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Dysphagia > Module 1 > Flashcards

Module 1 Flashcards

1
Q

Dysphagia:

A

impairment in emotional, cognitive, sensory and/or motor acts transferring food from mouth to stomach
Swallowing disorder
Any difficulty swallowing
Difficulty moving food from mouth to stomach

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2
Q

“dysphagia”…. How do we say that?

Not to be confused with dysphasia

A

Childhood aphasia (developmental)

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3
Q

Aspiration:

A

anything going below the level of the VF (food, liquid, saliva)

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4
Q

FTT:

A

Failure to thrive not commuting enough nutritions for your body’s needs

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5
Q

Bolus:

A

latin for ball: anything we swallow

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6
Q

Regurgitation:

A

Spitting food back up

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7
Q

Odynophagia:

A

pain when swallowing

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8
Q

Stricture:

A

closing off of throat?

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9
Q

Alimentation:

A

how you eat and drink

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10
Q

PO:

A

Per oral

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11
Q

NPO:

A

Nothing per oral

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12
Q

Penetration:

A

Things stating to go the wrong way almost aspirated

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13
Q

Peristalsis:

A

How muscles contract to move things down

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14
Q

PNA:

A

Pneumonia

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15
Q

GERD:

A

Gastro-esphogeal reflux disease

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16
Q

Hypernatremia:

A

too much sodium and not enough water

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17
Q

Swallowing

A

is a response that triggers a sequence of muscle contractions that propels prepared food to the stomach
The mechanism of swallowing is a timed series of events.
Muscle contractions/relaxations must take place smoothly.

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18
Q

Swallowing requires:

A

large area of brain stem
—-sequence is preprogrammed by neural ——–circuitry in the brain stem called the “swallowing center”.
6 cranial nerves (paired= 1 for each side)
—–5,7,9,10,and 12
numerous receptors
——Sensory
——taste and the swallow trigger and cough reflex
31 pairs of muscles
—–face, mouth, pharynx, esophagus

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19
Q

Reflexive Swallow

A

swallowing can be reflexively evoked (involuntary swallowing)
Several regions of the brain can be stimulated and evoke a swallow that is not a part of voluntary deglutition
Swallowing occurs ~ 600 - 1000 times a day (one time a min)
»»most times during a meal
»»least while sleeping
We all probably aspirate some while we’re sleeping
That’s OK – we’re normal (hopefully)
.5 ml of saliva produced per minute in adults

20
Q

Incidence

A

160,000 to 573,000 new cases of dysphagia each year caused by stroke.
25%-50% of stroke patients
Overall incidence? 6-10 million (ASHA)
13-14% of all patients hospitalized in major medical centers
30-35% of pts in rehab centers
up to 59% of pts in SNFs

21
Q

Acute Care (ICU, step down unit, floor)

A 
Shorter stay
Medically involved, notable medical  complications 
13-33% prevalence within the hospital
i.e. CVA, TBI, SCI, brain tumor patients
Inpatient Rehab Setting
usually a floor of a hospital 
	Stable but still needing medical assistance 
Typical length of stay: 14-21 days
3 hours or more of tx per day
----1 speech 
----1 occupation 
----1 physical
22
Q

Long-term Care/SNF

A

Can’t live independently

Can get discharged if they get better

23
Q

Home health

A

You go to the patients house

24
Q

Outpatient

A

You are in your clinic and they come to you

45min to 1hr 1-3 times per week

25
Q

Who is on the dysphagia team?

A 
SLP
	Must get referral from DR
Pt/Family
Dietician
OT/PT 
Nurses
CNAs
MDs (i.e. primary care physician, GI, otolaryngologist, neurologist)
Radiologist (swallow study)
RT (respiratory therapy)
26
Q

Neurologic disorders (most common)

A

caused by a change in the neurology of the brain
CVA: Stroke
Motor Neuron Diseases (ALS): changes in motor movement and function
Parkinson’s: motor and sensory component
Alzheimer’s/Dementia: cognitive change in function
MS: Coordination issue or feeling things in their mouth

27
Q

Pulmonary complication (quick track to dying)

A

Choking episodes
Asphyxia: solid getting lodged
Laryngospasm: constriction in the larynx
Bronchospasm: a sudden constriction of the muscles in the walls of the bronchioles.
Chronic bronchitis
Aspiration pneumonia

