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663: Exam 2 > Management of Dysphagia (1) > Flashcards

Management of Dysphagia (1) Flashcards

1
Q

A pt should receive treatment regardless if they’re PO or NPO. T or F?

A

True; if patient is candidate for treatment, they should receive tx regardless of NP/NPO status

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2
Q

What 2 questions should be considered if client is to receive treatment?

A
  1. What type of treatment is most appropriate?
  2. If PO, what diet is most appropriate?

Why?
To improve safety of swallowing and quality of life.

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3
Q

What are the characteristics (8) to consider when deciding if pt is candidate for treatment?

A
  • medical diagnosis/prognosis
  • patient choice/ethical issue/QOL
  • ability to follow directions
  • reaction to compensatory strategies
  • severity of problem
  • respiratory function
  • caregiver support
  • patient motivation
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4
Q

What are VFSS/bedside S/S of dysphagia (oral)?

A
  • food falls out of mouth
  • bolus spreads through oral cavity
  • residue/food remains on tongue or falls into sulcus
  • no lingual movement when food in mouth
  • residue on tongue
  • residue on hard palate
  • difficulties moving bolus in AP
  • slow oral transit times
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5
Q

food falls out of mouth; why?

A

poor lip closure; CN VII

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6
Q

bolus spreads through oral cavity; why?

A

reduced tongue coordination; XII

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7
Q

residue/food remains on the tongue or falls into sulcus; why?

A

tongue weakness; XII

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8
Q

residue on tongue; why?

A

tongue weakness; coordination problem

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9
Q

residue on hard palate; why?

A

tongue weakness

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10
Q

difficulties moving bolus in AP; why?

A

weakness of tongue

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11
Q

What are VFSS S/S of dysphagia (trigger & pharyngeal)?

A
  • delayed triggering of pharyngeal swallow
  • nasal regurgitation
  • residue on 1/both sides of pharynx
  • premature spillage or residue in valleculae
  • reduced displacement of larynx
  • residue in pyriform sinuses bilaterally
  • penetration and/or aspiration
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12
Q

nasal regurgitation; why?

A

weakness in VP port/ CN XII

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13
Q

premature spillage or residue in valleculae; why?

A

weakness of BOT

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14
Q

residue in pyriform sinuses bilaterally; why?

A

poor coordination of pharyngeal constrictors; reduced laryngeal elevation

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15
Q

penetration or aspiration; why?

A

no airway protection

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16
Q

What is the main goal of management?

A

safe non aspirative oral feeding while maintaining adequate nutrition and hydration

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17
Q

What is the goal of management for pts who are NPO?

A

re-establishing oral feeding

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18
Q

For all pts w/ dysphagia, goals are to?

A

resume prior level of diet, tolerate a least restrictive diet, ensure safe swallow and optimize quality of life

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19
Q

_________: surgical and nonsurgical :: _________: compensatory strategies and therapeutic/rehab techniques

A

Medical management

Behavioral management

20
Q

Techniques to improve disorders caused by anatomic/ physiologic abnormalities =

A

Medical Management

21
Q

Procedures to control for prolonged, unremiting aspiration, including artificial airway =

A

Medical Management

22
Q

Surgical procedures to provide nutrition and hydration via nonoral means =

A

Medical Management

23
Q

Laryngeal/Airway-related procedures are meant to?

A

Improve glottal closure and protect the airway

24
Q

What are the Laryngeal/Airway-related procedures (3)?

A

− Vocal cord injection
− Laryngeal closure
− Tracheotomy

25
Q

Cricopharyngeal dysfunction procedures are meant to?

A

Improve opening of PES

26
Q

Cricopharyngeal dysfuncion procedures (2)

A

Myotomy

Dilation

27
Q

Non-surgical procedure ?

A

Medications for reflux

28
Q

Compensatory treatment (indirect)

A

Circumvents the problem using indirect strategies to alter bolus flow: Posture, sensory procedures, manuevers, combine posture and maneuvers, and diet changes

29
Q

Rehab treatment (Direct)

A

Changing the swallowing pysiology to restore function and directed at improving neuromuscular control: Auditory feedback, sensory therapy, physiotherapeutic ex, and E-Stim therapy

30
Q

Comp Strategies (5)

A 
Postural changes
Maneuvers
Intra-oral prosthetics 
Increasing sensory input
Altering diet/consistencies
31
Q

Performed to improve airway protection and/ or improve oral and/or pharyngeal transit of food/ liquid.

A

Postural changes/adjustments

32
Q

Postural Changes/adjustments (5)

A
  • Chin tuck / chin down
  • Head back / chin up
  • Head tilt
  • Head turn / rotation
  • Combination

look at maneuver cards

33
Q

What are pt requirements when applying airway protection maneuvers?

A
  • ability to learn/ intact cognition
  • motivation
  • respiratory reserve
34
Q

Airway Protection Maneuvers (3)

A
  • Supraglottic/Super supraglottic
  • Effortful
  • Combinations of other compensatory strategies (posture or increasing sensory input)
35
Q

“Inhale, exhale slightly, hold breath, swallow, clear pharynx/cough, swallow again”

A

Supraglottic

36
Q

Designed to close the airway at the level of true vfs

before and during swallow

A

Supraglottic

37
Q

Who can benefit from the supraglotitc maneuver?

A

Pt w/ reduced or late vf closure
Pt w/ delayed pharyngeal swallow

may be too stressing for pts with poor respiratory function or hx of heart disease

38
Q

“hard swallow”; ask patient to “swallow hard”; “swallow forcedly”; “as you swallow, squeeze hard w/ all your muscles and push your tongue to roof of mouth. “

A

effortful swallow

39
Q

Promotes stronger tongue to palate contact, and stronger BOT to posterior pharyngeal wall contact

A

Effortful Swallow

40
Q

Who can benefit from effortful swallow maneuver?

A

Pts w/ reduced tongue base retraction, residue in vallecular space, residue in laryngeal wall

41
Q

To facilitate lingual motion, to improve the triggering of pharyngeal swallow

A

Increase sensory input

42
Q

Volume of bolus and temoerature ir taste change –>

A

Increase sensory input

43
Q

Bolus change: decreasing volume of bolus. Why?

A

Pt may have respiratory issue or poor bolus control

44
Q

Bolus change: increasing volume of bolus. Why?

A

Pt may have decreased sensation in oral cavity

45
Q

Teaches oral containment and control, while heightening

sensory input of feeling the bolus and good procedure to use with a delayed pharyngeal swallow.

A

Bolus hold

46
Q

Double or multiple swallows

A

good for pts with pharyngeal residue

663: Exam 2 (5 decks)

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