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Adult Swallowing Disorders > Dysphagia Unit 3 > Flashcards

Dysphagia Unit 3 Flashcards

1
Q

signs are ___, symptoms are ___

A

objective (observable), subjective

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2
Q

common cold: sign

A

runny nose

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3
Q

common cold: symptom

A

sinus pain from congestion

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4
Q

chickenpox: sign

A

spots blisters

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5
Q

chickenpox: symptom

A

fatigue

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6
Q

dysphagia: sign

A

coughing post swallow

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7
Q

dysphagia: symptom

A

stated discomfort post swallow

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8
Q

anatomical refers to…

A

structure and variations in structure

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9
Q

anatomical issues includes

A
  • insufficent tissue
  • excessive tissue
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10
Q

insufficient tissue

A
  • birth deficits (cleft palate, atresia)
  • injuries causing loss of tissue
  • surgical removal of tissues due to disease
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11
Q

atresia

A

absence of abnormal narrowing of an opening or passage in the body

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12
Q

excessive tissue

A
  • growths such as osteophytes (calcifications or bony growths), scar tissue as a result of injury, radiation, or surgery
  • benign soft issue growths such as cysts, polyps, tumors
  • malignant growths (cancers)
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13
Q

tx for head and neck cancer: palliative care

A
  • to help improve the quality of life regardless of life expectancy
  • management of the symptoms/pain and comfort
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14
Q

tx for head and neck cancer: hospice care

A
  • someone with a serious illness and a life expectancy measured in months (< 6 months), not years
  • no curative years
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15
Q

tx for head and neck cancer: curative care

A

curing the patient not just comforting

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16
Q

tx for head and neck cancer: primary goal of tx

A
  • to eliminate the tumor
  • surgical resection
  • radiation
  • combination of surgical resection and radiation dependent on size and location of tumor
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17
Q

tx for head and neck cancer: surgical resection

A
  • in oral cavity generally remove tumor and 1.5-2 cm of normal tissue
  • pharyngeal tissue removal depends on size and location of tumor
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18
Q

tx for head and neck cancer: secondary goals of tx

A
  • adjuvant
  • reconstructive
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19
Q

tx for head and neck cancer: adjuvant

A
  • care after initial treatment of cancer
  • control regional and metastatic disease
  • chemotherapy after resection and/or radiation
  • radiation in cases of very large tumors (4-6 weeks postoperatively)
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20
Q

tx for head and neck cancer: reconstructive

A

address tissue insufficiencies in affected areas to provide more normal function (flaps, grafts, tissue transplants)

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21
Q

potential complications and side effects of radiation therapy that may contribute directly to dysphagia

A
  • mucositis
  • xerostomia
  • sensory changes in taste and smell
  • fibrosis
  • neuropathy
  • changed anatomy (structure)
  • odynophagia
  • loss of appetite
  • edema
  • infection (fungal, bacteria)
  • dental changes
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22
Q

mucositis

A

inflammation of the mucous membrane (very painful)

23
Q

xerostomia

A

dry mouth

24
Q

fibrosis

A

excessive tissue development

25
Q

neuropathy

A

general disease of malfunction of nerves and causes pain/numbness

26
Q

odynophagia

A

painful swallow

27
Q

edema

A

swelling caused by excess fluid

28
Q

general characteristics of dysphagia associated with radiation therapy for head/neck cancer

A
  • bolus control deficits (63%)
  • small amounts per bolus and multiple swallow attempts
  • increased meal times
  • reduced frequency of swallowing
  • dry mouth (92%)
  • pain (56%)
  • altered taste (75%)
29
Q

potential side effects from chemotherapy to treat head/neck cancer

A
  • fatigue
  • nausea and vomiting
  • hair loss
  • dry mouth
  • loss of appetite
  • reduced sense of taste
  • weakened immune system
  • diarrhea and/or constipation
  • open sores in mouth potentially leading to infection
30
Q

common swallowing disorders resulting from various surgeries to treat head/neck cancer oral resections: partial glossectomy

A
  • removes less than 50% of tongue
  • difficulty holding and preparing bolus
  • anterior tissue removal increases difficulties
31
Q

common swallowing disorders resulting from various surgeries to treat head/neck cancer oral resections: total glossectomy

A
  • removes more than 50% of tongue
  • difficulty moving materials from oral cavity
  • flap technique influences result
  • reduced tongue driving force
  • may show reduced pharyngeal clearance
32
Q

common swallowing disorders resulting from various surgeries to treat head/neck cancer oral resections: tonsil/base of tongue

A
  • reduced anterior tongue range
  • reduced tongue driving force
  • difficulty moving materials through oropharynx
33
Q

common swallowing disorders resulting from various surgeries to treat head/neck cancer oral resections: palatal resection

A
  • removal of less than 50% of soft palate
  • velar leak results in retrograde movement of materials into the nasopharynx
34
Q

common swallowing disorders resulting from various surgeries to treat head/neck cancer oral resections: anterior/lateral floor of mouth

A
  • reduced anterior tongue range
  • reduced control of oral bolus (tongue driving force)
  • unable to lateralize tongue
  • reduced ability to elevate hyoid/larynx
  • difficulty moving material through oropharynx
  • reduced opening of upper esophageal
  • delayed triggering of pharyngeal swallow, reduced clearance of bolus from pharynx sphincter
35
Q

overview of common swallowing disorders resulting from various surgeries to treat head/neck cancer: partial pharyngeal resection

