Module 8

Question 1

Kidney Function (renal function)
the kidneys filter
nephrologists are physicians that specialize in ?
alter drugs and drug dosage based on
the kdineys metabolize most (some eliminated by?)

Answer 1

waste and excess water from the blood

kidney function

patient’s kidney function

drugs (liver)

Question 2

Acute kidney failure/renal failure 
-conditions that result in limited blood flow to the kidneys
blood ..
in..
M
hert
...
liver..
use of certain ? 
-..agents 
-dyes used in 
NS...
al..
severe 
severe 
severe

Answer 2

loss-fluid loss 
infection 
MI 
heart disease 
lupus 
liver failure 
drugs 
-chemotherapy agents 
radiographic imaging 
NSAIDs
alcohol 
burns 
dehydration 
allergic reaction (anaphylaxis)

Question 3

Chronic Kidney failure: diseases that impact on kidney function 
-...
high 
plyscystic 
recurrent

Answer 3

Diabetes (DM) -IDDM
type 1 and type 2

blood pressure - hypertensio (HTN)
-kidney disease
kidney infection

Question 4

Kidney damage in COVID-19
the protein spikes on this virus detect ?
the virus uses the ACE2 receptors to enter the ?
some organ cells have greater expression of ACE2 receptors which put those organs at greater risk from ?

Answer 4

ACE2 receptors found on cells in the host
cells of the host
SARS CoV-2 includes the kidneys

Question 5

How does COVID damage the Kidneys:
the virus itself infects the ? kidney’s have receptor cells that allow the virus to ? (similar receptors found on?)
too little oxygen causes kidneys to ? (low oxygen levels in blood leads to ?)
the body’s reaction to the infection (…storm)
-body sends out ? that help cells communicate as the immune system tries to fight ?
but this results in severe ? this inflammatory reaction can destroy ? including?
COVID-19 causes tiny ? this can clog the small blood vessels leading to and within ? which impairs ?
repair of kidneys following COVID is ?

Answer 5

kidneys
-attach and invade (lungs and heart)
-malfunction/ kidney damage
cytokine/ cytokines/ an infection / inflammation / healthy tissue including kidney tissue

blood clots to form in blood stream/ kidneys / kidney function

uncertain

Question 6

Kidney damage in COVID:
reduced kidney function can occur despite no prior history of ?
up to 30% of patients hospitalized in china and ny developed ?
detected through abnormal ?
patients may require ?
kidney issues and the need for dialysis can persist beyond the ?

Answer 6

kidney dysfunction 
moderate or severe kidney injury 
lab work findings (BUN and Creatinine) 
dialysis 
acute phase of illness

Question 7

Dialysis: 
a process to remover ? from the blood of the body when kidneys are not ? 
typically completed? 
duration of dialysis is about ? 
considerations for SLP intervention 
-
-
-

Answer 7

waste products and fluid from blood of body / functioning properly
3 times per week
4 hours

• positioning
• fatigue
• cognitive status

Question 8

Clinical symptoms of renal impairment: 
xero..
H...
shortness of 
reduced 
n..
v...
dehy...
wea...
...cramps 
f...
dry...
and possible

Answer 8

xerostomia 
HTN 
breath 
appetite 
nausea 
vomiting 
dehydration 
weakness 
muscle cramps 
fatigue 
dry,itchy skin 
changes in cognitive function

Question 9

Dialysis: hemodialysis and peritoneal dialysis
acute
chronic

Answer 9

renal failure (ARF) 
renal failure - chronic kidney disease (CKD)

Question 10

Lab values: renal function
creatinine: a waste product made when your body breaks down ?
increased creatinine may indicate that kidneys are not

Answer 10

protein you eat and when muscles are injured

not working normally

Question 11

BUN-
urea is a waste product of ?
produced from breakdown of protein already ?
BUN can increase if intake of ?
patients with kidney disease are frequently placed on?
lower in? may also have ?
increased BUN levels can mean kdiney function is ?
BUN levels may also be elevated related to

Answer 11

blood urea nitrogen 
-metabolism 
in body and in diet 
protein increases 
-renal diet
-sodium, phosphorous and protein/ fluid restrictions 
reduced from normal 
-other conditiosn

