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Dysphagia > Final Exam > Flashcards

Final Exam Flashcards

1
Q

If a bolus enters the laryngeal vestibule (inferiorly and anteriorly at the level of the epiglottis) and does NOT go below the level of the vocal folds, this is known as what?

A

Penetration

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2
Q

If this same bolus DOES go below the vocal folds this is known as what?

A

Aspiration

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3
Q

List three neurological diagnosis that may contribute to dysphagia:

A

ALS Dementia Parkinsons

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4
Q

Aspiration of liquid food may result in a lung infection known as what?

A

Aspiration Pneumonia

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5
Q

Which lobe is most likely, based on the division of the main bronchus, to be infiltrated an aspirated bolus?

A

Right Mid Lobe

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6
Q

List the 4 stages of swallowing:

A

Oral Prep
Oral
Pharyngeal
Esophageal

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7
Q

Upon seeing a lemon, salivation begins.

A

Oral Prep

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8
Q

The food is moved to the back of the mouth by the tongue via an anterior to posterior rolling motion

A

ORal

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9
Q

The bolus is moved via peristaltic wave motion with some help from gravity.

A

Esophageal

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10
Q

The circopharyngeus muscle contracts to prevent reflux and respiration resumes.

A

Esophageal

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11
Q

The velum is raised, primarily by the levator and tensor veli palatini muscles. This prevents the entry of food into the nasopharynx.

A

pharyngeal

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12
Q

Inspiration is inhibited during this stage of the swallow.

A

Pharyngeal or ORal

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13
Q

The true and false vocal folds adduct.

A

Pharyngeal

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14
Q

This stage normally lasts between 8 & 20 seconds.

A

Esophageal

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15
Q

During the pharyngeal stage of the swallow the larynx and the hyoid bone are pulled both ______ and _________.

A

Anterior & Superior

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16
Q

At rest, the upper and lower esophageal sphincters are in what position?

A

Closed and Contracted

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17
Q

What is diminished esophageal peristalsis?

A

When a person has diminished muscle strength to move a bolus from the esophagus into the stomach through a sequential peristaltic wave

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18
Q

What is retrograde aspiration? Explain how diminished esophageal peristalsis could contribute to retrograde aspiration

A

Retrograde aspiration is when the food comes back up from the esophagus to the airway. As a result of poor musculature food and liquids may accidently get into the lungs resulting in aspirations.

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19
Q

Dry mouth, where secretions are notably copious or essentially absent is known as:

A

Xerostomia

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20
Q

What is swallow apnea? What happens

A

The point during the swallow where you are no longer breathing

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21
Q

Three aspiration precautions:

A

a. Make sure client is seated in the upright position
b. Make sure the client is exporting after swallows
c. Have the client swallow every bolus three times

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22
Q

The procedure establishing a hole in the anterior neck in to the trachea to establish an airway is called:

A

Tracheostomy

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23
Q

List 3 signs of OVERT aspiration

A

a. Shortness of breath
b. Coughing
c. Vomitting

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24
Q

List 3 signs of COVERT aspiration

A

a. Sneezing
b. Nasal flares
c. Color change

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25
Q

Name a potential side effect of each of the treatments for head and neck cancer:

A

a. Surgical: Scaring, fatigue, nausea, skin malformation
b. Chemotherapy: loss of hair, fatigue, nausea
c. Radiation: irritation/redness of skin

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26
Q

What is a partial glossectomy?

A

Removal of part of the tongue; client will have difficulty maintaining, formation, and transportation of bolus

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27
Q

What is a hemilaryngectomy?

A

Removal of part of the larynx; client will present with inadequate structures to swallow

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28
Q

What is the normal range of breaths per minute for an adult at rest?

A

12-20

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29
Q

Explain why a patient with Chonic Obstructive Pulmonary Disease (COPD) is at significant risk if they have a resting respiratory rate of 30 breaths per minute.

A

They will have a very dry swallow making it difficult for them to get a bolus down adequately and apnea will be difficult to tolerate

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30
Q

Name two things that happen to the esophagus with age?

A

a. LES musculature decreases

b. Stomach capacity decreases

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31
Q

Gastroesophageal reflux is what?

