Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Dysphagia > Evaluation > Flashcards

Evaluation Flashcards

1
Q

Evaluation

Implementation of dysphagia programs is accompanied by substantial reductions in pna rates

A

3 programs evaluated pre- and post- implementation of formal dysphagia eval programs = pna rate dropped from 8.2% to 1.3%- an average of an 87% decline across programs
Aspiration increases the relative risk of pna by 6.5%
A reduction in pna by as little as 1/3 could result in savings of more than $1 billion annually nationwide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Improved quality of life…

Limited published data on this,

A

SLPs are able to help avoid PEGs and / or overly restrictive diets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Measures of Swallowing (Objective)

A

Clinical Swallow Evaluation / Bedside Swallow
Modified Barium Swallow Study / Videofluoroscopic Swallow Study
Fiberoptic Endoscopic Evaluation of Swallowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Measures of Swallowing (Subjective)

A

Clinical Swallow Eval

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Requirements

A 
MD order
Chart Review
Go see the patient
Patient / caregiver report
Brief speech, language, cognitive screen
Oral Motor Eval
Bolus Presentations
Make appropriate recommendations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Physician’s Order

Will contain the patient’s basic info:

A 
Name
Age
DOB
MR Number
Location
Primary Diagnosis
Reason for Request
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Chart Review

A
  1. Past Medical History
    - —Related medical history (CVA, COPD, pna, cancer)
    - —Related psycho-social history
  2. Current Medical Status /
    - ——Reason for Admit
    - —–List of meds
    - —–POC
  3. Other Physician Consultations (ENT, GI, Neurology, Neurosurg)
  4. Other Ancillary Services (OT/PT, Nursing, Social Work)
  5. Lab work / Diagnostic Testing Results
    - –Head CT / MRI — GI work up
    - –CXR — Bloodwork
  6. Other
    - –Current po status
    - –Overall mental status
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Go See the Patient: Formal and Informal Observations

Introduction

A 
Explanation of why you are there
Talk to the patient, talk to the caregiver
Brief cognitive screen 
(A & O X 3) person, place, and date 
Speech, language, apraxia screen
Decision making abilities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Speech Intelligibility

Impact of Dysarthria

A

Muscles as face aren’t moving as efficiently as they should
Is the Patient easily understood?
With / without careful listening and attention
Could this be correlated to a swallowing problem?
Weak speech muscles = weak swallowing muscles
Possible lingual strength and coordination deficits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Cough Production

Strength of Volitional Cough and Throat Clear

A

Is it productive enough to move material out of larynx?
Are there secretions that currently need to be cleared?
General pulmonary power / effort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Voicing

A 
Normal
Wet
Breathy?  Hoarse?  Strained?  
Volume
Aphonic
Resonance
Positioning
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What position is the patient in?

A 
Flexed:
Flaccid
Leaning to one side
Leaning back
Head position  -  up, down, rotated
----Reclined 45 degree 
----Supporting apparatus  (OT/PT aides)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Safety concerns

A

C-spine precautions, drain in place, lumbar puncture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Secretion Management

A 
No overt secretion difficulties
Wet breath sounds at baseline
Coughing at baseline
Suction set up at the bedside
Anterior spillage of secretions
Pooled secretions in mouth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Other Considerations

A

Respiratory Rate
Heart Rate
Oxygen Saturations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Patient Report

A

1.Do you have difficulty swallowing? In what way?
2.Is the swallowing difficulty greater for solids or liquids?
3.Do you have this sensation without swallowing food?
4.How long has swallowing difficulty been present?
5.Has heartburn been associated with your dysphagia?
6.Is swallowing painful?
7.Do you get chest pain?
8.Does food get stuck when you swallow? If so, where?
9.Do you choke or cough when you swallow?
10Is there temperature sensitivity to dysphagia (especially cold)?
11.Has there been weight loss?
12What types of foods or liquids are hardest for you to swallow
13Have you lost any weight?
14Do you have frequent respiratory issues, such as pna or bronchitis?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Facial

A

movement: VII
sensation: V
.Lips
Tongue
Buccal Cavity
Soft and Hard Palate
Gag
Lip movement
Closure
Strength of closure
Pucker / Smile
Droop
Eye brow lift
Symmetry in general
Unilateral, Bilateral?
Jaw movement and strength

