L13 Pulmonary Function Flashcards
It was previously thought that swallowing and breathing were mutually exclusive, but now we know _______
although they don’t occur simultaneously, they functions are complementary and overlap one another
T or F;swallowing and breathing have common neural afferent and efferent pathways with brainstem CPG
true
T or F: swallowing and respiratory dynamics are affected by bolus factors (volume and viscosity)
true
What is the function of the genioglossus during swallowing?
protrudes tongue
What is the function of the styloglossus during swallowing?
retracts tongue
What is the function of the stylopharyngeus during swallowing?
elevates larynx
What is the function of the cricopharyngeus during swallowing?
relaxes to increase compliance and stretch during hyolaryngeal elevation
What is the function of the sternothyroid and omohyoid during swallowing?
hyolaryngeal return
What is the function of the velopharyngeal port during swallowing?
closes to prevent nasal backflow
What is the function of the base of tongue during swallowing?
propels bolus through the pharynx
What is the function of the larynx during swallowing?
adducts for airway closure
What is the function of the genioglossus, styloglossus and stylopharyngeus during breathing?
stiffens to maintain airway patency
What is the function of the cricopharyngeus during breathing?
maintains tone to prevent air entry into esophagus during inspiration
What is the function of the sternothyroid and omohyoid during breathing?
stabilizes larynx for quiet breathing
What is the function of the velopharyngeal port during breathing?
opens for nasal breathing
What is the function of the base of tongue during breathing?
maintains patent airway
What is the function of the larynx during breathing?
abducts for airway opening
In healthy adults, list the 4 breathing patterns around swallowing from most frequent to least frequent
E-E (75%)
I-E (20%)
E-I (4%)
I-I (1%)
When eating solids, 50% of swallows occurred in the ________ half of the expiratory cycle at lower quiet breathing lung volumes
second
What is are the advantages of an E-E pattern
increased safety, less risk of aspiration
-expiration prior to swallow may encourage medicalization of VFs
How does the diaphragm affect swallowing?
Diaphragm remains contracted during initial part of respiration. The diaphragm pulls on the larynx when contracted. Therefore there is more resistance to hyolaryngeal excursion in the initial stages of expiration
Liquids are generally swallowed during expiration at ______- lung volumes which may be advantageous if cough is required to clear liquids
high
T or F: age can shift individuals from E-E to another pattern
true
Respiratory pause can lengthen to nearly _______ in older patients swallowing liquids
double
Can swallow patterns be retrained?
yes!
Neural control centers responsible for coordination of breathing and swallowing are contained in the dorsomedial and ventrolateral medullary regions of the ________
brainstem
T or F: Cortical structures also play an important role in facilitating and modulating the coordination of breathing and swallowing
True
In Langmores study, the highest incidence of aspiration was found in the _________ and the lowest incidence was found in ___________
nursing home
outpatient
List the 7 significant predictors of aspiration pneumonia
- dependent for feeding
- dependent for oral care
- number of decayed teeth
- tube feeding
- more than one medical diagnosis
- number of medications
- smoking
Which is the single most significant predictor of aspiration pneumonia?
-dependent for feeding
How might being dependent for feeding lead to aspiration pneumonia (AP)
- Marker for dependence for other activities of daily living
- Increased risk for aspiration
- may be fed too fast or too much food at once
How might being dependent for oral care lead to AP
poor oral hygiene resulting in increased pathogens that can then be aspirated
How might number of decayed teeth affect AP
-increased oral pathogens
How might tube feeding affect AP
-reduced salivary flow and poor oral hygiene
How might more than one medical diagnosis affect AP
-marker for compromised host immunity
How might number of medications affect AP
- marker for compromised host immunity
- higher risk for xerostomia and increased concentration of oral pathogens
How might smoking affect AP
reduced response to aspiration
T or F: dysphagia itself is enough to cause pneumonia
FALSE
T or F: if you aspirate you will develop pneumonia
FALSE - only 38% of people who aspirated developed AP
T or F: you can only aspirate on food or drink
False you can micro-aspiration on saliva, plaque or reflux