Question 12

Complete Metabolic panel”

includes

Answer 12

BUN and Creatinine

Question 13

The gastrointestinal System: 
GI structures: what receptors 
includes: 
-
-
-

Answer 13

ACE 2
liver
intestine
pancreas

Question 14

COVID- GI function
impact on GI function
-initial symptoms of infection can include

limited number of ?
for patients with chronic GI issues, monitoring was ?

in patients with COVID injury/disorders of the GI system have been found including
liver 
acute 
acute 
feeding

Answer 14

diahrrea, vomiting and abdominal pain

• endoscopic procedures completed
• limited

liver injury 
acute cholecystitis 
acute pancreatitis 
-necrotizing pancreatitis 
feeding intolerance 
-medications 
virus itself

Question 15

Importance of GI function on decision making for evaluation of swallowing/PO intake
-is digestive tract
are there digestive issues that impact on patient’s ability to ?
sall?
bowel ?
NGT suction of ?
impact of anasthesia on

Answer 15

functional
eat by mouth/ receive non oral nutrition via the gut

small bowel obstruction (SBO)
-bowel sounds (present/absent)
gastric contents
GI function

Question 16

Aritifical nutrition:
enteral:
utilizes the
delivered by ?

parenteral: bypasses the ? and delivers nutrition to the body via the

Answer 16

GI tract (stomach or intestines) 
-mouth, via tube, or a combo of two 

GI tract/ blood stream (via a vein)

Question 17

Non Oral means of Nutrition
utilizing the GI Tract (enteral nutrition) 
short term: 
oral 
naso 
-large 
-small 

longer term:
peri…
gas..
jeuji

Answer 17

oral gastric tube (OGT)
Nasogastric tube (NGT)
large bore
small bore

pericutaneous endoscpoic gastrostomy (PEG) 
Gastric tube (GT) 
jeujinostomy tube (J-tube)

Question 18

Nasogastric tube: 
lare bore ? 
aka? 
double ? can also ? 
-frequently placed in 
sometimes remains in place after

Answer 18

nasogastric tube (NGT or OGT) 
salem slump tube 
lumen/suction gastric contents 
intubated patients 
extubation

Question 19

DHT: 
smaller ? 
placed at the bedside by 
a guide wire is used with tube for ? then? 
placement is checked by ?

Answer 19

bore/diamter than the NGT
qualified nurse (RN)
placement (stiffness) then removed
X-ray prior to intiaiton of any feedings

Question 20

Risk of nasal tube placement: 
patient ...
difficulty with 
...
digestive ? 
-intolerance o the ?
.. syndrome (rapid stomach emptying into? )
gastro..
aspiration of tube feedings due to ?

Answer 20

discomfort 
placement 
sinusitis 
issues 
-tube feeding formula 
-dumping syndroe (small intestine) 
-gastroesophageal reflux 
-incorrect tube placement or tube displacement

Question 21

Percutaneous Endoscopic Gastrostomy:
an .. procedure
-
-

-

Answer 21

endoscopic procedure

• gastroenterology
• PEG

radiology procedure

• interventional radiology
• IR-guided percutaneous gastrostomy

Question 22

G-tube:
Sometimes the term G-tube is used intechangeably with

cand be confused with an

initially it was the sole way of ?

G-tube placement requires ?

a surgical procedure where an incision is placed in

Answer 22

PEG

open g-tube

placing feeding tube

general anasthesia

upper abdomen to expose stomach

Question 23

Percutaneous Endoscopic Jeujunostomy:
feeding goes directly to

typically administered via

Answer 23

small intestine

pump (slow, constant delivery of nutrition)

Question 24

Gastro-jejunal (GJ) tube:
placed in the stomach but with a ?

feeds directly into the ?

has a ? as well which can be used to give? drain? vent?

can use the gastric port for? if safe to do so depending on patients

a PEG can be converted to a ?
-often done if patient is not

Answer 24

thin long tube that is threaded into the jejunal portion of the small intestine

jejunum, second part of small intestine

feedings as well/ condiiton

GJ tube
-tolerating tube feedings

Question 25

Tube Feeding Delivery:
bolus feedings: more in line with ?
can help to mantain

continuous feedings:
completed if body is not tolerating
-… issues
always provide if the feeding tube is ?

