Dysphagia PP Flashcards
What is dysphagia? What is it not?
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
What are potential causes of dysphagia?
congenital abnormalities, structural changes, metabolic and/or neurologic etiology, effects of medications
What are common myths in relation to food intake?
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
Dysphagia exists on a ____ , it can range from ____ to_____
continuum; can’t eat or drink anything to no texture modifications
What percentage of adults admitted into acute trauma centers have dysphagia?
61%
What percentage of individuals admitted into rehab settings have dysphagia?
41%
What percentage of patients in nursing homes have dysphagia?
30-75%
What percentage of patients admitted into hospitals have dysphagia?
25-30%
Exact prevalence of dysphagia is unknown, but may be as high as ___ in _____
22%; those over age 50.
What are the 5 phases of swallowing?
oral acceptance, oral prep, oral, pharyngeal, esophageal
What is the oral acceptance phase?
when you sense and recognize that food is approaching your mouth
What is the oral prep phase?
begins when food is placed into your mouth, food/liquid is manipulated and prepared in the mouth
What is the oral phase?
when tongue moves food to the back until the pharygneal swallow is triggered.
What is the pharyngeal phase?
the involuntary stage of swallow, as soon as the swallowing reflex is triggered, then the bolus of food moves through the pharynx
What is the esophageal phase?
when peristalsis (rhythmic contractions) moves the bolus through the cervical and thoracic esophagus and into the stomach
How would one describe normal swallowing?
a fast act involving involuntary and voluntary aspects which require complex neuromotor control
What is involved in swallow physiology?
bolus is sent from the oral cavity to the pharnx, airway is closed, the upper esophageal sphincter is open, and a tongue
What must humans do in order to swallow?
they must hold their breath, since they cannot breathe and swallow simultaneously
How is the airway closed during swallowing?
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
What are some signs of a potential swallowing difficulty?
unexplained weight loss, recurring pneumonia, lots of coughing before, during, or after a swallow, gurgly voice quality after swallowing
What are signs/sx and/or complications of dysphagia?
pneumonia, malnutrition, dehydration, emotional reactions (embarassment, depression, denial), social isolation, death
What are some disorders that put one at risk for dysphagia?
stroke, TBI, spinal cord injury, down syndrome, unilateral recurrent laryngeal nerve paralysis, brain tumors
What are some additional risk factors for dysphagia?
older age, poor oral hygiene/dental status, drooling, AIDS
What are risk factors in babies and children for dysphagia?
premature birth, unable to suck bottle or breast, syndromes, structural abnormalities, lung and/or heart conditions
What is a tracheostomy tube and what risk can it increase?
faciltates breathing, it increases risk of dysphagia
What is laryngeal aspiration?
when food or liquid enters the airway below the true vocal folds.
What happens after food or liquid enters the airway?
coughing and/or choking
What is overt aspiration?
when a person coughs or chokes because food enters the airway and they are trying to expel it. The person may appear distressed.
What is silent aspiration?
food enters the airway, yet there is no obvious distress, no coughing, no choking, or other protective responses
What are some assessment techniques used when assessing one for dysphagia?
clinical/bedside evaluation; videofluoroscopy, FEES
What can aspiration do to the lungs?
it may lead to aspiration pneumonia
What is the hierachy of liquid consistencies? How are liquids listed?
From thin to nectar-thick to honey thick; they are listed from least restrictive to most conservative.
What defines a thin liquid?
anything that quickly liquefies in the mouth; it includes water, coffee, tea, soda, ices, tomato juice
What defines a nectar-thick liquid?
a liquid that has been thickened to a consistency that coats and drips off a spoon, similar to unset gelatin or jello.
What defines a honey-thick liquid
a liquid that has been thickened to honey consistency; it flows off a spoon, just like real honey
What is the hierarchy of texture modifications?
Regular diet to a chewable diet to mechanically altered diet to creamy puree diet
What is include in a chewable diet?
foods that are soft, moist, and easily chewable; foods should be cut into bite-size pieces; e.g. cooked carrots
What foods should you avoid when on a chewable diet?
very hard, sticky, or crunchy foods; nuts, apples, dry fruit, coconut, raw vegetables, and corn.
What foods are included in a mechanically altered diet?
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.
What foods should you avoid when on a mechanically altered diet?
rice, corn, bread, soups, casseroles that have large chunks, nuts, chewy, stringy, or dry foods
What foods are included in a creamy puree diet?
pureed and cohesive foods, no mixed textures, everything is pudding-like; ex. pureed carrots
What foods should you avoid when on a creamy puree diet?
foods that require chewing
What are some intervention methods to treat patients with dysphagia?
swallow maneuvers, chin-tuck, head turns, sitting up straight, placing a pillow behind the back and neck to achieve a chin-down posture.
If oral food/liquid is not an option, what are the alternatives?
IV fluids, nasogastric tube, orogastric tube
What is an orogastric tube?
tube is placed in the mouth that reaches to the stomach; this allows one to provide a liquid diet.
What is a nasogastric tube?
tube is placed in the nose that reaches to the stomach.
What is a nasogastric tube?
tube is placed in the nose that reaches to the stomach.
What are syndromes?
A group of symptoms that consistently occur together or a condition characterized by a set of associated symptoms , ex. Down Syndrome)