A

GERD is when a patient has difficulty with the digestion of foods. Clients typically present with eructation, regurgitation, chest pressure/ pain, and burning of throat.

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32
Q

Give two examples of patient complaints as a result of GERD:

A

a. Patient will burp/eructate a lot

b. Regurgitate after meals

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33
Q

With the use of Passy-Muir Speaking Valve, must the cuff be inflated or deflated?

A

Deflated

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34
Q

Why must the cuff be deflated ?

A

Because if the cuff is inflated the client is susceptible for aspiration when the cuff becomes deflated. They will suffocate if the cuff is inflated and use of valve

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35
Q

An 80-year old female with primary diagnosis of a left CVA presents with a swallow delay of 2 seconds. What would be a safer choice – thin liquids or nectar thick? Why

A

Nectar thick would be safer because it is more likely she will aspirate on the thin liquids. Especially since she had a stroke and is already at risk for aspiration.

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36
Q

What is the difference between a mandibular munching pattern and rotary jaw movement?

A

a. Mandibulary munching is primitive

b. Rotary Jaw Movement is secondary and is acquired over time.

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37
Q

Why is oral care so imperative in individuals with pharyngeal dysphagia? What can potentially happen if oral care is not provided?

A

Oral care is very important to make sure it is not affecting the client negatively. If oral care is not provided pocketed food may remain in the clients mouth, thrush may form, and crud will remain in the mouth.

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38
Q

Three recommendations that you would share with hospital staff regarding oral care:

A

a. Imporant ot clean out a clients mouth multiple times a day
b. Without proper oral care we may be placing patients at risk for aspiration
c. Important to clean out the oral cavity after every meal to ensure no food has been pocketed

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39
Q

IF during feeding a bolus is not contained in the oral cavity and leaks out past the lips, it is referred to as :

A

Anterior Leakage

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40
Q

The CNS centers for swallowing and respiration are linked and located in the:

A

medulla of the brainstem

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41
Q

G-tube:

A

surgically placed directly into the stomach.

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42
Q

J Tube:

A

jejunum; button can be surgically placed directly into the intestines or into the stomach

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43
Q

NG Tube:

A

Naso Gastric; runs from the nose to the stomach

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44
Q

Before the onset of the swallow response, the bolus leaks over into the vallecular space prematurely. This is known as:

A

Prematrue Posterior Leakage

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45
Q

Once the swallow response is completed, there are aspects of the bolus still remaining throughout the pharynx. These do not clear with subsequent swallows or strategies. This is called:

A

Pharyngeal Retention

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46
Q

Disorder that is both psychological and nutritional; Uncontrollable eating binges followed by periods of fasting, purging, or vomiting; Overtime can lead to swallowing impairments

A
  1. Bulimia Nervosas
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47
Q

How can Bulimia contribute to dysphagia?

A

a. Self-induced vomiting can lead to oral dental issues, decreased production of saliva, and mild esophagitis to fatal esophageal rupture
b. Chronic bulimia patients may have acquired esophageal strictures which lead to dysphagia

48
Q

What are the four diagnostic symptoms of Wernicke’s enceophalopathy:

A

a. Malnutrition
b. Involuntary or Jerky Eye Movement
c. Poor balance or unsteadiness – indication of damage to cerebellum
d. Disorientation, confusion, mild memory loss

49
Q

type of dementia that results from permanent damage to areas of brain involved in memory; Brain disorder due to vitamin B1 Deficiency

A

Korsakaff syndrome

50
Q

Symptoms of Korsakaff syndrome include:

A

a. Inability to learn new information or form new memories
b. Inability to retrieve old memories
c. Making up stories (because they believe it to be true)
d. Hallucinations

51
Q

What is severe epiflottitis:

A

Epiglottitis is a potentially life-threatening condition that occurs when the epiglottis — a small cartilage “lid” that covers your windpipe — swells, blocking the flow of air into your lungs.

52
Q

Describe the Frazier Free Water Protocol and someone who would be a beneficial candidate.