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Tongue

A 
Protrusion
Deviation noted
	Always deviates to the weak 
ROM (range of motion)
Strength
Coordination + ROM
Diadochkinesis
Dysarthria?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Soft Palate

A 
Palate Movement
Quick?
Symmetry
Deviation of uvula indicates palatial weakness
Motion of PPW?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Interior sensation

A 
Tongue
Buccal Cavities
Gag
Anterior faucial pillars
PPW?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Dentition

A

Number of teeth
Location
Status
Decaying? Clean?

22
Q

Saliva

A 
Wet / shiny mucosa in oral cavity and tongue
Hypo salivation
Tongue may be cracked
Whitish-grey in color
Dried secretions
23
Q

Oral care (done before

A 
feeding or swallow study)
Supply as needed
toothbrush 
sponge
mouthwash
24
Q

Laryngeal Palpation

A

Thyroid notch between the middle and ring fingers

Should move in a superior and anterior direction to clear or nearly clear the middle finger

25
Q

Know the patient’s medical status. May re-consider moving forward if:

A 
Pt is not alert enough to swallow
Pt cannot cough 
Pt cannot manage own secretions
Pt cannot volitionally swallow
Trial of ice chip
26
Q

Bolus Presentation

A 
Mastication / Oral stage
Swallow Initiation
Laryngeal Elevation
Cough, throat clear, other s/sx aspiration (change in vocal quality, eye watering,  changes in breathing)
Use of cervical auscultation?
27
Q

Bolus Consistencies Typically Used

Ice chip

A 
Water
Nectar thick liquid (gross)
Honey thick liquid (gross)
Extra thick liquid – pudding
Puree
Soft solid
Solid
Mixed consistency (liquid and solid)
28
Q

Bolus Presentations:
Volumes Typically Used

A 
Siphoned sip via straw
½ teaspoon
Teaspoon
Cup sip
Straw sip
Multiple sips
Progression of bolus presentation
29
Q

Start with an ice chip almost always
Then, small sip of water vs. teaspoon of puree
Progression of bolus presentation:

A

If no clinical s/sx aspiration noted, move on to the next “easiest” consistency
If started with water, may try puree next
If started with puree, may try water next
If difficulties noted with purees or water, may try thickened liquids
If the pt does well with water, likely do not need to try thickened liquids
If too many difficulties noted, consider discontinuing the eval
Continue this process throughout the consistencies, concluding with mixed consistencies and large, multiple sips of liquids
Have pt self administer pos as able

30
Q

Progression of bolus presentation:

A

If no clinical s/sx aspiration noted, move on to the next “easiest” consistency
If started with water, may try puree next
If started with puree, may try water next
If difficulties noted with purees or water, may try thickened liquids
If the pt does well with water, likely do not need to try thickened liquids
If too many difficulties noted, consider discontinuing the eval

31
Q

Continue this process throughout the consistencies, concluding with mixed consistencies and large, multiple sips of liquids

A

Have pt self administer pos as able
Stop eval at consistent aspirations
During each bolus presentation

32
Q

Timing of each stage?

A

Feel for laryngeal elevation
After each bolus presentation
Listen to the pt’s voice
Recommend a type of liquid and type of solid

33
Q

Other considerations:

A 
Consistent / Inconsistent s/sx aspiration?
Soft clinical s/sx aspiration?
Effects of NGT on swallowing?
When to terminate eval?
Secretion management?
34
Q

Posture

A

Upright positioning?, Limitations- Shunt? Fractures? Drains?

Need for objective swallow study?

