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

Management of Dysphagia (2) Flashcards

1
Q

Level 1: Puree

A

no chewing, has potato like consistency

i.e., pureed meats, soups, mashed potatoes

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2
Q

Level 2: Mechanical Soft

A

semi solids texture consistency

i.e., baked fish, cottage cheese, fine ground meats

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3
Q

Level 3

A

Near normal texture, cut into small bits

i.e., tuna, pancakes

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4
Q

Level 4

A

Regular consistency diet; most foods included

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5
Q

Thickener alters the ______, but not the ______ of the liquid.

A

texture

taste

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6
Q

Target populations for thinner liquids

A
  • pt w/ good airway protection
  • overall tongue dysfunction
  • reduced UES opening
  • reduced pharyngeal constriction
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7
Q

Target populations for thicker liquids

A
  • pt w/ tongue base weakness
  • delayed trigger (thicker liquids help trigger pharyngeal swallow/airway protection)
  • reduced laryngeal closure
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8
Q

Thickening liquids does not reduce aspiration rates in groups of patients (particularly, during evaluation). T or F?

A

False; it does

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9
Q

The effects of thickening liquids on dysphagic intervention is still unclear for long term benefit. T or F?

A

True

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10
Q

Who are candidates for Free Water Protocol?

A
  • Pts are NPO or currently taking honey thick or nectar thick liquids
  • Pts are able to swallow water without demonstrating excessive coughing and discomfort
  • Pts are able to maintain alertness and arousal
  • Pts are able to maintain upright posture
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11
Q

Who are NOT candidates for Free Water Protocol?

A
  • Pts are not alert
  • Fragile Pts w/ acute pulmonary disorders or a hx of recurrent aspiration pneumonia
  • Pts w/ a fever of unknown origin
  • Pts demonstrating excessive coughin and discomfort after drinking water
  • Pts are not able to maintain upright posture
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12
Q

Pills can be given w/ thin water. T or F?

A

FALSE

Pills should always be crushed and mixed w/ one of the following: appleasuce, yogurt, thickened liquids or pudding

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13
Q

Pills w/ thin liquids may be allowed for pt w/ only ________ such as mastication difficulty.

A

mild oral dysphagia

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14
Q

Minimizes pt with airway protection issue

A

Cut-out cup

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15
Q

For Pt without good motor control

A

Universal ADL cuff or Good grips utensils

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16
Q

Therapetic/rehab techniques

A
  • oral moto exercises
  • swallow maneuver exercises
  • thermal tactile stimulation
  • e-stim therapy or NMES
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17
Q

Focusing on improving strength/ROM or more general control/manipulation (tongue, lips, face/cheeks, jaw/mandible, VF adduction)

A

Oral Motor Exercises

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18
Q

Improving strength, ROM of tongue may…

A

increase bolus retention and transit time

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19
Q

Tongue OME

A
  • tip lick
  • lick around lips
  • tip pushes to sides/up against fingers/blades
  • tip push to inner left/right sides against fingers
  • push up to flatten tongue
  • tongue click
  • back of tongue: /ka/
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20
Q

Improving strength, ROM of lips may…

A

increase lip closure

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21
Q

Lip OME

A
  • lip resistance: pucker lips against blade, place straw btw lips
  • upper lip resistance: place straw on lower lip
  • smile ex.
  • lip stretch and pucker (i-u)
  • kissing ex.
22
Q

Improving strength of face/cheeks may…

A

improve bolus retention

23
Q

Face/Cheeks OME

A
  • cheek puff
  • lip and cheek toner: suck in inner cheeks
  • massage
24
Q

Mandible OME

A
  • jaw rotation (slide jaw from side to side)
  • jaw resistance (open and close)
  • massage jaw and chin
25
Q

VF Closure OME

A
  • falsetto voicing
  • sit on chair
  • hand push ex
  • neck ex
26
Q

Direct Treatment Strategies

A

Supraglottic
Mendelsohn
Shaker
Masako

27
Q

Direct treatment strategies/manuevers are designed to…

A

give the pt more info to faciliate swallowing, improve swallow function/safety, performed w/out food [except supraglottic]

28
Q

individual voluntarily prolongs the duration of laryngeal elevation resulting in increased duration of CP opening and laryngeal elevation

A

Mendelsohn

29
Q

“Swallow and feel the larynx lift but do not let it drop. Hold it w/ your muscles for ___ sec. Release and repate ___ times.”