A

a. For patients on oral diets, water is permitted between meals. Water intake is unrestricted prior to a meal and allowed 30 minutes after a meal.
b. Because the human body is 60% water, small amounts of water taken into the lungs is quickly absorbed by the body
c. NPO or currently taking honey or nectar thick liquids; swallow water without demonstrating excessive coughing and discomfort; able to maintain alertness and arousal; elicit a timely/efficient swallow ;able to maintain upright posture

53
Q

What is a gap in either or both the hard and soft palates that conjoin the nasal and oral cavities. This congenital defect causes difficulties for newborn feeding, hearing and speech production due to lack of inter-oral pressure

A

cleft palate

54
Q

Complications associated with feeding an infant with CP:

A

Nasal regurgitation, poor lip closure for latching on, poor inter-oral pressure, fatigue, prolonged feeding time, excessive air intake/nutrition, failure to thrive

55
Q

Chronic autoimmune neuromuscular disease characterized by weakness and rapid fatigue of any of the muscles under your voluntary control

A

Myasthenia Gravis

56
Q

What is the goal of using thickened liquids?

A

a. make all liquids a thicker consistency that is less likely to cause aspiration.
b. Thicker liquids travel more slowly down the throat, giving the body more time to control and direct the fluid toward the stomach.

57
Q

Different liquid consistencies:

A

Nectar, Honey Thick, Pudding Thick

58
Q

Name three populations thickened liquids would benefit:

A

Elderly, Parkinsons disease, stoke patients, Any patient who is found to aspirate thin liquids.

59
Q

a type of muscular dystrophy that is caused by a genetic mutation of DNA; specifically 4q35 of the long arm of chromosone 4.

A

Facioscapulohumeral

60
Q

Persistent failure to eat adequately as reflected in failure to gain weight or significant weight loss in less than 1 month.

A

Pediatric Aversion

61
Q

Insufficient food intake can cause weight loss, malnutrition, impaired mental & physical development, and in the worst cases death.

A

.

62
Q

consistent of reinforcements contingent on accepting bites of food and extinction of avoidance behaviors.

A

Behavioral Treatments

63
Q

gentle pressure is placed on child’s chin, so the child’s mouth is guided open then clinician places the food in the child’s mouth.

A

Physical prompting

64
Q

this technique is used when a child spits out food. The food is then re-presented and reinforcement is contingent on the child swallowing.

A

Re-presenting expelled food

65
Q

toys are available continuously during meals , making meal-time more appealing.

A

non-contingent play

66
Q

focuses on a treatment program to keep the child as close to the developmental progression of oral skills as possible during the first year of life

A

pre-chaining

67
Q

is a therapy program that uses foods as desensitization and/or as therapy tools in treatment. The therapist analyzes the current food repertoire of the child to determine similarities in taste/texture/temperature

A

food chaining

68
Q

A traditional tracheostomy tube is always in an ________ position so that the patient is inhaling and exhaling through the trach

A

open

69
Q

With the attachment of the Passy Muir Valve to the hub of a tracheostomy tube, a ________ system is created. The valve is in a closed position until the patient inhales. The patient inhales through the trach, but exhales through the mouth and nose.

A

closed

70
Q

Who is a Candidate for the Passy-Muir Valve?

A

a. Adults & Pediatric & Neonatal
b. Awake & Responsive
c. Medically Stable
d. Tolerate deflated cuff
e. Manage secretions
f. Airway is cleared and is able to exhale around the trach tube

71
Q

What is the ultimate goal for dysphagia patients:

A

Patient will tolerate least restrictive diet with 0% CSA/P.

72
Q

a progressive disease in which the myelin covering of axons in the CNS degenerates

A

Multiple Sclerosis

73
Q

This technique helps the patient gain some voluntary control over the opening and closing of the pharyngoesophageal (p.e.) segment. Laryngeal movement opens the UES and prolongs laryngeal elevation and UES opening

A

Mendelsohn Maneuver

74
Q

The patient is told to pay attention to the way the thyroid cartilage (Adam’s apple) goes up and down during swallowing. Then he learns to use muscles to keep the larynx elevated for several seconds after the swallow. This should facilitate the opening of the cricopharyngus muscle

A

Mendelsophn Maneuver

75
Q

holding bolus in cohesive form for 3 seconds before swallowing.” The reason is to get them more organized before the swallow.