28
Q

Structural Impairments

A

Vertebre calcification
Extra bone forming, making area more ridged and bulky
Tumors
Traumatic injuries: broken jaw
Webs: Pieces of tissue connecting one side to the other that causes things to get stuck
Diverticulum
Cleft lip/palate
Micrognathia (Pierre-Robin syndrome)
Inflamation of the oral/pharyngeal/esophageal tract

29
Q

Psychiatric

A

Bulimia related
This can lead to burning away the muscles of the larynx or pharynx

Psychogenic dysphagia
phagophobia: scared to swallow
maybe it hurts when they swallow

30
Q

other causes of dysphagia

A

Infectious diseases
Muscular disorders
Iatrogenic: caused by treatment of diagnostic procedures
Normal Aging

31
Q

Malnutrition

A 
Inadequate dietary intake
Involuntary weight change
Decreasing functional status
Dizziness
Fatigue
Decreased immune response
32
Q

Dehydration

A 
Dryness of lips
Dryness or thickened oral secretions
Sunken eyeballs
Elevated temperature
Hypotension: changes in blood pressure (lower)
Decreased urine output and UTI
Constipation
Decreased cognitive status and confusion
Nausea and vomiting
Non-oral feeding
Increased dependence, cost, and time consuming care.
33
Q

Anatomic Structures of Swallowing

Oral Cavity

A 
lips
teeth
hard/soft palate
mandible
uvula
floor of mouth (FOM)
tongue, base of tongue
34
Q

Pharynx

A 
Pharyngeal constrictor muscles
Wavelike motion of muscles to move food down 
superior
medial
inferior
35
Q

Vllecula

A

a wedge-shaped space formed between the BOT and epiglottis

36
Q

Pyriform sinuses:

A

the space formed by the attachment of the fibers of the inferior pharyngeal constrictor to sides of thyroid cartilage
Pyriform sinuses & valleculae are the pharyngeal recesses into which food can fall and get trapped

37
Q

Larynx:

A 
Purpose is to keep things out of the lungs when you swallow 
Begins at the base of the tongue 
epiglottis
aeryepiglottic folds
laryngeal vestibule
FVF
TVF
subglottic space
38
Q

Esophagus

A

About 22 cm long
Flaccid collapsed tube (flat at rest/ closed)
Bounded by 2 tonically contracted spitter muscles
UES: about 1 inch long
LES: about 1.5 inches long

39
Q

Cricopharyngeus muscle

A

UES, PE segment, CP segment
Most inferior structure of the pharynx
pyriform sinuses end here
valve at the top of the esophagus
designed to keep air from entering esophagus
prevents material from refluxing into pharynx

40
Q

3 sections of the esophagus

A
  1. Cervical esophagus
    runs from suprasternal notch to thoracic inlet
  2. Thoracic esophagus
    from inlet, around aortic notch to level of 8th thoracic vertebrae
  3. Abdominal esophagus
    mainly the LES
41
Q

Layers

A 
epithelium
laminae propria
muscularic mucosae
Esophageal muscles
---inner circular
---outer longitudinal
---1/3 striated, 1/3 striated/smooth, 1/3 smooth
42
Q

Feeding

A

is placement of food in the mouth through the oral stage of swallowing when food is propelled posteriorly.
Generally discussed when talking about newborns or infants

43
Q

Therapy for feeding:

A

positioning of food
tongue manipulation excercises
chewing varying consistencies
organizing lingual peristalsis

44
Q

Swallowing

A 
involves all stages
Therapy for swallowing
stimulation of swallowing response
improving pharyngeal transit of material
airway protection
strengthening swallowing musculature
all feeding techniques
45
Q

Gag

A

Noxious stimulus or motorically triggered
Gag is a reflex
Purpose of gag is to eliminate foreign substances anteriorly
Absent gag reflex with poor cough trigger= dysphasia

46
Q

Volumes Swallowed

Varies with viscosity of food

A 
Saliva:  1 ml
Cup drinking:  20+ ml
Pudding:  6 cos
Thick paste:  5 cos
Meat:  2 ccs

Dysphagia (6 decks)

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