Exam 3 Flashcards
What three things comprise the prefeeding assessment?
Review of medical records, history, and observations of oral/pharyngeal/laryngeal function
The dysphagia evaluation is a multi-step process including what 3 things?
1 - Prefeeding assessment
2 - Clinical evaluation of swallowing
3 - Radiographic assessment
What does FEES stand for?
Fiberoptic endoscopic evaluation of swallowing
What oxygenation level do we want to see in our patients?
Above 90%
What is the normal number of breaths per minute a person takes?
12-15
What questions are important to ask when history taking?
Asking about medical history, when the problem first began, if the onset was sudden or gradual, if the problem varies depending on food type or time of day, etc.
What might we think if the symptoms had a sudden onset vs. a gradual onset?
Sudden onset - more indicative of something like a stroke or TBI; gradual onset - more indicative of a degenerative neurological disease or of a growing mass/tumor
Why is it important to ask about the medications the patient is taking?
Because certain drugs can have negative effects on swallowing or could cause xerostomia
What is the primary purpose of a case history? Second/third purposes?
To identify which stages of swallowing might be involved/specific areas so we know what to target during the MBS/instrumental eval. Second purpose - identify the safest material for the patient to swallow so we know where to start. Third - get some indication that there is a swallowing disorder/what might be the cause.
What are 6 common signs that indicate a high risk of aspiration?
1 - reduced alertness
2 - decreased responsiveness to stimulation
3 - absent swallow reflex
4 - absent protective cough
5 - difficulty handling secretions
6 - significant reductions in range and strength of oral, pharyngeal, and laryngeal movements
What are some common signs/symptoms of aspiration?
Coughing before, during or after the swallow response
Wet, gurgly voice quality after swallowing
Watery eyes
Facial grimace
What are some important things to remember/do when evaluating a patient with a tracheostomy tube?
- check and see if the cuff can be deflated
- suction via trach tube, deflate cuff, then repeat suctioning
- occlude tracheostomy with your gloved finger during swallow
- dye bolus blue to check for aspirated secretions/bolus when suctioning
Why is it so important to have the three step suctioning process?
Because there can be a significant amount of secretions/residue built up on top of the inflated cuff. when the cuff is deflated, those particles could fall down into the trachea and will immediately need suctioned out or else the patient could suffocate.
Why is it important to suction after every consistency presented?
To see which ones specifically are being aspirated
If you see evidence of aspiration on the MEBD test, what should happen next?
Blue secretions mean the test is positive for aspiration. Aspiration is just a sign of a swallowing disorder, so we need to do a video fluoroscopic study in order to figure out what is causing the problem.
When is radiographic assessment recommended?
1 - any signs of aspiration are evident
2 - suspected difficulties cannot be directly observed
3 - latency or absence of the swallow reflex is suspected
4 - pharyngeal, cricopharyngeal, or esophageal dysfunction is suspected
What is the purpose of the modified barium swallow study?
1 - measure speed of swallow
2 - measure efficiency of swallow
3 - define movement patterns of structures in oral cavity, pharynx, and larynx
4 - determine if aspiration occurs and when, why, and how much
5 - examine effectiveness of rehab strategies
How are the regular barium swallow test and the modified barium swallow test different?
Regular - patient swallows large amounts of barium to fill the esophagus and stomach and then still x-ray pictures are taken
Modified - smaller amounts of barium in varying consistencies, focuses on oral and pharyngeal stage, and it’s a video
How is the efficiency of swallow determined?
If there is any residue (stasis) leftover
What are the three primary components to include on a dysphagia report?
1 - relevant background info and history
2 - a description of the patient’s oropharyngeal anatomy and swallowing physiology
3 - recommendations
What should be described in the report regarding the oral phase?
If there are any motility disorders or if there was any oral residue.
What should be written in the report regarding triggering of the pharyngeal swallow?
Estimation of the duration of any delay, location of the bolus in pharynx during delay, occurrence of any aspiration during the delay (before).
How should the pharyngeal stage be described in the report?
Location and approx. amount of residue, movement disorder causing residue, presence and approx. amount of aspiration, etiology of aspiration, and indicate if problems occur over all consistencies or vary
How do we determine when the patient is unlikely to maintain sufficient nutrition and hydration by mouth? What will this patient then require?
If the combined oral and pharyngeal transit times are more than 10 seconds for ALL consistencies swallowed. If so, the patient will require non-oral supplements.
