Exam 1 Flashcards
What are the stages of swallowing?
Oral prep
Oral transit
Pharyngeal
Esophageal
What events are part of the oral prep stage?
Mastication
Bolus formation
Bolus maintenance
What events are part of the oral transit stage?
Starts when bolus moves posteriorly
Tongue tip and sides lift to alveolar ridge
Velum elevates
Tongue base drops
Pressure exerted by tongue increases as viscosity increases
Ends when reaches Ramus of mandible
Pharyngeal stage events
Velum elevates BOT retracts Epiglottic retraction/inversion VF addiction Simultaneous contraction of pharyngeal constrictors Laryngeal/hyoid elevation and ant. Mov Constriction of laryngeal vestibule Relaxation/opening of cricopharyngeous
Esophageal stage events
Bolus enters esophagus
Bolus lowers via gravity and esophageal peristalsis
Esophagus connects to diaphragm via diaphragmatic hiatus
What are the 4 mechanisms of airway protection?
Epiglottic retroflexion
TFC adduction
FVC adduction
Ant. Mov. Of arytenoid cartilage
What cranial nerve is responsible for the reflexive cough?
CN X motor and sensory
What are the age related changes in swallowing?
Sense of taste Dippers increases Increased oral/pharyngeal residue Increased transient penetration Increase in delay triggering swallow Decrease in laryngeal elevation=decrease in UES opening Decrease in sensitivity of cough reflex Esophageal changes
Do age related changes in swallowing result in a less safe swallow?
No, but means elderly have less “reserve” and more prone to aspiration when ill
Symptoms of dysphagia
Coughing/choking Throat clearing SOB Wet vocal quality Multiple swallow patterns Drooling Edentulous Weight loss Spike in temp Odynophagia Oral residue/pocketing Resistance to eating/drinking
Dysphagia populations
- Neurologic (CVA), head and neck cancer
- Lung disease, very elderly, long Hx of psychiatric meds
- Surgical causes
Basic steps of bedside swallow evaluation
- Chart review
- Intake
- Oral mech
- Trial feeding
Bedside swallow eval purpose
Screening for possible dysphagia
Det. Physiologic factors cont. to dysphagia
Det. Need for another test
Make recommendations for safest means of intake (diet)
When do you not do a bedside eval?
Pt. not alert Pt. NPO Pt. refuses Pt. can't manage saliva Pulse oximetry indicates drop in blood stats when move or raise head
Limits of bedside
Can’t see swallow
Silent aspiration