A

Prep-set

76
Q

Touching the chin to the neck

A

Chin Down

77
Q

When should you used the Chin Down technique?

A

Try this technique when fluroscopy shows a delay in triggering the pharyngeal swallow (Bolus passes the ramus of the mandible, but the pharyngeal swallow does not trigger). This is also helpful if the patient has reduced tongue base retraction, and or reduced airway entrance closure.

78
Q

It widens the valleculae to prevent the bolus from entering the airway; narrows the airway entrance; pushes the epiglottis posterior; pushes the tongue base backward, closer to the pharyngeal wall

A

chin down

79
Q

This increases the tongue driving force by causing exaggerated retraction of the tongue. This helps to get food past the valleculae. The effort increases posterior tongue base movement. The patient is directed to squeeze hard with his throat and neck muscles during the swallow.

A

Effortful Swallow

80
Q

Perform this maneuver when there is reduced or late vocal fold closure. The patient is told to take a breath and hold it while swallowing and then coughs after the swallow. This results in the voluntary closure of the vocal folds before, during and after the swallow.

A

supraglottic swallow

81
Q

This is for reduced closure of the airway entrance. This technique closes the entrance to the airway at the level of the arytenoid cartilages. The patient follows the same procedure as with the supra-glottic swallow, but “bears down while holding his breath.”

A

super supra glottic swallow

82
Q

strengthens the muscles that lift the hyoid bone, which lift the larynx upward and forward and open the upper esophageal sphincter (UES). The isometric strengthening portion involves three consecutive head lifts for 60 seconds, with a 60-second rest period between each head lift. The isometric exercise causes tension on the muscle without movement. The isokinetic strengthening portion involves 30 consecutive head lifts without holding.

A

shaker exercises

83
Q

a pharyngeal strengthening exercise; Performed by protruding your tongue between your front teeth, holding it in place by gently biting down on the anterior portion of your tongue and maintaining this posture while swallowing saliva.

A

masako maneuver

84
Q

Patient tilts the head to the side that is stronger without weakness directing the bolus down the stronger side

A

Head Tilt

85
Q

When should you use the Head Tilt?

A

Unilateral oral and pharyngeal weakness is on the same side

86
Q

Patient turns his head to the weak/damaged side; placing extrinsic pressure on thyroid cartilage, increasing adduction when there is a vocal fold weakness. Twists the pharynx and closes the damaged side of the pharynx so food will pass down the normal side

A

Head turn

87
Q

When should you use Head Turn?

A

Unilateral pharyngeal wall impairment or vocal fold weakness

88
Q

Alternating bites of food with sips of water; getting ride of any existing residue

A

Cyclic ingestion

89
Q

When should you use cyclic ingestion?

A

With Patients with bolus manipulation deficits, especially those who exhibit post swallow residue

90
Q

This should be the last compensatory strategy examined. This should only be done if all other compensatory strategies and postural strategies are ineffective or the patient is unable to follow the directions. Liquids may need to be thickened if the patient is showing aspiration on thin liquids.

A

Least Restrictive Diet/ Diet regulation

91
Q

Postural Techniques for Dysphagia Treatment Include:

A

Head Back, Chin Down, Head Turn, Head Tilt, Diet Changes

92
Q

When would you use Head Back Posture?

A

Do this when fluoroscopy shows inefficient oral transit (reduced propulsion of bolus by the tongue) but good airway protection

93
Q

Why would you use Head Back?

A

It allows gravity to clear oral cavity of the bolus

94
Q

When would you use Chin Down ?

A
  • Do this when fluoroscopy shows a delay in the triggering of the pharyngeal swallow (bolus passes the ramus of the mandible but pharyngeal swallow has not triggered).
  • Do this when fluoroscopy shows reduced tongue base retraction or reduced airway entrance closure
95
Q

Why would you use Chin Down?

A
  • It will widen the valleculae to prevent bolus from entering the airway; narrow the airway entrance; pushes the epiglottis in a more overhanging position; pushes the tongue base backwards; closer to the pharyngeal wall
96
Q

When would you use Head Turn to damaged side ?

