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Dysphasia > Lecture 3 powerpoints > Flashcards

Lecture 3 powerpoints Flashcards

1
Q

What do you do first with a potential dysphagia client?

A

do a quick screening.

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2
Q

What things do you do in a screening?

A

3 basic things.

  1. chart review
  2. take quick info on signs and symtoms
  3. do an observation of 3oz water test or a timed swallow test
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3
Q

what are some of the concerns of a screening?

A

It is not 100% accurate!

_false positives/False negatives further dx treatment is needed

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4
Q

what are the good things about screenings?

A

quick, its non invasive, low risk and low cost

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5
Q

symtoms of dysphagia?

A 
4
Valleculae hesitation/pooling
-base of tongue/epiglottic area
-stuck high in throat
pyriform pooling
-stuck in the middle of the throat (just below larynx
UES dysfunction\-pain in upper chest or inches below larynx or stuck in throat/high in chest
Aspiration
-couching/choking
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6
Q

How many px will have s/a? (silent aspiration?

A

50%

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7
Q

What do you want to find out during a bedside?

A 
5 things:
1. Hx, Dx, Px's perception
-medical status 
    -nutitional status 
      (tube? restrictions?)
  -respiratory status (trach or   
   vent)
2. Oral anatomy - oral mech
    - control and function of
      labial, lingual, palatal, 
      pharyngeal, laryngeneal) 
3. congitive status (comprehension)
4. Sensory - taste temp texture
5. s/s of swallow attempts
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8
Q

Items for a bedside

A 
9things:
laryngeal mirror
tongue blades
cup
spoon
straw
syringe (for delievery?)
Towel/cloth
gloves/gown
eyewear/mask
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9
Q

What to look for in the chart review and what to ask for at the bedside

A 
Resp. status and history
Pnuemonia history (check for fever now)
dysphagia history
History of pneumonia
Nutritional status
Medications
Physical exam
Trial swallows
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10
Q

what to look for in Resp. status and hx

A 
Trach, vent, intubated??
whats the rate at rest?
Time saliva swallows and phase respiration
Time cough
Time breath hold (1 sec, 3 secs, 5 secs)
Breathing pattern (nose or mouth)
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11
Q

what to look for in Dysphagia History

A

Onset? symptoms, Pt awareness, Localization?

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12
Q

What to look for in Nutritional status

A

Diet type/ duration/ tube? adequacy, complications

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13
Q

Medications complications could be?

A

some cause decreased alertness, zerostomia, delayed reaction time

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14
Q

After you take in information (interview/chart review) what do you do?

A 
Physical exam (bedside swallow)
Test:
Oral cavity
pharynx
laryngeal function/signs
respiratory function
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15
Q

During the physical exam, what are the first things you look for?

A

Anatomy and physiology

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16
Q

What are you looking for when you are examining the anatomy?

A

Posture and oral exam

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17
Q

what structures are you looking at, and what are you looking for when you are looking at the anatomy during an oral exam?

A

looking at the :
Lips, hard palate, soft palate, uvula, faucial arches, sulci, teeth and secretions
*you are looking for scarring and/or assymetry

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18
Q

When veiwing physiology, what are you testing for? what does the client do, and why?

A

You are testing for taste/texture/temp stimuli reactions, checking for Range of motion and functionality

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19
Q

Labial function… what would you do to see if it is working well?

A
  • say /i/ (lip retraction)
  • say /u/ (lip rounding)
    ddk
    -stops and lips around an object (test for lip closure/strenght)
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20
Q

Lingual function…. what would you do to see if its working well?

A 
extension/retraction, corners of mouth, 
clear sulcus, 
tip to ridge, 
behind bottom teeth with open mouth. 
ddk, 
alveolar stops 
rub on palate
velar stops for posteror tung
21
Q

Soft palate

A

say /a/ -like apple (velum should stay down)

look for palatal reflex and gag reflex

22
Q

physiologic exam you test for:

A

Tung function, lip fu\nction, soft palate function, apraxia, and abnormal oral reflexes

23
Q

what are some abnormal oral reflexes?

