Feeding/Swallowing Flashcards
Poor Feeding Can Lead to
-malnutrition
-dehydration
-weight loss
-emotional distress
-choking
-airway obstruction
-aspiration
-pneumonia
-death
What is dysphasia
Difficulties with chewing and swallowing
Dysphasia/malnutrition makes patients susceptible to
-Increased rate of hospitalization
-poor wound healing
-pressure injuries
-infections
-decreased muscle strength
-post op complications
-increase morbidity and mortality
Emotional Distress and Dysphagia
-Is an issue in those with dysphasia who report anxiety and panic during meals
-They also report eating less meals due to these feelings and being very self conscious when eating with others due to coughing, choking, or drooling =increasing sense of isolation and decreased self esteem
Aspiration
-When food and/or liquid goes down the trachea into the lungs
-linked to longer hospital stays, transfer to other facilities rather than back home, and mortality
Aspiration Pneumonia
-Lung lobes affected depends on the patients position when aspiration occurred
-Most commonly it is the RLL
-Mortality rate for aspiration pneumonia is dependent on the volume and content aspirated but has been reported as high as 70%
Swallowing involves
-Combination of voluntary and involuntary movements
-Involves 50 paired muscle movements and almost all levels of CNS and ANS
-Three stages, 1. Oral stage, 2. Pharyngeal stage, 3. Esophageal stage
Muscle Tone and Swallowing
-Swallowing involves many muscles to efficiently work
-Need good muscle tone in the jaw, tongue, esophagus, sphincters as well as body trunk control
-If there are deficiencies on any of these areas, it can impact swallowing
Swallowing and respiration’s
-During swallowing, resps stop as the respiratory passage (trachea) is blocked
Three main stages of swallowing
- Oral stage
- Pharyngeal stage
- Esophageal stage
Oral phase
-Voluntary phase
-Purpose is to prepare the food/liquid for the swallow
-Food is placed in mouth and chewed to prepare bolus and liquid boluses are held very briefly between the tongue and roof of mouth
-Bolus is moved to back of mouth by tongue
Potential Problems in Oral Phase
-Lips need to be coordinated and strong enough to keep food/fluids inside, if unable may see dribbling/spillage from mouth
-Tongue needs good control to move the food to the back of the mouth, if control is lacking food spillage to the back of throat and towards esophagus May occur
-Jaw needs good enough strength and control for chewing if not cannot mince food to form a good bolus
-Good dentition is required to mince food adequately or may be painful
-Mouth must be moist, xerostomia makes it difficult to soften food = dry bolus is difficult to swallow
Interventions to assist with oral phase
-Provision of frequent and adequate mouth care
-Treat or correct underlying reason for xerostomia
-Provide manageable amount of food when assisting client to eat
-Use a teaspoon and ensure client is tolerating what is being provided
-Pace the meal as it is important to make sure mouth is empty before adding more food
Pharyngeal phase
-Involuntary phase = takes 1-2 secs and purpose is to protect the airway
-Once bolus enters the upper throat above the larynx, soft palate rises to block off nasal passage
-Next hyoid bone moves to allow epiglottis to invert closing off the trachea
-Tongue base moves forward = leads to bolus moving downward to esophagus, all resp passages are blocked
Potential problems in pharyngeal phase
-Aspiration is significant risk during this stage as the esophagus and trachea share a passage, if any step isn’t working aspiration may result
-Older adults tend to have a prolonged pharyngeal phase and a reduced cough reflex
-Strong cough reflex is important during this phase as it allows food/liquid which has entered the trachea to be expelled
Esophageal Phase
-Involuntary phase with the purpose of transferring the bolus from pharynx to stomach
-During this phase bolus moves to the stomach through peristaltic waves of esophageal muscles
Potential Problems in Esophageal Phase
-Retention of food and liquid in the esophagus after swallowing can result from a mechanical obstruction (tumour or stricture), a motility disorder (weakness or in coordination or esophageal spasm) or impaired opening of lower esophageal sphincter
-GERD is closely related problem although it is not a swallowing disorder. Individuals with gerd are at risk for reflux esophagitis as well as peptic strictures which can lead to an esophageal obstruction and result in dysphagia
Reasons for difficulty chewing and swallowing
-Normal aging processes
-Medications
-Neurological changes
-Physical/structural diseases or injury
Potential Complications/Consequences of difficult Chewing/Swallowing
-Malnutrition
-Dehydration
-Weight loss
-Emotional distress
-Choking
-Airway obstruction
-Inability to take medications
-Aspiration
-Pneumonia
-Death
Dysphagia: Normal Aging
-Decreased saliva production making it harder to chew and swallow, also changes the way dentures fit
-Esophageal sphincter weakens and reflex may result
-Tongue mass and strength decrease making it harder to control food and clear the mouth
-Facial muscles atrophy which makes it harder to control the food in the mouth and may lead to pocketing of food in cheeks
-Cough reflex weakens sometimes resulting in “silent aspiration”
Dysphagia: Medication
-Can cause drug induced Dysphagia
-Can result as a side effect of medication, a complication of therapeutic action, or drug induced esophageal injury
-Anticholinergics, antipsychotics, antidepressants, anti anxiety, anticonvulsants, neuromuscular blocking and muscle relaxers, immunosuppressants
-Many of these meds can cause effects such as dried mouth, sedation, confusion, and movement disorders which in turn can lead to Dysphagia
Dysphagia: Neurological Condition
-Aquired: CVA, head/spinal cord trauma, infection such as polio, anorexia
-Congenital: Cerebral palsy, muscular dystrophy
-Degenerative: Parkinson’s, MS, ALS, Huntington’s, dementias
-Any condition that causes injury or damage to anatomical structures required for effective chewing and swallowing can cause Dysphagia including trauma and surgical intervention for disease management such as for cancer
Clinical Manifestations of Dysphagia in the Swallowing Phases
-Drooling/leaking of food (oral)
-Prolonged chewing/delay/multiple swallows (oral)
-Coughing and/or choking during or after swallowing (pharyngeal)
-Gurgly or wet sounding voice (pharyngeal)
-Feeling if having food stuck in the chest (esophageal)
-Reflux (esophageal)
-Weight loss (any stage)
-Refusal of food or reluctance to eat (any stage)
Who to refer to if these issues occur
-Document findings and communicate them to the team
-Dietician, OT, PT