Answer 25

typical consumption of 3 meals per day
-circadian rhythms

bolus feeds
-GI tract issues
lower in the GI tract than stomach (within intestine)

Question 26

Formulations for enteral nutrition: 
formula: 
varous ? depending on?
who decides?
-
-
-
-

Answer 26

brand and types depending on pt needs or tolerance
MD or clinical dietitian

ensure
boost
glucerna
jevity

Question 27

Things to consider:
the impact of a feeding tube that is in place may?
may see decreased ? due to presence of NGT
risk of ?
Pt’s mental status for compliance to ?
patient/family?

Answer 27

have impact on swallowing function 
pharyngeal clearance of bolus / decreased epiglottic inversion 
aspiration with tube feedings
leave tube in place
wishes

Question 28

Total Parenteral nutrition: 
feeding directly into the 
utilized only when the GI tract is ?
through a ?
contains: 
-
-
-
-
-
-
custom prepared by a ? for each individual patient

Answer 28

bloodstream (bypasses GI tract)
-non-functional
vein

lipids
dextrose
vitamins 
minerals 
amino acids 
water 

pharmacist

Question 29

-

Answer 29

total parenteral nutrition (TPN)

peripheral Parenteral nutrition (PPN)

Question 30

total parenteral nutrition:
typically administered ? per day
can be completed ?

Answer 30

10-12 hours

during sleep

Question 31

Resections:

Answer 31

intestine
small intestine/bowel
large intestine/bowel

Question 32

Nutritional status/nutritional recommendations: 
NPO
NPO except 
NPO with? 
oral diet: 
-clear...
-full...
...diet 
mechanical ? 
regular 
**** what initiative

Answer 32

nil per os
meds
non oral means of nutrition

clear liquid (post-surgical)
full liquid (includes liquids not clear)
soft consistency diet (chopped vs. ground meats/veggies)
-regular consistency diet
**international dysphagia diet standardization initiative (IDDSI)

Question 33

Other diet considerations: 
other necessary diet alterations, other than texture can include: 
sodium 
cardiac 
...diet 
...diet 
...diet 
fluid ...
...diet

Answer 33

restrictions (Na restiction) 
cardiac diet/ heart healthy diet
diabetic diet (ADA diet) 
low-residue diet 
low-fat diet 
fluid restrictions 
1800 calorie diet

Question 34

Lab Values: nutritional status
visceral protein status: ...
low albumin levels indicate 
albumin levels are also linked with ? 
-consider these levels when determining 
typically monitored by the ? can become an issue for patients receiving SLP services with regard to ? or poor ? 
-calorie count by ? 
elderly patients in hospital with dysphagia only consumed?

Answer 34

non-muscle proteins circulating in the blood
malnourishment
-strength of immune system
pneumonia risk in a pt with aspiration
clinical dietician / prolonged nPO status or poor oral intake on modified diet
clinical dietician

14.5% of their estimated energy requirements

Question 35

Albumin Levels: 
albumin: half life of approx. ? 
-thus not the best indicator of ? 
does not show 
albumin levels may be ? if patient is dehydrated 

prealbumin: half life of ?
- a better indicator of current ?

Answer 35

18-21 days (current status)
immediate changes
elevated

1-2 days
-current status

Question 36

Tube Feeding in Dementia:
34% of 186,835 nursing home patients with dementia were ?
no evidence of?
no evidence of?
tube feeding may actually increase the risk of ?

Answer 36

tube fed
increased QOL
improved nutritional status
developing pneumonia

Question 37

Tube feeding in severe dementia:
main results:
there was no evidence of increased ? in patients receiving enteral tube feeding
none of the studies examined ? and there was no evidence of benefit in terms of ?
authors conclusions: despite the very large number of patients receiving this intervention there is insufficient evidence to suggest that enteral tube feeding is ?
data are lacking on the ? of this intervention

Answer 37

survival

QoL / nutritional status or prevalence of ulcers

beneficial to patients with advanced dementia / adverse effects

Question 38

Slp Involvemetn in non-oral nutrition / end of life discussions
patient and family education regarding ?
where are we now - what are the options moving forward
-SLP
family

coordinate with ?
.. care team

Answer 38

swallowing function and or comm. function
-treatment management options
family wishes

clinical dietitian and physicians
palliative care team

Question 39

SLP end of life discussion
can involve methods to facilitate? when possible to determine ?
… on ventilator

cna involve teaching regarding ? for the least restrictive ?
document??!!!

can involve discussion with MD/care team regarding ? and will the findings have a role in ?
are the patient and family wishes ?

