Midterm Flashcards
(44 cards)
What are five components involved in central alignment?
- Head flexion neutral
- Neck and trunk elongated
- Shoulder girdle stable & depressed
- Hips at 90 degrees
- Pelvis stable and symmetrical in neutral position
Stability is the foundation for ________ and _________.
function - movement
What cranial nerves are involved in the pharyngeal phase ?
IX, X, XI
Describe some aspects of the Upper Aerodigestive Tract
2 tubes: oral cavity and pharynx with valves with a variety of functions
Lips: keep food in mouth
Oral tongue: push food against palate
Velopharyngeal region: closes to keep food from nose
Larynx: prevent food from going into airway
Tongue base/pharyngeal wall: squeeze bolus through the pharynx
CP region (UES): allows bolus into esophagus
LES: muscular sphincter, keeps food in stomach
What are some differences between infant and adult anatomy?
- Oral space in newborn is small
- Lower jaw in newborn is small & retracted
- Sucking pads present
- Tongue takes up more space
- Infant tongue has restricted movement
- Newborns are obligate nose breathers (means they are preferred nose breathers, 6-8 mos. Is when they start to use their mouth)
- Epiglottis and soft palate are in approximation in the newborn as a protective mechanism
- Larynx is higher in the newborn pharynx eliminating the need for coordinated laryngeal closure to protect the airway
- Eustachian tubes of the infant lie horizontal, with a more vertical angel in the adult
What are some signs of dysphagia in an adult?
- Recurrent pneumonia
- Wet/Gurgley vocal quality
- Drooling
- Refusal to eat
- Multiple swallow pattern
- Coughing/choking before/during/after swallow
Describe the Phasic Bite reflex. When is it present/decrease?
- Pressure to gums = rhythmic open/close of jaws
- Present 28 weeks gestation, decreases by 9-12 months after birth
When does pharyngeal swallow develop in utero?
One of the first motor responses seen in pharynx at 10-11 weeks
Swallow has been observed at 12.5 weeks
When should a baby start eating by mouth? What week?
- Around 32 weeks
- This is when the suck pads come in and you can start to feed them orally
What are the suck pads? What muscles are involved?
- An encapsulated mass of fat in the cheek on the outer side of the buccinators muscle especially marked in the infant; supposed to strengthen and support the cheek during the act of sucking
- Just help to close the oral cavity and help to keep things organized
Explain APGAR scores.
- Scores range from 0-2 on each section, the higher the score the better
- 0-10 scale to evaluate infant’s physical condition; heart rate, respiration, muscle tone, response to stimuli, color are evaluated at 1 and 5 minutes after birth; may be continued every 5 minutes up to 20 minutes until two scores of 8 or more are achieved
- Rated on skin color/complexion, pulse rate, reflex irritability, and muscle tone
What are some calming/arousal techniques?
CALMING: swaddle, non-nutritive sucking (pacifier), create nesting, change position, or change environment
AROUSAL: unwarp, massage, and elicit rooting, face-to-face interactions, smooth gradual transitions
How do you facilitate infant feeding?
- Rooting
- Non Nutritive suck
- Cheek support- increases flow
- Chin/jaw support- increases flow
- Pacing- brief breaks (external pacing=caregiver imposed, self-pacing= infant imposed)
- Change nipple flow
- Positioning
- Alertness
What are some generic problems that cause GERD?
-Too much volume
-Too fast of rate
S/S: gagging, projectile vomiting, arching, head turning, irritability, inconsolable crying and feeding aversion
What is considered full term for a baby?
-37 weeks, the average is 38, and 40 weeks is preferable but should NOT go over 40 weeks
What should the goals be for a hypertonic child?
Inhibition of excessively increased tone
Inhibition of proximal fixation
Facilitation of end range of movement
Prevention of further physical deformity
What should the goals be for a hypotonic child?
Promotion of alignment and stability
Maintenance of upright posture for feeding
Promotion of symmetry and midrange control
Anticonvulsant – what can that cause/side effects as far as dysphagia?
- Indication: Anti-seizure, mood stabilizer, pain
- Common Drugs: (1) Phenobarbital, (2) Dilantin, (3) Tegretol
- Effect: (1) Dry mouth, sweating, hypotension, tremor (2) ataxia, slurred speech and dystonia, (3) glossitis, stomatitis, dry mouth
Nutritional Risk Factors - name a few.
Failure to grow over 2-3 months Weight/height below the 5th percentile Chronic diarrhea/constipation Long term use of drugs (especially seizure medication) Excessive drooling Frequent reflux / emesis Mechanical feeding difficulties Metabolic disorders Abnormal CBC / urine screen Suspected caregiver neglect
What are some important factors when choosing a nipple?
- Flow rate (how fast)
- How firm is the nipple (firm/no firm)
- How much contact the baby’s tongue is making with it
What are some signs and symptoms during an evaluation that would make you want to do a swallow study?
- Weak suck
- Sucking/swallowing incoordination
- Breathing disruptions or apnea during feeding
- Excessive gagging or recurrent coughing during feeds
- New onset of feeding difficulty
- History of recurrent pneumonia and feeding difficulty
- Feeding periods longer than 30-40 minutes
- Delay in feeding developmental milestones
Signs of Dysphagia
- Inability to recognize food
- Inability to control food or saliva
- Coughing/choking before/during/after swallow
- Frequent throat clearing
- Multiple swallow pattern
- Recurrent pneumonia
- Unexplained weight loss
- Wet/Gurgley vocal quality
- Drooling
- Cyanosis (around the lips)
- SOB (short of breath)
- Increased time to finish meal
In what order do the laryngeal sphincters close?
-From the bottom up – to protect the airway!
Explain the difference between tippers and dippers?
Tippers (80%- held between midline then put it back to the alveolar ridge then you swallow)
Dippers (20% hold on the floor of their mouth)