35
Q

Types of Diet Recommendations

If recommending pos, make recommendation on solid consistency and liquid consistency

A 
Regular solids 			--  Thin
Soft mechanical solids		--  Nectar
Chopped				--  Honey
Ground
Purees
36
Q

Types of Diet Recommendations

Dysphagia diets may be used in some institutions

A 
Dysphagia 1:  Pureed
Dysphagia 2:  Minced
Dysphagia 3:  Ground
Dysphagia 4:  Chopped
Dysphagia 5:  Modified Regular (Soft Mech)
37
Q

Silent aspiration may be occurring if:

A

The pt exhibits a clear voice prior to presenting a bolus… and a wet voice after
There is a drop in the pt’s oxygenation
There is an increased work of breathing noted
The pt has a delayed cough (greater than 1 minute)

38
Q

The Gag

A

30% of healthy younger adults and 44% of healthy older adults may have unilateral or bilateral absent gag reflexes
Absent gag reflex can be associated with dysphagia, but does not predict aspiration risk in insolation
Absence of gag alone is not statistically significant in predicting aspiration
Abnormal cough and abnormal gag predicts aspiration 85% of the time

39
Q

Accuracy of the CSE

A

Presence of aspiration can be predicted 66% of the time by trained SLPs
Ability to detect aspiration
Absence of aspiration can be predicted 67% of the time by trained SLPs
Ability to detect no aspiration

Aspiration is more frequently silent in the neurogenic population

50% of patients who aspirated during the MBSS complained of difficulties swallowing to their medical team or SLP
Often complaints of swallow difficulty do not produce evidence of actual swallowing disorder when measured objectively
Up to 90% noted in one study
So… Is a CSE sufficient
How acceptable is an ~30% false negative rate when dealing with aspiration?
Conversely, how acceptable is a 30% over-identification rate?

40
Q

Clinical consequences include oral feeding and medications incorrectly withheld in a large number of patients until an objective swallow study can be performed, or overly restrictive diets are recommended

A

Certain patients can tolerate a degree of aspiration

True, but a CSE is not sufficient in determining amounts of aspiration

41
Q

Why not go straight to an objective?

A

Lose valuable information re: CN function and involvement, cognitive linguistic abilities, pulmonary status

42
Q


Aspiration Prevalence

A

59% of acute care patients are silent aspirators with highest incidence in the youngest, oldest, and neurologically impaired age groups
58% of patients with dysphagia are silent aspirators
Further Considerations:
30 – 50% of CVA population aspirate
40% of patients with Unilateral CVA aspirate
56% of patients with Bilateral CVA aspirate
67% of patients with Brainstem CVA aspirate

43
Q

How does the CSE direct treatment?

PROS

A 
Generally effective for straight forward patients
Relatively few supplies
Patient directed and centered
SLP can typically readily do
Cost effective
Non-invasive
44
Q

CONS

A

Do not detect pharyngeal delay or pharyngeal residue

45
Q

Sometimes need to know more than aspiration vs. no aspiration
Effectiveness of compensatory strategies?

A 
Ability to clear aspiration materials
Amount of aspiration
Referrals to other specialists
There are many benefits to the CSE
However, when readily available, objective swallow evaluations are often significantly more useful than clinical evaluations alone in the assessment of patients with dysphagia
46
Q

Types of Nutrition
Parenteral / Hyperalimentation
Via the veins

A 
Bypasses the intestines
Infusion, injection or implantation of medications or nutrition
Pharmacological uses (to administer meds)
IVs
TPN
Central Lines
Enteral
Nasogastric tube (NGT)
Corpak, panda, dubhoff
Gastrostomy feeding tube
percutaneous endoscopic gastrostomy (PEG)
Jejunostomy tube (J-tube)
47
Q

Enteral

A

Absorption through the GI tract
NG Tubes
Not permanent, most temporary
NG Tubes
Can be used to administer liquid tube feeds/nutrition/medications
Or can be set to suction- meaning they are used to suction out gastric contents that the stomach or intestines may not be able to pass through (i.e. in patients diagnosed with a GI bleed) (take a look back at the last slide- this is pictured in the top right corner)

48
Q

FOOD for THOUGHT: Can SLP’s perform a swallow eval on patients with an NGT in place?

A

YES

49
Q

Corpak

A

Not permanent, but can remain in place longer than NGTs

Inserted similarly to NGTs

50
Q

G Tubes

A

Permanent, but removable

Does not decrease the risk of pneumonia for patients with advanced dementia

51
Q

J Tubes

A 
Helpful for individuals with:
Poor gastric motility
Chronic vomiting
At high risk for aspiration 
Patients in whom 
G-tubes are contraindicated

Dysphagia (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions