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
2
Q
If this same bolus DOES go below the vocal folds this is known as what?
A
Aspiration
3
Q
List three neurological diagnosis that may contribute to dysphagia:
A
ALS Dementia Parkinsons
4
Q
Aspiration of liquid food may result in a lung infection known as what?
A
Aspiration Pneumonia
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
6
Q
List the 4 stages of swallowing:
A
Oral Prep
Oral
Pharyngeal
Esophageal
7
Q
Upon seeing a lemon, salivation begins.
A
Oral Prep
8
Q
The food is moved to the back of the mouth by the tongue via an anterior to posterior rolling motion
A
ORal
9
Q
The bolus is moved via peristaltic wave motion with some help from gravity.
A
Esophageal
10
Q
The circopharyngeus muscle contracts to prevent reflux and respiration resumes.
A
Esophageal
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
12
Q
Inspiration is inhibited during this stage of the swallow.
A
Pharyngeal or ORal
13
Q
The true and false vocal folds adduct.
A
Pharyngeal
14
Q
This stage normally lasts between 8 & 20 seconds.
A
Esophageal
15
Q
During the pharyngeal stage of the swallow the larynx and the hyoid bone are pulled both ______ and _________.
A
Anterior & Superior
16
Q
At rest, the upper and lower esophageal sphincters are in what position?
A
Closed and Contracted
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
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.
19
Q
Dry mouth, where secretions are notably copious or essentially absent is known as:
A
Xerostomia
20
Q
What is swallow apnea? What happens
A
The point during the swallow where you are no longer breathing
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
22
Q
The procedure establishing a hole in the anterior neck in to the trachea to establish an airway is called:
A
Tracheostomy
23
Q
List 3 signs of OVERT aspiration
A
a. Shortness of breath
b. Coughing
c. Vomitting
24
Q
List 3 signs of COVERT aspiration
A
a. Sneezing
b. Nasal flares
c. Color change
25
Name a potential side effect of each of the treatments for head and neck cancer:
a. Surgical: Scaring, fatigue, nausea, skin malformation
b. Chemotherapy: loss of hair, fatigue, nausea
c. Radiation: irritation/redness of skin
26
What is a partial glossectomy?
Removal of part of the tongue; client will have difficulty maintaining, formation, and transportation of bolus
27
What is a hemilaryngectomy?
Removal of part of the larynx; client will present with inadequate structures to swallow
28
What is the normal range of breaths per minute for an adult at rest?
12-20
29
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.
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
30
Name two things that happen to the esophagus with age?
a. LES musculature decreases
| b. Stomach capacity decreases
31
Gastroesophageal reflux is what?
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.
32
Give two examples of patient complaints as a result of GERD:
a. Patient will burp/eructate a lot
| b. Regurgitate after meals
33
With the use of Passy-Muir Speaking Valve, must the cuff be inflated or deflated?
Deflated
34
Why must the cuff be deflated ?
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
35
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
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.
36
What is the difference between a mandibular munching pattern and rotary jaw movement?
a. Mandibulary munching is primitive
| b. Rotary Jaw Movement is secondary and is acquired over time.
37
Why is oral care so imperative in individuals with pharyngeal dysphagia? What can potentially happen if oral care is not provided?
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.
38
Three recommendations that you would share with hospital staff regarding oral care:
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
39
IF during feeding a bolus is not contained in the oral cavity and leaks out past the lips, it is referred to as :
Anterior Leakage
40
The CNS centers for swallowing and respiration are linked and located in the:
medulla of the brainstem
41
G-tube:
surgically placed directly into the stomach.
42
J Tube:
jejunum; button can be surgically placed directly into the intestines or into the stomach
43
NG Tube:
Naso Gastric; runs from the nose to the stomach
44
Before the onset of the swallow response, the bolus leaks over into the vallecular space prematurely. This is known as:
Prematrue Posterior Leakage
45
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:
Pharyngeal Retention
46
Disorder that is both psychological and nutritional; Uncontrollable eating binges followed by periods of fasting, purging, or vomiting; Overtime can lead to swallowing impairments
39. Bulimia Nervosas
47
How can Bulimia contribute to dysphagia?
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
What are the four diagnostic symptoms of Wernicke’s enceophalopathy:
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
type of dementia that results from permanent damage to areas of brain involved in memory; Brain disorder due to vitamin B1 Deficiency
Korsakaff syndrome
50
Symptoms of Korsakaff syndrome include:
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
What is severe epiflottitis:
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
Describe the Frazier Free Water Protocol and someone who would be a beneficial candidate.
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
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
cleft palate
54
Complications associated with feeding an infant with CP:
Nasal regurgitation, poor lip closure for latching on, poor inter-oral pressure, fatigue, prolonged feeding time, excessive air intake/nutrition, failure to thrive
55
Chronic autoimmune neuromuscular disease characterized by weakness and rapid fatigue of any of the muscles under your voluntary control
Myasthenia Gravis
56
What is the goal of using thickened liquids?
