Midterm Flashcards
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)
What are the 3 functions of the larynx?
- Protection
- Respiration
- Phonation
What are the phases of the swallow?
- Oral Prepitory
- Oral
- Pharyngeal
- Esophageal
Define: Failure to thrive -
Term used to describe a child’s abnormal growth in which weight drops below 5th percentile; also used with adult population
Define: Oral aversion -
negative association with or response to anything placed in or near the mouth
Define: Pacing –
systematic stopping of nipple flow to impose breathing pauses-=-do NOT remove from mouth!
Define: Stridor –
upper airway noise that indicates turbulent airflow through a narrow airway, not a diagnosis but an indication of abnormal airway
Define: TPN –
Total Parenteral Nutrition- nutrition provided exclusively by intravenous access, not the GI tract (means this person is not at all eating)
Define: Aspiration –
anything that goes below the level of your true vocal folds has been aspirated, entry of food or liquid into the airway below the level of the true vocal folds
Define: Penetration –
entry of food or liquid into the larynx at same level down to but NOT below the true vocal folds
Define: Gestational Age -
the number of weeks the baby has been in the uterus
Define: Swallowing -
it is the entire act of deglutition from placement of food in the mouth through the oral, pharyngeal and esophageal stages of the swallow, until the materials enter the stomach through the gastro esophageal junction.
Define: Silent Aspiration –
when someone aspirates but doesn’t know it
Define: Dysphagia –
difficulty swallowing or inability to swallow
Define: Aphagia –
when a person cannot swallow at all
Define: Vallecula –
wedged shape space formed between the base of the tongue and the epiglottis
Define: Neonate -
term for infants in first 28 days of life
How do neonates coordinate breathing and swallowing?
Because they are Predominately nose breathers
When should you begin spoon feeding a baby? When feed self?
4 months spoon feed, feed self by 12-18 months
What are some signs of aspiration?
Wet gurgle sound, coughing, gagging, gulping
Name 6 milestones of a 4 month old
Blowing bubbles w/ saliva, eating rice cereal, suckle off a spoon, increased sound imitation, voluntary control of mouth, and tactile awareness of hands
