy puree diet?

Answer 42

foods that require chewing

Question 43

What are some intervention methods to treat patients with dysphagia?

Answer 43

swallow maneuvers, chin-tuck, head turns, sitting up straight, placing a pillow behind the back and neck to achieve a chin-down posture.

Question 44

If oral food/liquid is not an option, what are the alternatives?

Answer 44

IV fluids, nasogastric tube, orogastric tube

Question 45

What is an orogastric tube?

Answer 45

tube is placed in the mouth that reaches to the stomach; this allows one to provide a liquid diet.

Question 46

What is a nasogastric tube?

Answer 46

tube is placed in the nose that reaches to the stomach.

Question 47

What is a nasogastric tube?

Answer 47

tube is placed in the nose that reaches to the stomach.

Question 48

What are syndromes?

Answer 48

A group of symptoms that consistently occur together or a condition characterized by a set of associated symptoms , ex. Down Syndrome)