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
Different liquid consistencies:
Nectar, Honey Thick, Pudding Thick
58
Name three populations thickened liquids would benefit:
Elderly, Parkinsons disease, stoke patients, Any patient who is found to aspirate thin liquids.
59
a type of muscular dystrophy that is caused by a genetic mutation of DNA; specifically 4q35 of the long arm of chromosone 4.
Facioscapulohumeral
60
Persistent failure to eat adequately as reflected in failure to gain weight or significant weight loss in less than 1 month.
Pediatric Aversion
61
Insufficient food intake can cause weight loss, malnutrition, impaired mental & physical development, and in the worst cases death.
.
62
consistent of reinforcements contingent on accepting bites of food and extinction of avoidance behaviors.
Behavioral Treatments
63
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.
Physical prompting
64
this technique is used when a child spits out food. The food is then re-presented and reinforcement is contingent on the child swallowing.
Re-presenting expelled food
65
toys are available continuously during meals , making meal-time more appealing.
non-contingent play
66
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
pre-chaining
67
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
food chaining
68
A traditional tracheostomy tube is always in an ________ position so that the patient is inhaling and exhaling through the trach
open
69
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.
closed
70
Who is a Candidate for the Passy-Muir Valve?
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
What is the ultimate goal for dysphagia patients:
Patient will tolerate least restrictive diet with 0% CSA/P.
72
a progressive disease in which the myelin covering of axons in the CNS degenerates
Multiple Sclerosis
73
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
Mendelsohn Maneuver
74
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
Mendelsophn Maneuver
75
holding bolus in cohesive form for 3 seconds before swallowing." The reason is to get them more organized before the swallow.
Prep-set
76
Touching the chin to the neck
Chin Down
77
When should you used the Chin Down technique?
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
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
chin down
79
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.
Effortful Swallow
80
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.
supraglottic swallow
81
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.”
super supra glottic swallow
82
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.
shaker exercises
83
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.
masako maneuver
84
Patient tilts the head to the side that is stronger without weakness directing the bolus down the stronger side
Head Tilt
85
When should you use the Head Tilt?
Unilateral oral and pharyngeal weakness is on the same side
86
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
Head turn
87
When should you use Head Turn?
Unilateral pharyngeal wall impairment or vocal fold weakness
88
Alternating bites of food with sips of water; getting ride of any existing residue
Cyclic ingestion
89
When should you use cyclic ingestion?
With Patients with bolus manipulation deficits, especially those who exhibit post swallow residue
90
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.
Least Restrictive Diet/ Diet regulation
91
Postural Techniques for Dysphagia Treatment Include:
Head Back, Chin Down, Head Turn, Head Tilt, Diet Changes
92
When would you use Head Back Posture?
Do this when fluoroscopy shows inefficient oral transit (reduced propulsion of bolus by the tongue) but good airway protection
93
Why would you use Head Back?
It allows gravity to clear oral cavity of the bolus
94
When would you use Chin Down ?
- 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
Why would you use Chin Down?
- 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
When would you use Head Turn to damaged side ?
- Do this when there is unilateral pharyngeal wall impairments or vocal fold weakness
97
Why would you use head turn to damaged side?
- 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
When would you use Head tilt to the stronger side?
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
Why would you use Head tilt to the stronger side?
To direct the bolus down the stronger side
100
Would not use postural compensation if the patient has _______ or if they have _______
dementia or spinal injuries
101
Techniques that can be used when improving oral sensory awareness:
- 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
Results of Supraglottic Swallow:
in the voluntary closure of the vocal folds before, during, and after the swallow
103
What to do during the Supraglottic Swallow:
Patient is told to take a breath and hold it while swallowing and then cough after the swallow
104
Results of Super Supraglottic Swallow:
close the entrance to the airway at the level of arytenoid cartilage
105
What to do during Super Supraglottic Swallow
Patient will do as same as supraglottic swallow, but “bear down while holding breath”
106
Results of the Effortful Swallow
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
What to do during the Effortful Swallow
Patient is direct to squeeze hard with throat and neck muscles during swallow
108
What the Mendehlson Maneuver does
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
What to do during the Mendelsohn Maneuver?
- 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
What happens during Thermal Stimulation
involves tapping or rubbing of the patient’s anterior
| faucial pillar with an iced dental mirror on the strong side
111
When to use Shaker Swallow Exercise?
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
Why is the Shaker swallow exercise beneficial?
- 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
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
Masako Maneuver
114
When to use the Masako Maneuver?
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
Treatment Considerations Focusing on the Nature of the Swallowing Deficit:
Feed or swallowing deficits
voluntary or involuntary processes
Stage of Deficit
Deficit or Compensatory Activity
116
Treatment Considerations Focusing on Patient Characterisitics:
- Etiology
- Severity
- Eating History
- Social Factors
- Anticipated Medical Course
- Caregiver Factors
- Residential Environment