A

Mendelsohn

30
Q

Mendelsohn is best for what pts?

A

Pts w/ reduced laryngeal elevation, reduced CP opening and discoordinated swallow

31
Q

Presumably improves suprahyoid function, improves PES opening, anterior laryngeal excursion and reduce backflow aspiration, strengthens mylohyoid, geniohyoid, and ant. belly of digastric

A

Shaker

32
Q

“Lay on your back and raise your head to look at your shoes, do not raise your shoulders.”

A

Shaker

33
Q

Shaker is best for what pts?

A

Pts w/ weak pharyngeal muscular strength and reduced laryngeal elevation, resulting in UES dysfunction

34
Q

Tongue hold/bite exercise; improves movement of PPW

A

Masako

35
Q

“hold tongue btw teeth/lips while swallowing”

A

Masako

36
Q

Masako is best for what pts?

A

Pts w/ incomplete tongue base contact with PPW and reduced laryngeal elevation

37
Q

Thermal Tactile Stimulation

A
  • Use cold object (laryngeal mirror, ice sticks, lemon glycerin swab)
  • Rub pillars and sides of tongue vigorously
  • Have pt swallow hard after 1 trial
38
Q

Improve trigger swallowing by heigtening sensitivity

A

Thermal tactile stimulation

39
Q

Thermal tactile stimulation is best for what pts?

A

Pts w/ delayed initiation of pharyngeal swallowing (delayed greater than 2 sec.), aspiration or no swallow response.

40
Q

After swallowing eval, SLP’s need to make?

A

Recommendations

why?
to ensure safety of oral feeding

41
Q

The common reasons for placing a feeding tube are? (4)

A
  1. Pt fails the swallow test; unable to swallow safely
  2. pts unable to sustain nutrition orally
  3. the requirement for sufficient calories on a short term basis to overcome an acute medical problem
  4. high risk of aspiration
42
Q

Catheter/tube placed transnasally to the stomach

A

Nasogastric Tube (NG Tube)

43
Q

Nutritional solution administered through GI tract

A

Percutaneous endoscopic gastronomy (PEG)

44
Q

Feeding tube inserted directly into the stomach

A

G-TUBE/PEG

45
Q

Feeding tube inserted directly into the jejunum

A

J-Tube/PEG

46
Q

Nutritional solution adminstered directly into vien

A

Total parenteral nutrition (TPN)

*does not eliminate aspiration

47
Q

What is the SLP’s role when pt is NPO w/ feeding tube?

A
  • secretion management, oral care
  • trials of swallow (often using water, ice chip, puree) if pt has potential to resume oral intake
  • if pt has reflux issues, recommend proper posture when feeding (via tube)
  • may have small PO feeds for oral gratification or trials
48
Q

What is the SLP’s role when pt is PO w/ feeding tube?

A
  • unable to consume adequate nutrition via oral intake

- intervention usually framed in terms of increasing activities and participation and not restoration of function

49
Q

What are 3 other considerations in RE to management for NPO pt?

A
  1. Frazier Free Water Protocol: find out if it acceptable
    yes –> SLP and trained nurse can do
    no –> SLP can incorporate into tx
  2. Quality of Life Issue: is oral gratification safe?; min amount of ice chips ok?; daily oral hygiene a must
  3. Dietary Waivers: when NPO is not an option for pt
50
Q

What must candidates to return to oral feeding demonstrate?

A

a safe and efficient swallow on a consistant basis, able to consume adequate amounts of food or liquid to support nutritional requirements, follow single stage commands and remain alert long enough to finish meal, respiratory stability, ability to self feed or cooperate fully w/ feeding assitance.

51
Q

Once NPO pt w/ feeding tube passes instrument swallow exam –>

A
  • work closely w/ a dietician
  • when pt is able to consume 75% or more of nutritional requirements consitantly for 3 to 5 days
  • document progress and inform nursing or dietician to place order for removing the tube

663: Exam 2 (5 decks)

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