Exam 2 - Evaluation

Question 1

when IS an instrumental swallowing examination indicated?

Answer 1

when clinical evaluation fails to answer relevant questions
if patient reports problems that are not clarified in clinical examination

Question 2

when MAY an instrumental swallowing examination indicated?

Answer 2

many reasons - mostly related to the condition of the patient
conditions that pose high risk for dysphagia - instrumental examination may help identify issues early and improve level of care
some patients cannot participate well in clinical exam ( e.g., due to cognition)

Question 3

when is an instrumental swallowing examination NOT indicated?

Answer 3

patients had problems, but no longer has problems
patients condition is too compromised to tolerate
patient that is not cooperative
if instrumental examination will not provide useful info

Question 4

instrumental swallow evaluation - requested:

Answer 4

NOT to determine if a pt is penetrating
to UNDERSTAND the pt’s physiology
to DETERMINE appropriate treatments that can be utilized
the study should NOT be terminated when the pt aspirates

Question 5

GOAL of instrumental swallow evaluation

Answer 5

identify conditions under which they CAN eat rather than keeping them from eating orally!

Question 6

clinical swallow eval

Answer 6

done before instrumental exam
help to guide items to be addressed in the instrumental swallow exam

Question 7

goals of instrumental swallow exam

Answer 7

provide info on a&p of structures and muscles
evaluate ability to swallow a variety of consistencies
assess secretions and patient’s reaction to them
coordination between respiration and swallowing - adequacy of airway protection
help eval impact of compensatory therapy strategies/maneuvers for swallowing and airway protection

Question 8

chart review things to consider:

Answer 8

BMI
Alb
RBC
WBC
hydration/electrolytes
SpO2
arterial blood gas (ABG)
respiratory rate(RR)
international normalized ration (INR)

Question 9

low alb levels can be indicative of

Answer 9

poor nutrition

Question 10

low lab RBC values in the area may indicate

Answer 10

anemia
protein energy malnutrition and nutrition deficiencies

Question 11

elevated WBC may indicate

Answer 11

infection

Question 12

severely high ammonia levels can cause

Answer 12

cognitive and neurologic changes and pts may become dysphagic

Question 13

oxygen saturation shouldn’t be below:

Answer 13

90%

Question 14

higher than 25 breaths/min respiratory rate may be associated with

Answer 14

aspiration in patients with COPD

Question 15

INR is important to know if you are performing

Answer 15

FEES

Question 16

trauma =

Answer 16

inflammation = edema

Question 17

pneumonitis

Answer 17

lung inflammation

Question 18

anticholinergics may cause

Answer 18

decreased mucous and saliva production in the nose, mouth, and throat causing a dry mouth

Question 19

infiltrates

Answer 19

something is in the lungs
in the alveoli and airways, infiltration of something

Question 20

costophrenic angles

Answer 20

where ribs meet the diaphragm, should be clear; blunted means they are not well delineated

Question 21

atelectasis

Answer 21

collapsed alveoli
*not necessarily a red flag

Question 22

pulmonary edema

Answer 22

leakage of pulmonary fluid in the alveoli
most common cause of CHF