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Dysphagia > Final > Flashcards

Final Flashcards

1
Q

Maneuvers

A

Are used to help patient swallow more effectively. Require that the patient be able to follow complex commands, but can be broken down into smaller steps. Practice as exercises and use as in assessment and treatment. Check under floro or FEES to determine effectiveness.

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2
Q

Supraglottic Swallow

A

Is a breath hold technique. Targets reduced or late vocal fold closure. Closes vocal cords before and during the swallow, protecting the airway from aspiration. May be used in oral cancer patients but have to trigger the swallow a different way due to reduced tongue mobility.

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3
Q

Directions for Supraglottic Swallow

A

Take a deep breath and hold your breath. Keep holding your breath. Keeping holding your breath while you swallow. Immediately after swallowing patient should cough.

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4
Q

Super Supraglottic Swallow

A

Is a breath hold technique. Closes entrance to the airway by tilting arytenoid cartilage to base of epiglottis before and during swallow. Used in patient with reduced vocal fold closure or those who have a superglottic laryngectomy. Improves rate of laryngeal elevation. Is helpful for those who have had radiation to the neck.

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5
Q

Super Supraglottic Swallow Directions

A

Inhale, hold breath, bear down. Keep holding breath and continue to bear down as you swallow. Cough when finished.

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6
Q

Mendehlson

A

Improves swallow coordination and eeppiglotic inversion. Increases extent of laryngeal elevation and increases width and duration of UES opening.

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7
Q

Mendehlson Directions

A

Swallow saliva several times and pay attention to the way your neck acts as you swallow. Tell clinican if you can feel your voicebox/Adam’s apple rise and fall. Now this time when you swallow and you feel the voicebox/Adam’s apple lift keep it there and do not let fall. Hold it for several seconds.

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8
Q

Effortful Swallow

A

Helps with tongue base retraction. Increases lingual force, improves bolus clearance, and reduces residue form the vallecule.

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9
Q

Effortful Swallow Directions

A

As you swallow squeeze hard with all of your muscles.

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10
Q

Extended Supraglottic Swallow (Dump and Swallow)

A

Used for triggering of pharyngeal swallow. Like a normal swallow taking constitutive sips from a cup. As confidence increases so does the bolus size.

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11
Q

Extended Supraglottic Swallow (Dump and Swallow)

A

Hold breath. Put in 5cc/10cc in mouth. Hold breath and toss head back. Swallow 2-3 times or as many as necessary to clear majority of the bolus while holding your breath. Cough to clear residue.

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12
Q

Positions for Swallowing

A

May be combined with maneuvers to help increase ability to swallow.

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13
Q

Chin Tuck

A

Tuck the chin. Forces the entryway to the airway to narrow. Is used to target a delayed swallow.

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14
Q

Head Rotation

A

Turn the head to either direction to force the bolus down the opposite side. Used for patients with unilateral weaknesses on one side of the throat or if they have a paralyzed vocal fold on side. Rotate the head to the weak side and thus force the bolus to go down the stronger side of the throat.

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15
Q

Head Extension

A

Raise the chin when swallowing and gravity causes the bolus to move towards the pharynx. Widens the oropharynx and may be helpful in moving the bolus from the mouth to the pharynx when oral/lingual deficits are present. Good for patients who have had lossectomy/oral resections, reconstruction, or lingual paralysis.

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16
Q

Laying Down/Side Lying

A

Decreases the effect of gravity during the swallow or on post swallow residue. May be applied when a difference in pharyngeal function is noted between right and left side. Uses gravity to direct the bolus to the stronger hemipharynx. Increased hypopharyneal pressure on the bolus leads to increased maxium opening of the PES and reduced duration of sphincter opening during the swallow.

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17
Q

Oral Prep Stage

A

Break down food to a consistency appropriate or swallowing. Mixes food with saliva. Starts with visual and sensory recognition of food. Also includes mastication.
Starts- When you see food.
Ends- When tongue moves posteriorly and chewing stops.