Answer 39

communication/ patient wishes
-minimal leak speech

swallowing precautions for least restrictive PO diet
-understood risk

what will results of this evaluation demonstrate / moving forward with care for this patient

already known?

Question 40

Surgical intervention in GI:
…
-resection of
… surgery

Answer 40

esophagectomy : removal of esophagus typically due to cancer
small or large intestine
bariatric surgery

Question 41

anastomosis:
a surgical connection between ?
potential for

stricture ?

Answer 41

between two tubular structures
leak

narrowing of lumen

Question 42

Bariatric surgeries:
roux en Y ?
creates a small pouch from the ? connecting this newly created pouch to ?

sleeve gastrectomy

• typically a laparoscopic procedure meaning ?
  approx. 80% of stomach is ? leaving a … about the size and shape of a banana

-

Answer 42

gastric bypass
-stomach/ small intestine

small instruments inserted through multiple small incisions in upper abdomen

removed/ tube shaped stomach

esophageal
potential for oral/pharyngeal dysphagia

Question 43

The esophagus:
about .. long
primary role: move ?

passes behind the ? through the ?

barrett’s esophagus:
acid coming up into the ? results in ?
these cellular changes… can result in ?

Answer 43

25 cm long (from incisors to stomach)

food/liquid from throat to stomach (peristalsis)

heart/diaphragm

esophagus from stomach (gastroesophageal reflux)/ cellular changes

dysplasia/ cancer

Question 44

Esophagectomy:
removal of a portion of the ?
rebuilding a structure to ?
various

Answer 44

entire esophagus to remove disease
replace esophagus
surgeries

Question 45

The immune system: 
recognizes ? 
destroys ? 
made up of ? 
-
-
-

cytokine storm in COVID:
an over response to the body’s ? that leads to ? which destorys?

Answer 45

pathogens invaded the body 
pathogens and clear them from the bod 
white blood cells (WBC) (Leukocytes) 
-lymphocytes (B&T cells) 
phagocytes 
granulocytes 
-neutrophils (largest number of WBC found within the body) 

immune system inflammation/ healthy tissue

Question 46

Immune system, lab values:
elevated WBC counts indicate that there is an immune system ?

an elevated ANC can indicate ?
neutrophils are present in the oral cavity and work to ?

changes to the immune response can occur after ?
-this can result in a reduction in ?
in this case, secretion of salive is?
-leads to an increase in the number of ? which if aspirated presents a greater risk of

Answer 46

response taking place

bacterial infection present
trap bacteria and remove debris

stroke or TBI (reduced WBC)

• changes in oral protection from bacteria
• diminished
• bacteria/ infection

Question 47

Immune system - lab values: 
WBC levels: 
low levels
-indicate risk for 
-neutropenia can be caused by  ? 
-risk for changes in ?
high levels ? 
can indicate ?

Answer 47

also called neutropenia
-developing infection
systemic stress
-oropharyngeal bacteria control can result in pneumonia

neutrophilia
acute infection

Question 48

COVID testing: 
antigen testing: 
detects certain 
... swab 
can be completed as a ? 
false negatives are ? 
patient is positive for COVID 19 but the test shows a?
if COVID is highly suspected and results are negative an ? 

molecular testing-polymerase chair reaction (PCR)
detects
… how collected
can be completed as a ? or with ?
very ? with some reduction in accuracy when completed as a ?

Answer 48

proteins found in the virus
nasal swab
rapid test/ or results sent off to the lab

possible with rapid test

• negative result
• MD may order PCR test

genetic material of virus
nasal swab, throat swab, saliva sample
-rapid test or results sent to lab
accurate/ rapid test

Question 49

COVID antibody testing
utilized to determine whether someone has ?
not proven to detect ?
but it is all that is available for testing patients who have ?

timing of administration of this test is important for ?

Answer 49

HAD the virus
antibodies following vaccination
-immunocompromise

accuracy in detecting antibodies