HC 3: Assessment: screening + anamnesis Flashcards
What does the assessment look like? What is it?
= diagnostic process towards a conclusion with treatment and dietary recommendations:
- screening (if needed -> deglutologist)
- anamnesis + file study, based on:
- medical and swallow complaint & history
- swallowing history:
- method of feeding/eating
- schedule of feeding/eating
- diet
- onset
- description and variability
- compensations
- CSE: clinical swallow evaluation
- instrumental evaluation
Which people come into picture for a screening?
- People with dysphagic symptoms
- population at risk (often without symptoms, e.g. stroke, CVA, TBI,…) -> risk of silent aspiration
What is the purpose of a screening?
- often bedside for “at-risk” patients
- determine if the patient is dysphagic or is aspirating
- Key question: can the patient eat/drink orally safely?
- > yes = pass = no further action
- > no = fail = CSE needed?
What is the screening constisting of?
- medical history (look at risks)
- water swallow test:
- Yale Swallow Protocol
- Timed-test
- in combination with instrumental tests
- cervical ausculations: recording airway or swallowing sounds with stethoscope or laryngeal microphone
- pulse oximetry: detect changes in arterial blood oxygenation in response to aspiration
There are some basic terms and conditions required for screening and CSE. Which ones?
- cooperation
- body posture: can the patient sit right up?
- consciousness
- alertness
- comprehension: does he understand what you’re asking or saying?
- voice quality: wet, gurgling?
- volutional coughing (= on demand)
Explain the Yale Swallow Protocol
−“3-ounce water swallow”
−To drink 90 ml water from a cup or straw, without interruption
−Fail (= risk for aspiration) if:
- Drinking with breaks
- Coughing during or immediatly after drinking
- Not able to drink the whole cup
−With 90 ml silent aspiration is not possible (patient will cough anyway)
Explain the Timed-Test.
−Gives more information
−To drink 150 ml water from a cup, “without interruption, as quick as comfortably possible”
−SLP:
- Makes subjective observations: drooling, voice quality, coughing
- Records total time required for ingestion
- Counts number of swallows
− Provides information about:
- average volume per swallow (mL/ swallow)
- average time per swallow (sec/swallow)
- swallowing capacity (mL/sec)
−Fail if:
- Complaints of discomfort
- Coughing, changes in voice quality
- Too slow (compare to normative data, <10ml/sec)
Why is the CSE different from the screening?
CSE = more in-depth
−Medical & feeding history review
−Physical examination of oral-motor anatomy and function
−Observation of swallowing
−Considers overall health
−Considers cognitive status
−Considers physical limitations
How do we identify the swallowing complaint?
- different sources of information: patient, family, professionals
- identify concerns of these sources: these can be different from one another
- questionnaire for the patient: description of the problem
- questionnaire for the patient: QoL
- identify onset time, type, symptoms, precipitating events, current situation
Why is it important to know the medical history of …
- cardiac problems?
- medical problems: disease, hospitalizations, surgeries,….?
- pulmonary problems
- gastrointestinal problems
- neurological problems
- diabetes?
- neuromuscular disease?
- head and neck radiation therapy
- enlarged heart or aorta -> presses against esophagus
- have an effect on general patient conditioning and fatigue
- may reduce tolerance for aspiration, may be a sign of silent aspiration
- long history of reflux may cause aspiration or indirectly impact laryngeal, pharyngeal and oral symptoms and problems
- could impact sensory and/or motor systems for swallowing
- reduced salivary flow, caused by disturbances in glycemic control
- provides information about etiology and prognosis
- may cause fibrosis and xerostomia
Why is the medication history important?
A lot of medication causes:
- decreased salivary production
=> poor bolus lubrication
=> poor clearing
=> difficult to start a swallow
- increased salivary production
=> drooling
- drowsiness
What do we consider symptoms/complaints of dysphagia?
- History of coughing or choking while eating (e.g. Heimlich maneuver)
- Increased need to clear the throat
- Increased mucus (lungs) production
- Sensation of something sitting on their vocal cords
- Wet or gurgling vocal quality
- (feeling of) food gets stuck at various locations
- Difference between solids and liquids
- Weight loss
- Meal duration
- Avoidance of certain types of food
- Trauma (sudden onset)
- Ingestion of a foreign body (sudden onset)e.g. fish bone, chicken bone,…
What do we want to know about method and schedule of feeding/eating?
−Current method of nutritional intake:
- Oral with utensils
- Oral with aids, syringes, …
- Non-oral feeding tubes: nasogastric, gastrostomy, duodenum or jejunum tubes
−Combination, one supplementing the other
−Which feeding method, what times, what substances
What do we want to know about diet?
−Type, amount, frequency of food and liquid intake
−Food preferences (may provide information about the comfort level managing certain foods)
−Change of eating habits?
−Avoidance of particular foods or liquids?
−Changes of eating habits over the course of a day
−Noting time, amount of intake for each type of meal
- Baseline information
- info about compensatory strategies
What is FOIS?
= Functional Oral Intake Scale: describes oral intake of the patient.
7 levels:
- Nothing by mouth (NPO)
- Tube dependent with minimal attempts of food or liquid
- Tube dependent with consistent intake of liquid or food (combination)
- Total oral diet of a single consistency
- Total oral diet with multiple consistencies but requiring special preparation or compensations.
- Total oral diet with multiple consistencies without special preparation, but with specific food limitations.
- Total oral diet with no restrictionn