A

Increased gag, tungue thrust and tontic bite

24
Q

During the laryngeal function exam what do you do/look for in s/s

A

Look for:

  • gurgly voice (penetration)
  • hoarsness/breathiness (incomplete glottic closure)
  • DDKs (neuro impairment)
  • vocal scaling (less senesitivity, SLN fnx, ct m)
  • cough strenght/throat cleer
  • phonation time (/z/ to /s/ ratio) laryngeal control and resp. function
25
Q

T or F: you always do a pft test?

A

PFT = pulminary function test

Falso!! only if warrented

26
Q

List the PFTs

A

Spirometry
Manometry
Pneumotachometry

27
Q

Spirometry

A

Measures Capacity in FVC and FEV1

28
Q

manometry

A

Mreasures strenght In MIP and MEP

29
Q

T/F you can always do trial swallows in a bedside?

A

Falso! if acutely ill, low pulmonary function, have a very weak cough, over 80 years old, less cognition, or suspect silent aspiration

30
Q

What do you use in a beside swallow?

A

material that is easier for the px to swallow

31
Q

where can you put your fingers during the bedside?

A

3 or 4 position on neck

32
Q

What are you looking for during a bedside?

A
  • reaction to tood
  • oral movements (chew/manipulation/propulsion)
  • coughing, throat clearing before/during/after
  • Secretion levels
  • Meal duration and amt
  • Resp/swallow coordination
33
Q

What can you find out from a bedside?

A
  • Best posture for the safest swallow
  • Best posture for food in mouth
  • Best food consistency
  • hypothesis to nature of swallowing disorder
  • Recoomendation for a dx
34
Q

What do you use during a Dx?

A

Imaging and non imaging tools

35
Q

List some imaging tools

A

Videofluoroscopy (xray)
FEES/FEESST/Videoendoscopy
ultrasound/fMRI/PET
Scintigraphy

36
Q

List some nonimaging tools

A

EMG
EGG
Acoustics
Manometery

37
Q

EMG

A

Measures m. activity

38
Q

EFF

A

Measures VF vibration at the TH level

39
Q

Acousitcs

A

accelerometer (microphone) or stethoscope to listen

40
Q

Monometry

A

Measures pressure

41
Q

How many, and what are the goals of Videofloroscopy

A

6:

  1. Identify normal/abnormal A+p of swallow
  2. Evaluate airway protection pre/peri or post swalllow
  3. test efftive postures, maneuvers, bolus modifications and sensory enhancements for improveing swallowing saftey and effiecincy
  4. provide recommendations for best delivery of food
  5. choose best techniques
  6. education for collaborators/refferal souces/caregivers and px
42
Q

Is MBSS always recommended?

A

NOO!

43
Q

When is an MBSS not recommended?

A
  1. medically unstable (lethargic/unoriented/agitated/uncccoorapative/ cognitive deficits)
  2. if cleint doesnt want to change (DNR/chronic diz/end of life sits)
  3. Px cant be adequately positioned
  4. client is too large to fit into the imaging room
  5. allergy to barium (VERY RARE!!
44
Q

What are some limitations to MBSS?

A
  1. barium is unnatural and may effectnatural swallow
  2. Time constraints do to radiation exposure
  3. not a true representation of a real meal
  4. hard to evaluate fatigue efect on swallow
  5. clients body may refuse the barium
  6. it is constapating
45
Q

what are the pros and cons of FEES?

A 
\+Examines A&P before and after swallow
\+No radiation exposure
\+Exellent view of VFS
-No oral stage visible
-White out
46
Q

What does the Ultrasound measure?

A 
\+tongue function
\+Oral Transit time
\+Hyoid motion
- cant image pharynx
-Oral stage only
47
Q

what is an fMRI

A

Functional Magnetic Resonance Imaging (Neural Basis/Mechanisms
Neural mapping - cortical control

48
Q

PET

A

Positron Emission TOmography Neural activity assoc. with motion - had radiation exposure

49
Q

Scintigraphy

A

It is highly radioactive with gama rays
Ammount of aspiration residue
Mouth and pharynx not well visualized (cant id dysfunction can dx esophageal (GERD)

Dysphasia (12 decks)

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