Evaluation of Swallowing Flashcards
Dysphagia Bedisde Screening is:
– quick, non-invasive, low risk, low cost
- 10-30min
- look inside mouth
- eat and drink something small
Trying to answer: DOES THE PATIENT HAVE DYSPHAGIA?
Bedside Screening Includes (3):
1) Signs & symptoms
2) Chart review
3) Observation
- 3 oz water test
- Timed swallow test
* False positive = id’d as aspirating but aren’t
* False negative = id’d as not aspirating but are
* NOT 100% accurate!
* Further dx assessment needed
If there is any inclination that there is aspiration, follow up with a FEES and/or MBSS
What is a false positive?
Id’ed as aspirating but they are not
better than false negative
What is a false negative?
Id’ed as not aspirating but are actually aspirating
NOT good. DO NOT want this to happen
Is a screening sufficient or is more assessment needed?
more dx assessment is needed
Symptomatology: (look for)
1) Valleculae hesitation/pooling
2) Pyriforms pooling
3) UES dysfunction
4) Aspiration
Symptom: If patient says they feel something is “stuck” high in throat
Valleculae hesitation/pooling (location and symptom)
Location: Base of tongue/ epiglottic area
Symptom: Patient complains something is “stuck” in middle of throat
Pyriforms pooling
Just below larynx
Symptom: Patient complains they feel something is “stuck” lower in throat or high in chest, pain in upper chest
UES dysfunction
Feels pain in upper chest or inches below larynx, about the level of vertebrate C6
Symptom: Patient complains of:
- Coughing
- Choking
Aspiration
***50%+ aspirate without cough (silent)
Bedside Clinical Exam Provides (8)
1) Medical dx, hx, pt’s perception
2) Pt’s medical status: nutritional (tube?), respiratory (trach tube? ventilator?)
3) Pt’s oral anatomy
4) Pt’s respiratory function
5) Control/fxn: labial, lingual, palatal, pharyngeal, laryngeal
6) Cognitive status: comprehension, awareness
7) Sensory: taste, temperature, texture
8) S/s during swallow attempts
Bedside Clinical Exam
Materials (11)
1) Laryngeal mirror
2) Tongue blades (for oral mech)
3) Cup
4) Spoon
5) Straw
6) Syringe
7) Towel/ drape cloth
8) Gloves
9) Gown
10) Eyewear/ mask
11) Stethoscope
(never sit directly in front of the patient)
Bedside Clinical Exam
PREP (6)
1) Chart review
2) Respiratory status /hx: trach? vent? intubated?
- Resp rate at rest (should me 6-12 cylces per min)
- Time saliva swallows (should be~every 2 min) & phase of respiration
- Time/gauge strength of cough (volitional and reflexive cough if it happens)
- Time apneic period– 1 sec, 3 secs, 5 secs?
- Breathing pattern: mouth or nose?
3) Dysphagia hx: onset? symptoms? pt awareness? localization?
4) Hx of pneumonia? Do they have a fever?
5) Nutritional status: diet type? duration? tubed? adequacy? complications?
6) Medications: xerostomia? ↓alertness?
delayed rxn time?
Respiratory status /hx (taken during PREP part of bedside evaluation) (6):
1) trach? vent? intubated?
2) Resp rate at rest (should me 6-12 cylces per min)
3) Time saliva swallows (should be~every 2 min) & phase of respiration
4) Time/gauge strength of cough (volitional and reflexive cough if it happens)
5) Time apneic period– 1 sec, 3 secs, 5 secs?
6) Breathing pattern: mouth or nose?
Bedside Clinical Exam PHYSICAL EXAM (5)
1) Posture
2) Oral exam
- Anatomy
- Physiology
3) Laryngeal Function Exam
4) Pulmonary Function Testing (if warranted)
5) Pneumotachometry (if warranted)