A
  • Do this when there is unilateral pharyngeal wall impairments or vocal fold weakness
97
Q

Why would you use head turn to damaged side?

A
  • Pushes open the cricopharyngeus and closes pyriform sinuses on damaged closed
  • This will place extrinsic pressure on the thyroid cartilage, which increases adduction when there is vocal fold weakness.
  • It will twist the pharynx and close the damage side of the pharynx so the food will pass down the normal side.
98
Q

When would you use Head tilt to the stronger side?

A

Do this when there is unilateral oral and pharyngeal weakness on the same side (residue in the mouth and pharynx on the same side)

99
Q

Why would you use Head tilt to the stronger side?

A

To direct the bolus down the stronger side

100
Q

Would not use postural compensation if the patient has _______ or if they have _______

A

dementia or spinal injuries

101
Q

Techniques that can be used when improving oral sensory awareness:

A
  • Using downward pressure of a spoon against the tongue when presenting food
    • Present different temperature bolus
    • Present a sour bolus
    • Present a larger volume of bolus
    • Present a bolus requiring chewing
  • Thermal or tactile stimulation (rub faucial arches to aid in triggering a swallowing)
102
Q

Results of Supraglottic Swallow:

A

in the voluntary closure of the vocal folds before, during, and after the swallow

103
Q

What to do during the Supraglottic Swallow:

A

Patient is told to take a breath and hold it while swallowing and then cough after the swallow

104
Q

Results of Super Supraglottic Swallow:

A

close the entrance to the airway at the level of arytenoid cartilage

105
Q

What to do during Super Supraglottic Swallow

A

Patient will do as same as supraglottic swallow, but “bear down while holding breath”

106
Q

Results of the Effortful Swallow

A

Increases the tongue driving force by causing exaggerated retraction of the tongue
- Helps pass food past the valleculae, effort increased posterior tongue base movement

107
Q

What to do during the Effortful Swallow

A

Patient is direct to squeeze hard with throat and neck muscles during swallow

108
Q

What the Mendehlson Maneuver does

A

this helps gain some voluntary control over the opening and closing of the pharyngoescophageal segment
- Laryngeal movement opens up the UES and prolongs laryngeal elevation and UES opening

109
Q

What to do during the Mendelsohn Maneuver?

A
  • Patient is directed to pay attention to the way the thyroid cartilage (Adam’s apple) goes up and down during swallow. Use the muscles to larynx elevated for several seconds after the swallow.
  • opening of the circopharyngeaus muscle
110
Q

What happens during Thermal Stimulation

A

involves tapping or rubbing of the patient’s anterior

faucial pillar with an iced dental mirror on the strong side

111
Q

When to use Shaker Swallow Exercise?

A

Difficulty with pharyngeal strength, UES function or esophageal emptying (if the problem is liquids only, its not a problem with UES)

  • Difficulty elevating larynx, which means UES won’t open
  • Cricopharyngeal bar
  • Reduced UES opening with pyriform residue
112
Q

Why is the Shaker swallow exercise beneficial?

A
  • Beneficial because it strengthens the suprahyoid muscles that lift the hyoid bone, which lift the larynx upward and forward and open the UES
  • Involves isometric and isokinetic neck exercises
113
Q

Hold your tongue out while swallowing because anchoring of anterior tongue causes the glossopharyngeal portion of the superior constrictor muscle to use more force in contraction

A

Masako Maneuver

114
Q

When to use the Masako Maneuver?

A

Presence of pharyngeal weakness, incomplete contact between pharyngeal wall and base of the tongue
- Pooling of saliva or food and noticed by gurgly voice
Do NOT use with real food or liquid

115
Q

Treatment Considerations Focusing on the Nature of the Swallowing Deficit:

A

Feed or swallowing deficits
voluntary or involuntary processes
Stage of Deficit
Deficit or Compensatory Activity

116
Q

Treatment Considerations Focusing on Patient Characterisitics:

A
  • Etiology
  • Severity
  • Eating History
  • Social Factors
  • Anticipated Medical Course
  • Caregiver Factors
  • Residential Environment

Dysphagia (2 decks)

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