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18
Q

Cranial Nerves in Oral Prep Stage

A

V-Trigeminal
VII- Facial
X- Vagus
XII- Hypoglossal

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19
Q

Oral Stage

A

Main component of this stage is propulsion. A stripping action of the pharyngeal wall occurs. A good labial seal is needed for propulsion. Propels the food between the palate and the tongue. Minimal coating on the tongue. 1-2 seconds longs.
Starts- when tongue moves posteriorly.
Ends- triggering of the pharyngeal swallow.

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20
Q

Oral Stage Cranial Nerve

A

XII Hypoglossal

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21
Q

Pharyngeal (Key Activities)

A 
Closure of VP Port
Tongue Base Retraction
Elevation of hyoid and larynx. 
Closure of larynx and VP
Relaxation and opening of UES.
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22
Q

Pharyngeal Stage

A

Starts when swallow is triggered when the tongue base and faucil arches pass the lower rim of the ramus. Lasts a total of one second. Ends when the UES opens.

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23
Q

Pharyngeal Cranial Nerves

A

IX Glosspharyngeal
X Vagus
XI Spinal Accessory

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24
Q

Esophageal Stage

A

Voluntary. Primary, secondary, and tertiary perstalsis. Starts when the UES opens. Ends when bolus passes into the stomach.

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25
Q

Oral Examination

A

Check oral hygiene, dentition, xerostomia, thrush. Do not proceed if there is poor hygiene. Take care of then treat.

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26
Q

Oral Motor Exam

A

Do to test cranial nerves.

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27
Q

Other things to check for in oral & oral motor exam.

A

Dysarthria. Apraxia. Vocal quality. Respiration functioning. Protective reflexes.

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28
Q

What do you do first for a patient who is NPO?

A

Make sure the mouth is moist. Make sure there is adequate hydration and good oral hygiene. Look at physical appearance of the patient.

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29
Q

MBS Standard Protocall

A

Thin liquids-5cc, repeat 5cc , cup sip single, sequential swallow from cup or straw sip.
Nectar thickened- 5cc, cup sip single, sequential swallow.
Honey thickened- 5 cc.
Pudding- 1tbs.
1/2 cookie coated with barium.
1/2 cookie and 1 tbs pudding.

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30
Q

Exceptions for Neurogenic Patients

A

Aspirate on thin liquids start with pureed then proceed to thin liquids, then solids.

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31
Q

Exceptions for Respiratory and Artificial Airways

A

Start with thin liquids no matter what. Are at a high risk for aspiration. High risk for aspiration no matter what and thinner are easier to aspirate than solid. Easier to clear than solid and regain control and breathing after aspirating liquid.

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32
Q

When testing a patient for swallow evaluation you should always make sure that your information is

A

Reliable and reproducible.

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33
Q

When do you discontinue bedside swallow evaluation? (7)

A

Absent swallow-12 seconds.
Severe coughing or choking which they cannot recover from.
Absent laryngeal elevation.
Significant respiratory distress and vomiting.
Drop in O2 stats.
Fear of swallowing that cannot be remediated.
Patient cannot maintain alertness.

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34
Q

Detailed Bedside Exam (6)

A

Bedside Swallow, History, Patient Interview, Cognition, Oral Exam, Preparation for Swallowing, Other.

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35
Q

Bedside Swallow

A

May different evaluations, not universal. Try to be as standardized as possible.

36
Q

History (14)

A

Be sure to take history back 20 years becasue dysphagia can be intermittent, progerssive, or concomitant. Ask about previous surgeries, pneumonia history, medications, other diseases, nutrition, previous swallow evals, mechanical devices, primary diagnosis, physician notes, consultant notes, nurse notes, baseline diet, current diet, and and time frames.

37
Q

Patient Interview (6)

A

Symptoms, complaints, perception (life impairment), onset, localization, course (when is it better, when is it worse).