A
  • reduced pharyngeal wall constriction
  • reduced elevation of hyoid/larynx
  • difficulty clearing materials from the pharynx
  • delay triggering swallow
36
Q

overview of common swallowing disorders resulting from various surgeries to treat head/neck cancer: hemilaryngectomy (vertical laryngectomee)

A
  • unilateral resection
  • partial airway closure
  • unilateral pharyngeal weakness
  • reduced airway protection
37
Q

overview of common swallowing disorders resulting from various surgeries to treat head/neck cancer: supraglottic laryngectomy (horizontal laryngectomee)

A
  • incomplete posterior tongue movement
  • restricted arytenoids motion
  • partial airway closure
  • delay in bolus propulsion
  • difficulty with elevation of structures for swallow
  • reduced airway protection
38
Q

overview of common swallowing disorders resulting from various surgeries to treat head/neck cancer: total laryngectomy

A
  • removal of vibratory source
  • alternative source surgically developed
  • issues with negative pressure, bolus transit
  • anatomic or physiologic stenosis of PES possible
39
Q

hemilaryngectomee: unilateral

A
  • removal of 1 vertical half of the larynx
  • extended anteriorly
  • extended posteriorly
40
Q

unilateral hemilaryngectomee: removal of 1 vertical half of the larynx

A
  • 1 false vocal fold, 1 ventricle, 1 true vocal fold
  • exclude the arytenoid cartilage and portion of the thyroid on affected side
  • hyoid bone and epiglottis left intact
  • minimal swallowing problems due to reconstructive surgery for damaged side
41
Q

unilateral hemilaryngectomee: extended anteriorly

A
  • frontolateral laryngectomee affecting 1/3 of the front of the larynx on both sides
  • 3/4 laryngectomee: continues forward to include 1/2 of the other side of the larynx
  • normal arytenoid cartilage, hyoid and epiglottis intact
  • minimal swallowing problems due to reconstructive surgery for tissues removed
42
Q

unilateral hemilaryngectomee: extended posteriorly

A
  • includes removal of arytenoid cartilage
  • greatly decreased chances for returning to normal swallow and possible oral intake
43
Q

types of supraglottic laryngectomy

A
  1. standard supraglottic laryngectomy
  2. superiorly extended supraglottic laryngectomy
  3. inferiorly extended supraglottic laryngectomy
44
Q

standard supraglottic laryngectomy

A
  • remove all or part of hyoid bone (epiglottis, aryepiglottic folds, false folds)
  • in reconstruction, remaining larynx is elevated and tucked under base of tongue
  • no valleculae and smaller than normal pyriform sinuses
  • may have residue remaining in pharynx after swallow, also airway protection issues
  • can achieve functional swallow
45
Q

superiorly extended supraglottic laryngectomy

A
  • additional removal of base of tongue (results in precipitous drop of materials into pharynx)
  • may have loss of sensation in larynx due to potential sacrifice of 1 branch of laryngeal nerve
  • may have additional loss of lingual movement and control of bolus
  • takes longer to adapt and those with large resections of the base of the tongue may not be able to regain functional swallow
46
Q

inferiorly extended supraglottic laryngectomy

A

if extended to include arytenoid cartilage and large portions of vocal fold may not be able to regain functional swallowing

47
Q

total laryngectomy

A
  • removal of larynx: airway and swallowing tract are surgically separated
  • may have diminished sense of smell affect taste of foods
  • stenosis in the nasopharynx (narrowing resulting in difficulty handling solid foods)
  • postsurgical scarring: pseudo epiglottis
  • issues with the cricopharyngeal muscle especially for those utilizing same for speech production
  • tracheoesophageal fistulas
48
Q

other life changes after total laryngectomy

A
  • cosmetic issues with stoma site
  • infection at stoma site
  • keeping foreign objects out of stoma
  • change in respiratory patterns
  • bathing/showering become problematic
  • lifting is difficult without occlusion of stoma site (limited upper body strength)
  • no preparation or air entering stoma: moistening or warming
  • may not be able to perform previous activities such as running, swimming, cycling
  • aphonic initially
  • abnormal vocal quality with alternate sound sources including esophageal speech production
49
Q

types of artificial airways

A
  1. endotracheal tubes
  2. trachemostomy tubes
50
Q

endotracheal tubes

A
  • tubes inserted from outside the body into the trachea
  • oral endotracheal tube goes from mouth through the vocal folds into the trachea
  • may cause damage to vocal folds if inserted improperly and/or used for too long a time period (general use is 7-12 days)
  • may cause damage to pharyngeal mucosa as well
  • cannot eat or talk with oral endotracheal tube in place
  • intubation
  • extubation
51
Q

endotracheal tubes: intubation

A

placement of endotracheal tube

52
Q

endotracheal tubes: extubation

A

removal of endotracheal tube

53
Q

trachemostomy tubes

A
  • more permanent alternative to endotracheal tubes
  • surgically placed via vertical incision between 2nd and 3rd tracheal ring (below the level of the vocal folds)
  • may swallow (and under certain conditions speak) with same
  • less trauma to vocal folds
  • patient controls

Adult Swallowing Disorders (3 decks)

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