General Flashcards
Definition
disorder of, or difficulty swallowing (pain, coughing, choking, food sticking, drooling, regurgitation, weight loss)
*is a secondary diagnosis
Risks for aspiration pneumonia
(Langmore et. al. 1998)
- feeding tube (more colonization)
- dependent for feeding
- dependent for oral care
- number of decayed teeth
- presence of tooth decay/periodontal disease
- immunocompromised
- smoking
- multiple medical diagnosis/multiple medical medications
Swallow center
in the brainstem, associated with medulla
- involves precisely timed movements of 25+ muscles cordinated by generators in the reticular formation
- sensory info arrives at NTS and motor responses are generated in nucleus ambiguous and hypoglossal nucleus
Oral Preperatory Phase
food/liquid enters mouth and is manipulated into a cohesive bolus
- food containment within oral cavity
- problems: anterior or posterior spillage
Oral Phase
tongue begins to propel bolus towards pharynx
-problems: difficulty initiating swallow (delayed swallow)
Pharyngeal Phase
bolus reaches ramus of mandible and BOT
- swallow reflex should be triggered
- arytenoids medialize towards petiole of epiglottis, laryngeal vestibule lifts to retroflex epiglottis, VFs adduct to close off airway, pharyngeal constrictors squeeze bolus through pharynx towards esophagus
- problems: inadequate bolus clearance (residue in BOT, vallecula, pyriforms, diffuse)
- CN X relaxes cricopharyngeus muscle to open UES
Esophageal Phase
bolus passes through UES into esophagus
-Peristalsis continue (CN X)
pharyngeal delay
- seconds until swallow begins
- start timing when bolus reaches ramus of mandible and BOT
- note how far bolus spills before swallow triggered
- liquids on commands: <.5 seconds
- no command: liquids .8 seconds; food 1.3-1.6 seconds
- general… should be less than 3 second delay
residue indications
- laryngeal vestibule: epoglottis did not retroflex/comletely retroflex
- lateral channels: arytenoids did not cover cover glottis well enough
- beneath VFs: VFs did not close or timing was off
Trach patients
-blue dye screening: check immediately after swallow and 30 minutes after.. suction device inserted into trch to see if dye is present
swallow frequency
normal= every 2/3 minutes with scope in place
indicators of aspirations
throat clear before or after swallow
coughing before/after swallow
change in vocal quality
silent aspiration
protocol 201
(logemann)
- immediate effects of thin and thick liquids.. honey thick was aspirated the LEAST
- BUT: long-term effects found that honey-thick group was more dehydrated, had longer hospitalizations in long-term effect study over 3 months.. also more likely to get pneumonia if honey was aspirated
3 oz Water Swallow Test
- Suiter and Leder (2007)
- goal is to predict ASPIRATION in IPs
- very sensitive, but not very specific (too many people referred when they did not actually aspirat)
TOR-BSST
- Marinto
- administered by nurses
- goal to predict DYSPHAGIA
- 4 predictors of dysphagia: voice before, tongue movement, water swallow test (50 ml), voice after
- pt referred for instrumental if they follow and of the 4 predictor items