38
Q

Cognition/Present State

A

A & O, ability to follow commands.

39
Q

Pre Bed Side Swallow Exam (3)

A

History, interview, and cognition.

40
Q

Questions to answer before bedside exam (3)

A

Is the individual alert enough to swallow?
Can the individual handle secretions?
Can the patient support their own breathing? If yes to all prepare for bedside swallow.

41
Q

Preparations for Bedside Swallow

A

Oral care, clean moist mouth.

42
Q

Other considerations for bedside swallow

A

Explain protocol, have patient feel them-self, monitor O2 stats.

43
Q

Bedside Swallow Report Objectives (4)

A

Diagnosis- Only diagnosis oral can suspect pharyngeal.
Aspiration Risk
Recommendations.
Patient Education/ Participation in POC- Tell them what’s going on or what you think is going on, how you think they should manage it, and see if they agree or not.

44
Q

MBS vs FEES (8)

A 
Non invasive/invasive.
Views all stages/ pharyngeal only.
Cannot assess salivia/ assess salivia.
No direct view of larynx/ direct view of larynx.
Radiation/No radiation.
No anesthesia/ anesthesia.
Usually not portable/portable.
Diagnosis aspiration/ aspiration before or after swallow only.
45
Q

Limitations of Bedside Swallow (6)

A

Only oral stage.
Suspect pharyngeal and esophageal.
High rate of false positive.
Can do general transit times but not accurate enough for pharyngeal stage.
Is not sensitive for diagnosing aspiration.
Good to see if patient can handle an MBS.

46
Q

When to do further testing based off of bedside (3)

A

Patient is showing pharyngeal or esophageal stage symptoms or signs, unexplained symptoms related to swallowing/nutrition, recurrent medical outcomes with no found etiology.

47
Q

When not to do further testing based off of bedside (2)

A

Family/patient will not comply with recommendations, information received on diagnostic test will not increase the individuals quality of life.

48
Q

Stressing Patient on MBS

A

Test positions, maneuvers, sensory and behavior modifications, and collect responses. Behavior under stress may be different than ‘normal’ behavior. Helps you understand limits and differing pathophysiology in different situations.

49
Q

White Out During FEES

A

The period during the swallow where the tongue base meets the posterior wall of the pharynx and closes off the oral cavity. Thus cutting off the camera so it cannot record the pharyngeal stage of the swallow.

50
Q

Breathing and Swallowing

A

Closely realted and controlled by the MTS. Many muslces have dual roles during breathing and swallowing.

51
Q

Disorders that Affect Respiratory

A

Normal aging, COPD, head/neck cancer, neurological disease, stroke.

52
Q

Diaphragm and Inspiration

A

Flattens then contracts during inspiration to increase the height of the thoracic cavity and make room for the lungs to expand.

53
Q

Expiration in Healthy Adults

A

Quiet and passive.

54
Q

Swallow Apnea

A

Occurs when the airway closes for a fraction of a second during the swallow. If airway is closed individual cannot breathe. No chest movement. Can be longer. Highly variable based on bolus size, solid food, or cup drinking.

55
Q

Why is swallow apnea a problem for individuals with respiratory problems?

A

Disrupts the breathing process and their breathing is already insufficient. Can lead to insufficient breathing during the swallow and anxiety about suffocating while swallowing.

56
Q

Pulmonary Toliet

A

Body’s natural way of clearing secretions. Is composed of cillia, mucocilliary clearance, coughing, and expectorating.

57
Q

Artifical Pulmonary Toliets

A

Suction, broncoscopy, and inhalers.

58
Q

Mucocillary Clearance

A

Movement of mucous in the respiratory tract by movement of cillia. Ineffective mucocillary clearance is caused by poor hydration and can lead to mucous plugs, bacterial infections, and thick secretions.

59
Q

NPO and Pulmonary Toliet

A

Lack of hydration leads to lack of saliva which helps mucocilliary clearance.

