Module 9 Flashcards
dysphagia with aspiration alone is not sufficient ro cause ? other risk factors must be?
dependent on
dependent on
number of
new finding: dentures during sleep associated with
aspiration pneumonia /present as well
others for feeding
others for oral care
decayed teeth
higher risk of pneumonia
oral pathogens:
aspiration of oropharyngeal pathogens is the dominant cause of ?
poor oral health strongly correlates with an increased risk of
acquired pneumonia in nursing home patients
developing aspiration pneumonia
Predictors of aspiration pneumonia:
aspiration pneumonia is a major problem for the elderly, leading to ?
it accounts for anywhere from ? of all infections in nursing home residents and is the second most comon type of ? after ?
hospitalization, costly care, and at times death
13-48% nosocomial infection in hospitalized pt’s/ UTIs
risk of pneumonia in nursing home patients may be diffferent from ?
nursing home residents have chronic medical conditions that gradually lead to ?
dysphagia and aspiration are common complications of their ? and may slowly ?
acute care and outpatient setting
decompensation in functional status, nutritional status, and pulmonary clearance
medical conditions/ worsen as their status deteriorates
nursing home residents ages … and older
found .. significant predictors of aspiration pneumonia: ... use ... ... presence of ...fast high ... ...loss .. problems ..infection mechanically dependence for bed ... number of and ?
65 and older
18
suctioning use COPD CHF feeding tube bedfast high case mix index delirium weight loss swallowing problems UTI mechanically altered diet dependence for eating bed mobility locomotion number of medications age
alternatively a sudden adverse event may dramatically increase the ? and lead to sudden decompensation
clinical staff must identify residents with ? and work to prevent decline in ?
they must be aware of the dangers of adverse events that lead to sudden ? and increase risk of ?
prevention of this disease whenever possible will reduce? improve? and improve?
amount aspirated or ability to resist infection
dysphagia and aspiration / functional status in all residents
inactivity or illness/ aspiration pneumonia
costs/ health outcomes/ quality of care
Nosocomial infection: ... acquired condition medicare does not reimburse for saves... a year included - - - - -
hospital acquired
reimburse for care for many nosocomial infections
$350 mill a year
pneumonia UTI associated with catheter use MRSA C-diff some post-op infections
Nosocomial Pneumonia - risk factors; aspiration of ? endotracheal ? device/equipment ? - - -
oropharyngeal or gastric flors intubation - Ventilator dependence (VAP) contamination -nebulizers suction catheters ventilators
Risk of aspiration of oropharyngeal and gastric flora:
patients with a reduced level of consciousness known ? and or who are receiving
placement of the ? may increase ?
bacteria can migrate via the tube from the ? to the ?
potential contamination of enteral feeding solution during ?
… may occur
dysphagia or receiving enteral feeding
enteral feeding tube/ nasopharyngeal colonization of bacteria
stomach to the upper airway
preparation can lead to colonization in the stomach
gastroesophageal reflux
Ventilator dependent patients: presence of an endotracheal tube
patients on a ventilator have an increased risk of acquiring
-6-21 times the risk of those not ? risk may increase by ? per day on the ventilator
called ?
can be attributed to
-.. bacteria entering the ? during intubation
potential leak of ? around the ? into the trachea
patients with depressed ? due to significant ?
nosocomial pneumonia
- on a ventilator / 1%
- VAP (ventilator acquired pneumonia)
oropharyngeal bacteria / trachea
secretions around endotracheal tube
immune systems/ acute illness
The mouth:
studies have shown that there are .. bacteria in the human mouth
plaque forms in ? within ?
this plaque parks and then bacteria ?
in medical settings the mouth is one of the most ?
1-10 trillion bacteria
gingival spaces within 24 hours
attaches to plaque
under evaluated and under treated areas
Biofilm:
a thin layer of ?
biofilms have been associated with a variety of ?
-estimated at up to … of infections
microorganisms (bacteria) that form on and coat surfaces
microbial infections within the body
80%
Not just “oral care” it is infection control
address the mouth as though it is ? drisks: imapired impaired poor
aspiration pneumonia is an .. infection
infected
health status
airway protection
oral health
opportunisitc
Oral care program:
brushing teeth at least every ?
swabbing alone will not
utilize oral ?
suctioning of ? to decrease the ? without causing ? which would allow bacteria to enter ?
…. by prescription ?
12 hours (twice a day) accomplish this
swabbing to keep mucosa moist
oral secretions/ bacterial load/ mucosal injury/ bloodstream
chlorexidine gluconate
-risks
Oral care products :
oral
oral
…
suction -yaunker
swabs/toothette (with and without suction)
toothbrush (with and without suction)
Concerns assoiacted with oral care -patient ... choking risk with document the need for this ? -discuss with educate ..
dicomfort bleeding removal of large debris care and the condition of the mouth as it was found -staff staff
Frazier Free Water Protocol:
implemented at the ?
developed in response to patient ?
noted that despite this, ?
allowed patients who were aspirating thing liquids to?
based on the assumptions that allowing free water
1. increases patient ?
2. decreases risk of ?
consider that patients may not drink as much if their fluids are ?
Frazier rehab center in louisville KY
non-compliance with water restrictions if on thickened liquids
pneumonia rates in facility were low
drink water
comfort and compliance with diet/liquid modifications
dehydration
thickened
The protocol:
patients receiving thickened liquids may drink ?
receive ?
excludes patients who are ?
oral care was added to the protocol following the ?
think water between meal times (access to water 3o minutes after a meal, following oral care)
-thickened liquids during meals and snacks
-impulsive, demonstrate excessive coughing, or have reduced levels of alertness
langmore study in 1998
Efficacy data:
one year ?
no patients in either group developed ?
conclusion: it is recommended that water (and ice chips) be given presently only in instances of ? or when ?
randomized prospective study
aspiration pneumonia or dehydration
patient refusal to drink thickened liquids / hydration issues cause medical concern
argument against free water protocol:
not appropriate for medical professionals to implement ?
ethically obligated to utilize?
issue with the term ? as it implies it is based on ?
too focused on thickened liquids as ? what about ?
thickened liquids are absorbed ? as completely as thin liquids - dehydration is not an issue due to ?
cites a study with … in patients receiving free water
recommends a ? with water protocol with aggressive oral care versus ? versus?
methods not scientifically based
evidence-based methods in clinical decision making
protocol/evidence and has criteria for eligibility
only treatment/active intervention
95% as completely as thin liquids/thickener
2 deaths
randomized trial ordinary care with aggressive oral hygiene/water protocol with normal oral hygiene
Systematic review (Gillman, et al., 2017)
-in one study reviewed 6 patients developed ? these patients had ?
in 6 studies meta-analysis showed low quality evidence of ?
when degenerative neurological diseases and reduced mobility excluded no ?
lung complications on FFW protocl/ degenerative neurological disease and were immobile
no increase in risk of lung complications with FFW
lung complications or pneumonia reported
conclusion:
there is low quality evidence that adult rehab patients without degenerative disease with intact mobility and cognition can be considered for ?
there is low level evidence indicating that fluid intake levels may have ?
insufficient volume of evidence to demonstrate safety with implementation of FFW with ?
further research: determine which populations to ? which ? to exclude, find specific mobility and cognitive levels to ? determine appropriate ?
FFW
increased on protocol
FFW with unwell patients
include/ exclude/ include/ oral hygiene routine
