Module 9

Question 1

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

Answer 1

aspiration pneumonia /present as well

others for feeding
others for oral care
decayed teeth

higher risk of pneumonia

Question 2

oral pathogens:
aspiration of oropharyngeal pathogens is the dominant cause of ?

poor oral health strongly correlates with an increased risk of

Answer 2

acquired pneumonia in nursing home patients

developing aspiration pneumonia

Question 3

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 ?

Answer 3

hospitalization, costly care, and at times death

13-48% nosocomial infection in hospitalized pt’s/ UTIs

Question 4

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 ?

Answer 4

acute care and outpatient setting

decompensation in functional status, nutritional status, and pulmonary clearance

medical conditions/ worsen as their status deteriorates

Question 5

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 ?

Answer 5

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

Question 6

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?

Answer 6

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

Question 7

Nosocomial infection: 
... acquired condition 
medicare does not reimburse for 
saves... a year 
included
-
-
-
-
-

Answer 7

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

Question 8

Nosocomial Pneumonia - risk factors; 
aspiration of ? 
endotracheal ? 
device/equipment ? 
-
-
-

Answer 8

oropharyngeal or gastric flors 
intubation - Ventilator dependence (VAP) 
contamination
-nebulizers
suction catheters
ventilators

Question 9

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

Answer 9

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

Question 10

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 ?

Answer 10

nosocomial pneumonia

• on a ventilator / 1%
• VAP (ventilator acquired pneumonia)

oropharyngeal bacteria / trachea
secretions around endotracheal tube

immune systems/ acute illness

Question 11

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 ?

Answer 11

1-10 trillion bacteria

gingival spaces within 24 hours
attaches to plaque

under evaluated and under treated areas

Question 12

Biofilm:
a thin layer of ?
biofilms have been associated with a variety of ?
-estimated at up to … of infections

Answer 12

microorganisms (bacteria) that form on and coat surfaces

microbial infections within the body
80%

Question 13

Not just “oral care” it is infection control

address the mouth as though it is ? 
drisks: 
imapired 
impaired 
poor 

aspiration pneumonia is an .. infection

Answer 13

infected

health status
airway protection
oral health

opportunisitc

Question 14

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 ?

Answer 14

12 hours (twice a day) 
accomplish this 

swabbing to keep mucosa moist

oral secretions/ bacterial load/ mucosal injury/ bloodstream

chlorexidine gluconate
-risks

Question 15

Oral care products :
oral
oral
…

Answer 15

suction -yaunker
swabs/toothette (with and without suction)
toothbrush (with and without suction)

Question 16

Concerns assoiacted with oral care
-patient
...
choking risk with 
document the need for this ? 
-discuss with 
educate ..

Answer 16

dicomfort 
bleeding 
removal of large debris 
care and the condition of the mouth as it was found 
-staff 
staff

Question 17

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 ?

Answer 17

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

Question 18

The protocol:
patients receiving thickened liquids may drink ?
receive ?
excludes patients who are ?
oral care was added to the protocol following the ?

Answer 18

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

Question 19

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 ?

Answer 19

randomized prospective study
aspiration pneumonia or dehydration
patient refusal to drink thickened liquids / hydration issues cause medical concern

Question 20

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?

Answer 20

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

Question 21

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 ?

Answer 21

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

Question 22

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 ?

Answer 22

FFW

increased on protocol

FFW with unwell patients

include/ exclude/ include/ oral hygiene routine