60
Q

Tacheostomy Tubes

A

Used to reduce aspiration and protect the lungs. They can suction from a trach tube of the patient cannot handle secretions. May be used for patients who need a longer time to gain respiratory status back. Sized 1-8. Cuffed or non cuffed. Fenstrated or non fenstrated.

61
Q

Tacheostomy and Swallowing

A

Reduction in subglottic pressure. Some reduction in laryngeal elevation. Tethered affect.

62
Q

24 Wait Period after Extubation

A

May have erythema, edema, decreased senstation, and odynophasia. The vocal folds and pharyngeal cavity need time to heal.

63
Q

PSMV

A

Passy Muir Speaking Valve. Special cap placed on the trach that allows for speaking.

64
Q

Anti Psychotic Drugs and Swallowing

A

Iotragenic Swallowing Disorders. Neuroleptics. Tardive dyskinesia (tongue tremor due to the meds). Slow esophageal motility, aspiration, alter transport, overall uncoupling and delay of swallow.

65
Q

Normal Changes in Elderly Swallow

A

Slower oral transit, delayed swallow inititaion, longer oral prep stage. Delayed UES, reduced 2nd perstatlsis, LES pressure does not change.

66
Q

Why are elderly at risk for esophageal disorders?

A

Distorted anatomy, diseases, pill induced injury, calcified aortic knob, osteoarthritis, and less overall reserve.

67
Q

What should you do when creating treatment plans?

A

Gather information (assess anatomy, medical status, prognosis, behavior and cognition). Gather evidence (research).

68
Q

Best Practice

A

Research, patient wishes, clinical experience.

69
Q

Diet Levels

A

Purred, M Soft, and regular.

70
Q

Viscosity Levels

A

Nectar, honey, pudding.

71
Q

Silent Aspiration

A

Aspiration of food or liquid without coughing. Can occur in neurological patients.

72
Q

Parkinson’s and Swallowing

A

Impairment in execution of voluntary movement. Have poor oropharyngeal control, therefore poor bolus control. Random tongue movement, weak swallow reflex, drooling, and in-coordination of swallow and respiration.

73
Q

Brainstem CVA and Swallowing

A

Oral apraixa, in-coordination of swallow muscles, incomplete swallow, delayed or absent pharyngeal response, reduced hyoid and laryngeal elevation, reduced oropharyngeal constriction, reduced pharyngeal constriction, reduced laryngeal closure, reduced PES opening.

74
Q

Aspiration

A

Bolus enters airway below the level of the vocal folds.

75
Q

Penetration

A

Bolus enters glottic airway into trachea and stays above the vocal folds.

76
Q

Bedside Swallow Standardized

A

MASA (Mann Assessment of Swallowing)

SSA- Standard Swallowing Assessment

77
Q

Sensory Modifications for Swallowing

A

Mutli sensory dietary modifications, oral motor exercises, thermal-tactile stimulation, shaker exercises.

78
Q

Stroke Recovery

A

Oral Intake 3-4 months. Most progress is in first 3-4 weeks. 20-25 days is typical recovery time.

79
Q

RDS

A

Respiratory distress syndrome. Affects lungs of preterm neonates due to lack of surfactant. It infant has repriatroy problems individuals will not swallow.

80
Q

Surfactant

A

Fluid secreted by lungs to stabilize and prevent them from collapsing upon exhalation.

81
Q

Cerebral Palsy

A

Tonic bite, hypersensitivity.

82
Q

Brain Injury

A

Oral motor disorder, dysphagia, change in appetite, poor attention span, respiratory issues.

83
Q

GER

A

Gastroesophageal reflex causes respiratory distress and pneumonia.

84
Q

Esophageal Atresia

A

Esophagus not fully developed.

85
Q

Bronchopulmonary Dysplasia

A

Causes RDS

Dysphagia (1 decks)

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