Management of Dysphagia

Question 1

What are some examples of clinical decisions that will need to be made regarding a patient with dysphagia?

Answer 1

• Oral feeding or NBM?
• Limited oral feeding or unlimited oral feeding
• Normal diet or modified diet
• Normal fluids or thickened fluids
• Are there postural changes to be made

Question 2

What are examples of enteral feeding? What are some ethical problems?

Answer 2

-NG tube (nasogastric) : Usually used as a temporary
measure
-PEG tube (percutaneous endoscopic gastrostomy)
-RIG tube (radiologically inserted
gastrostomy)

-Some patients may not wish to be tube fed
-The use of it to prolong a patients life might not be
considered in their best interest.

Question 3

How might the diet be modified?

Answer 3

Diet and fluids are modified to make the preparation of foods for swallowing, and the process of swallowing easier.

• Fluids could be made thicker in order to slow their passage down the pharynx and allow more time for airway closure
• Solids can be made smoother in order to make the mastication and food preparation for swallowing easier.

Question 4

What are the different texture diets?

Answer 4

Normal Diet
Texture E- Fork mashable
Texture D- Pre-mashed, requires little chewing
Texture C- Thick puree, can hold its own shape
Texture B- Thick puree, needs a spoon
Texture A- Thin puree, needs a spoon

Question 5

What are the different stage fluids?

Answer 5

Normal fluids
Naturally thick fluids
Stage 1 fluids (syrup) 
Stage 2 fluids (honey)
Stage 3 fluids

Question 6

Why might a patient be given ‘limited oral intake’? how can it be limited?

Answer 6

A patient might be ‘limited oral intake’ if their are deemed ‘borderline safe’ for eating. So, most of the time their swallow is fine however they tire and lose attention sometimes during eating and it becomes unsafe.

Oral intake could be limited just by the size of mouthfuls or by the amount eaten at a time.

Question 7

What are some additional precautions to consider when feeding?

Answer 7

• Posture/ positioning
• Dentures?
• Visual, verbal cues for mealtime
• Supervision/ assistance
• Monitoring of chest status
• Encouragement of coughing
• Nutritional intake
• Oral hygeine
• Medication’s to be taken?

Question 8

What are the key principles in ethical practise?

Answer 8

1. Self determination (respecting the right of the patient)
2. Beneficence (acting for the good of the patient)
3. Non maleficence (avoidance of unnecessary harm)
4. Justice (acting fairly, distributing resources fairly)

Question 9

When liaising with the patient/ their family what must you determine?

Answer 9

 What does your patient want to do?
 Are they capable of making this decision?
 Are they aware of the risks if they go against
professional advice?
 What awareness, knowledge and skills do family
members have of the swallowing difficulty?
 Are family members able to accommodate the
recommendations?
 What family ‘history’ might help or hinder them
adhering to the recommendations?

Question 10

In order for our patient to give consent they must have?

Answer 10

Decision-making capacity.

“a person’s ability to understand, retain and
balance information, and communicate a choice.”

“It can be affected by many factors, such as: alcohol intoxication, acquired brain injury, developmental disability, cognitive impairment, or brain disorders such as dementia. Loss of capacity can be temporary, fluctuating or permanent”

Question 11

If a patient doesn’t have decision-making capacity, who might make these decisions on behalf of them?

Answer 11

• Power of attorney (appointed with capacity)
• Welfare guardian (appointed without capacity)

-Patient might’ve prepared Advanced Directive/statement

Question 12

What are principles for the 2015 mental health act?

Answer 12

-Take your past and present wishes into account
-Make sure you get the information and support you need
to take part indecisions
-Take the views of your carer, named person, guardian or
welfare attorney intoaccount
-Look at the full range of options for your care
-Give you treatment that provides maximum benefit
-Take account of your background, beliefs and abilities
-Make sure that any restrictions on your freedom should
be the ‘minimumnecessaryin the circumstances’
-Make sure that you are not being treated less favourably
than other patients
-Your carers’ needs are taken into account and they get
the information and supportthey need to help them care
for you
-Take special care of your welfare if you are under 18
years of age