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Dysphagia > midterm > Flashcards

midterm Flashcards

1
Q

Phasic bite reflex:

A

: Pressure/stimulation to gums = rhythmic open/close of jaws

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2
Q

Neonatal breathing and swallowing coordination

A
  • NNS burst = 6-8 sucks, then pause to swallow
  • Breathing is interrupted to swallow
  • As child ages, NNS bursts increase
  • 20-30 cycles of suck-swallow-breathe, followed by a pause of about 5 seconds of “catch-up breaths”
  • Type of nipple and rate of flow influence the cycle
  • Most often 1:1:1, increasing to 2:1:1 at end of feeding
  • Most important to develop and maintain a rhythmic pattern.
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3
Q

When pharyngeal swallow happen in utero

A

 One of the first motor responses seen in pharynx at 10-11 weeks
 Swallow has been observed at 12.5 weeks
 Primitive sucking in utero seen 15-18 weeks

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4
Q

When should a baby start eating by mouth (oral feeding)

A

Oral feeds not recommended until infants reach 32-33 weeks gestation, when buccal suck pads come in, although may need supplemented by tubes.

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5
Q

Suck pads and muscles involved

A

An encapsulated mass of fat in the cheek on the outer side of the buccinator muscle, especially marked in the infant; supposed to strengthen and support the cheek during the act of sucking.

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6
Q

Difference infant & adult anatomy

A

Tongue fills mouth (sits between lips and rests on palate), edentulous, suck pads, small mandible, no distinct oropharynx, narrow/vertical epiglottis

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7
Q

The Pharyngeal Phase:

A

• Velar elevation/retraction: Closure of the velopharyngeal port, Enables pressure to build in pharynx, A functional swallow is possible without velopharyngeal closure

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8
Q

Pharyngeal Phase: (cranial nerves involved)

A

• CN involved: IX, X, XI
• Voluntary/Involuntary stage
Gag by 9, puke by 10

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9
Q

Upper Aerodigestive Tract

A

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

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10
Q

functional swallow

A

possible without velopharyngeal closure
• Velopharyngeal port closes and hylolaryngeal moves up and forward
• UES opens and airway closes

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11
Q

APGAR → what is a good/bad score

A

to determine whether a newborn needs help breathing or is having heart trouble.
A score of 7, 8, or 9 is normal and is a sign that the newborn is in good health
Any score lower than 7 is a sign that the baby needs medical attention. The lower the score, the more help the baby needs to adjusting outside the mother’s womb.

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12
Q

When to start spoon feeding a baby

A 
4-6 months
•	Initially sucking off spoon
•	Opening mouth in anticipation
•	Tolerance of spoon pressed down at mid tongue
•	Closing lips around spoon
•	Lateral tongue movements minimal
•	Minimal loss of food around lips
•	Jaw stability (external control as needed
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13
Q

Calming techniques for an infant

A
  • Swaddle #1
  • Firm, gentle pressure
  • NNS
  • Change environment
  • Change position
  • Containment
  • Tucked, midline position
  • Create nesting
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14
Q

Alerting techniques for an infant

A
  • Unwrap
  • Massage
  • Change diaper
  • Change position #1?
  • Elicit rooting #1
  • NNS
  • Face to face interaction
  • Smooth, gradual transitions
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15
Q

How to facilitate infant feeding

A
  • 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
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16
Q

Describe the suckle pattern “in-out” tongue movement

A

Suckling the earliest intake phase for food and liquids, is charachterised b a definite backward and forward movement of the tongue, with the backward phase more pronounced. Tongue protrusion does not extend beyond the border of the lips.

17
Q

Generic problem that cause GERD

A

retrograde flow of gastric secretions from stomach into the esophagus (and possibly airway)

18
Q

What is considered full term for a baby

A

Early Term, between 37 weeks and 38 weeks 6 day

39 weeks is full term

19
Q

Goals positioning for hypertonic child

A

 Inhibition of excessively increased tone
 Inhibition of proximal fixation
 Facilitation of end range of movement
 Prevention of further physical deformity

20
Q

Goals positioning for hypotonic child

A

 Promotion of alignment and stability
 Maintenance of upright posture for feeding
 Promotion of symmetry and midrange control

21
Q

Anticonvulsant→ what it cause as far as dysphagia

A
  • Dry mouth, sweating, hypotension, and tremor
  • Ataxia, slurred speech and dystonia,
  • Glossitis, stomatitis, dry mouth
22
Q

Signs of aspiration-adult

A

Coughing or choking while or shortly after eating
Throat clearing while or shortly after eating
“Wet” or “gurgly” voice while or shortly after eating
Swallowing more than one time for each bite
Clear nose or sneezing while eating
Inability to handle own secretions

23
Q

Failure to thrive (define)

A

term used to describe a child’s abnormal growth in which weight drops below 5th percentile; also used with adult population

24
Q

Oral aversion

A

could be sensory, a response to treatment

Negative association with or response to anything placed in or near the mouth

25
Q

Pacing

A

systematic stopping of nipple flow to impose breathing pauses-=-do NOT remove from mouth just tip it!

26
Q

Stridor:

A

abnormality upper airway noise that indicates turbulent airflow through a narrow airway not a diagnosis but an indication of abnormal airway. Usually on inspiration but can also happen on expiration.

27
Q

TPN

A

Total Parenteral Nutrition- nutrition provided exclusively by intravenous access, not GI tract

28
Q

Nutritional risk factor

A
  • Failure to grow over 2-3 months,
  • Drop below 5th percentile height/weight,
  • Chronic diarrhea/constipation,
  • Long term use of seizure meds,
  • Excessive drooling, frequent reflux/emesis,
  • Mechanical feeding difficulties,
  • Metabolic disorders,
  • Abnormal urine screen, suspected neglect
29
Q

Two things that are important for choosing a nipple

A

o Type of nipple and rate of flow influence the cycle
o Thickness
o Firmness

30
Q

Central alignment

A

Central Alignment is basic for coordination of body and mouth for effective and safe eating
• Neutral head flexion
• Neck elongated
• Shoulder girdle stable and depressed
• Trunk elongated
• Pelvis stable and symmetrical in neutral position
• Hips at 90
• Feet in neutral with slight dorsiflexion

31
Q

Stability

A

Stability is the foundation for function and movement!

-Positioning is everything! No matter the age, stability is the most important way to set up the feeding experience!

32
Q

Feeding milestones (4months old) to see is if they have a problem eating.

A

progression of food & liquids: puree
oral motor skills: suckle–>suck & suckle off spoon
developmental skills: sitting balance & hands midline

33
Q

Signs and symptoms to use to ask for a swallow study

A
  • Inability to recognize food
  • Difficulty placing food in the mouth
  • Inability to control food or saliva
  • Coughing/choking before/during/after swallow
  • Frequent throat clearing
  • Multiple swallow pattern
  • Recurrent pneumonia
  • Unexplained weight loss
  • Wet/Gurgly vocal quality
  • Drooling
  • Cyanosis
34
Q

Four Phases of the swallow

A

1) Oral Prepatory Phase/ bolus formation (voluntary):Begins with the intake of
2) Oral Phase (voluntary):Starts with propulsion of bolus Bolus transport- ends when bolus head reaches anterior faucial arches (takes approx. 1
3) Pharyngeal Phase (voluntary and involuntary)
4) Esophageal Phase (involuntary)

Dysphagia (4 decks)

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